Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances of intentional wrongdoing, by males in nonacademic medical settings, with oversight problems and a selfish motive such as financial gain or sex. More than half of cases involved a wrongdoer with a suspected (...) personality disorder or substance use disorder. Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. (shrink)

This symposium includes twelve personal narratives from parents about making the decision whether to circumcise their infant male children. The authors of the narratives include five fathers and seven mothers. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss (...) their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium includes four expert commentaries on the narratives that are informed and enriched by the commentators' expertise in pediatric bioethics, healthcare ethics, gender studies, Jewish law and tradition, and the medical and surgical techniques of circumcision. (shrink)

Most people in the United States agree they want some income inequality but debate exactly how much is fair. High‐status people generally prefer more inequality than low‐status individuals. Here we examine how much preferences for inequality are (or are not) driven by self‐interest. Past work has generally investigated this idea in two ways: The first is by stratifying preferences by income, and the second is by randomly assigning financial status within lab‐constructed scenarios. In this paper, we develop a method that (...) combines both experimental control and the social experience of inequality—a simulated society experiment. Across two experiments (N = 138, observations = 690), participants voted on the distribution of rewards—first behind a veil of ignorance, and then when they were randomly assigned a status within a game of chance. Status varied repeatedly across five rounds, allowing us to measure dynamic preferences. Under the veil of ignorance, people preferred inequality favoring the top status. When the veil of ignorance disappeared, self‐interest immediately influenced inequality preferences. Those who randomly landed in top positions were satisfied with the status quo established under the veil of ignorance, whereas those who randomly landed in bottom positions wanted more equality. Yet these preferences were not stable; decisions about the optimal level of inequality changed according to changes in social status. Our results also showed that, when inequality grows in a society, preferences regarding inequality become polarized by social status. Individuals in low‐status positions, particularly, tend to demand more equality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after (...) transplant, Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)

Well-known predictors of prejudice toward Muslims include social dominance and authoritarianism. However, a gap exists for variables reflecting a rejection or mitigation of ideological motivations associated with prejudice toward Muslims. We examined if quiet ego was related to positive attitudes toward Muslims, and whether this could be explained by lower levels of authoritarianism, social dominance, and the motivation to express prejudice. We explored this possibility across two studies of adults in the United States. In Study 1, regression results showed quiet (...) ego was directly associated with positive attitudes toward Muslims. Study 2 utilized path analyses and found that the direct relationship between quiet ego and positive attitudes toward Muslims was explained by associations between quiet ego and lower endorsement of authoritarianism, social dominance, and the internal motivation to express prejudice toward Muslims. Moreover, these associations held when accounting for several correlates of intergroup attitudes. (shrink)

State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team’s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious (...) wrongdoing by physicians. (shrink)

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)

Over the past 3 years, the authors have pursued unique cross-college collaboration. They have hosted a National Endowment for the Humanities (NEH)–funded Humanities Gaming Institute and team-taught a cross-listed course that brought together students from the humanities and computer science. Currently, they are overseeing the development of an NEH-supported social history game called Desperate Fishwives. In the process, the authors have realized that “game” is not the most appropriate designator for the kind of projects they are pursuing. Instead, they propose (...) critical interactives, a term that suggests projects that mobilize ludic methods in order to engage participants in socially and politically sensitive, indeed controversial, subject matter. Their most recent project, Ghosts of the Horseshoe, offers an initial look at how critical interactives are particularly apt at raising awareness about the relations among institutional policy, broader public policy, and the ways that people negotiate the public history of a particular place. (shrink)

The author addresses the question of how to use value-learning processes to integrate corporate social responsibility (CSR) in organizations as an interesting challenge in (higher) education. Two strategies have been proposed for the issue of CSR: a compliance strategy and a cultural change strategy (Karssing, 2001). This article focuses on the ethical and philosophical presuppositions of these different approaches. The incorporation of CSR in organizations cannot be accomplished by means of a compliance strategy only. Rather, it needs to be supplemented (...) by a strategy aimed at stimulating a transformation process on the corporate culture level. The perspective of change through dialogue is proposed as a means of innovating the curriculum and the primary processes of student education. This organizational change perspective is demonstrated by describing how (ethical) reflective aspects are integrated in the curriculum of the Free University of Amsterdam. An additional case study on organizational value learning is presented to illustrate the thesis that CSR presupposes that university is an adequate context where life-long learning begins. (shrink)

Rhodopsin, upon activation by light, transduces the photon signal by activation of the G‐protein, transducin. The well‐studied rhodopsin/transducin system serves as a model for the understanding of signal transduction by the large class of G‐protein‐coupled receptors. The interactive form of rhodopsin, R*, is conformationally similar or identical to rhodopsin's photolysis intermediate Metarhodopsin II (MII). Formation of MII requires deprotonation of rhodopsin's protonated Schiff base which appears to facilitate some opening of the rhodopsin structure. This allows a change in conformation at (...) rhodopsin's cytoplasmic surface that provides binding sites for transducin. Rhodopsin's 2nd, 3rd and putative 4th cytoplasmic loops bind transducin at sites including transducin's 5 kDa carboxyl‐terminal region. Site‐specific mutagenesis of rhodopsin is being used to distinguish sites on rhodopsin's surface that are important in binding transducin from those that function in activating transducin. These observations are consistent with and extend studies on the action of other G‐protein‐coupled receptors and their interactions with their respective G proteins. (shrink)

We regularly wield powers that, upon close scrutiny, appear remarkably magical. By sheer exercise of will, we bring into existence things that have never existed before. With but a nod, we effect the disappearance of things that have long served as barriers to the actions of others. And, by mere resolve, we generate things that pose significant obstacles to others' exercise of liberty. What is the nature of these things that we create and destroy by our mere decision to do (...) so? The answer: the rights and obligations of others. And by what seemingly magical means do we alter these rights and obligations? By making promises and issuing or revoking consent When we make promises, we generate obligations for ourselves, and when we give consent, we create rights for others. Since the rights and obligations that are affected by means of promising and consenting largely define the boundaries of permissible action, our exercise of these seemingly magical powers can significantly affect the lives and liberties of others. (shrink)

Domestic violence is an important social problem that strongly impacts the healthcare system. It is estimated that two to four million women are physically abused each year by their husbands, ex-husbands, or boyfriends. Many of these abused women enter the medical system as patients with physical injuries, somatic symptoms, or psychiatric problems. These patients represent a large proportion of women patients in a variety of clinical settings: 22–35% of women presenting to emergency departments, up to 37% of obstetric patients, and (...) over 25% of women seeking primary care. Despite the significant health implications of marital abuse, healthcare providers often fail to identify and treat this problem when signs are present. (shrink)

Shame is a painful emotion concerned with failure to live up to certain standards, norms, or ideals. The subject feels that she falls in the regard of others; she feels watched and exposed. As a result, she feels bad about the person that she is. The most popular view of shame is that someone only feels ashamed if she fails to live up to standards, norms, or ideals that she, herself, accepts. In this paper, I provide support for a different (...) view, according to which shame is about failure to live up to public expectations. Such a view of shame has difficulties explaining why an audience is central to shame, why shame concerns the self as a whole, and why the social rank of someone affects their ability to shame others. These features, I argue, are best explained by reference to the descent of shame in the emotion connected with submission in nonhuman animals. The function of submission—to appease relevant social others—also throws light on the sort of emotion that shame is. From the point of view of other people, a subject who experiences shame at her own failing is someone who is committed to living together with others in a socially sanctioned way. The argument is not that we must understand the nature of shame in terms of what it evolved for, but that its heritage is important to understanding the emotion that shame has become. (shrink)

BackgroundInnovations in technology have contributed to rapid changes in the way that modern biomedical research is carried out. Researchers are increasingly required to endorse adaptive and flexible approaches to accommodate these innovations and comply with ethical, legal and regulatory requirements. This paper explores how Dynamic Consent may provide solutions to address challenges encountered when researchers invite individuals to participate in research and follow them up over time in a continuously changing environment.MethodsAn interdisciplinary workshop jointly organised by the University of Oxford (...) and the COST Action CHIP ME gathered clinicians, researchers, ethicists, lawyers, research participants and patient representatives to discuss experiences of using Dynamic Consent, and how such use may facilitate the conduct of specific research tasks. The data collected during the workshop were analysed using a content analysis approach.ResultsDynamic Consent can provide practical, sustainable and future-proof solutions to challenges related to participant recruitment, the attainment of informed consent, participant retention and consent management, and may bring economic efficiencies.ConclusionsDynamic Consent offers opportunities for ongoing communication between researchers and research participants that can positively impact research. Dynamic Consent supports inter-sector, cross-border approaches and large scale data-sharing. Whilst it is relatively easy to set up and maintain, its implementation will require that researchers re-consider their relationship with research participants and adopt new procedures. (shrink)

Calls for public engagement on emerging agricultural technologies, including genetic engineering of farm animals, have resulted in the development of information that people can interact and engage with online, including “Frequently Asked Questions” (FAQs) developed by organizations seeking to inform or influence the debate. We conducted a frame analysis of FAQs webpages about genetic engineering of farm animals developed by different organizations to describe how questions and answers are presented. We categorized FAQs as having a regulatory frame (emphasizing or challenging (...) the adequacy of regulations), an efficiency frame (emphasizing precision and benefits), a risks and uncertainty frame (emphasizing unknown outcomes), an animal welfare frame (emphasizing benefits for animals) or an animal dignity frame (considering the inherent value of animals). Animals were often featured as the object of regulations in FAQs, and questions about animals were linked to animal welfare regulations. The public were represented using a variety of terms (public, consumer) and pronouns (I, we). Some FAQs described differences between technology terms (gene editing, genetic modification) and categorized technologies as either well-established or novel. This framing of the technology may not respond to actual public concerns on the topic. Organizations seeking to use FAQs as a public engagement tool might consider including multiple viewpoints and actual questions people have about genetic engineering. (shrink)

Having enjoyed more than twenty years of development, feminist epistemology and philosophy of science are now thriving fields of inquiry, offering current scholars a rich tradition from which to draw. In addition to a recognition of the power of knowledge itself and its effects on women’s lives, a central feature of feminist epistemology and philosophy of science has been the attention they draw to the role of power dynamics within knowledge-seeking practices and the implications of these dynamics for our understandings (...) of knowledge, science, and epistemology. Feminist Epistemology and Philosophy of Science: Power in Knowledge collects new works that address today’s key challenges for a power-sensitive feminist approach to questions of knowledge and scientific practice. The essays build upon established work in feminist epistemology and philosophy of science, offering new developments in the fields, and representing the broad array of the feminist work now being done and the many ways in which feminists incorporate power dynamics into their analyses. (shrink)

: Feminist epistemologists have found the atomistic view of knowers provided by classical epistemology woefully inadequate. An obvious alternative for feminists is Lynn Hankinson Nelson's suggestion that it is communities that know. However, I argue that Nelson's view is problematic for feminists, and I offer instead a conception of knowers as "individuals-in-communities." This conception is preferable, given the premises and goals of feminist epistemologists, because it emphasizes the relations between knowers and their communities and the relevance of these relations for (...) epistemic assessments. Furthermore, it provides a sense of epistemic agents as active reflective inquirers, capable of transforming and improving knowledge-seeking practices. (shrink)

Although medical and public health practitioners aim for high rates of vaccination, parent vaccination concerns confound doctors and complicate doctor-patient interactions. Medical and public health researchers have studied and attempted to counter antivaccination sentiments, but recommended approaches to dispel vaccination concerns have failed to produce long-lasting effects. We use observations made during a small study in a rural area in a southeastern state to demonstrate how a shift away from analyzing vaccination skepticism as a national issue with a global remedy (...) reveals the nuances in vaccination sentiments based on locality. Instead of seeing antivaccinationists as a distinct public based on statistical commonalities, we argue that examining vaccination beliefs and practices at the local level offers a fuller picture of the contextualized nature of vaccination decisions within the psychosocial spaces of families. A view of vaccination that emphasizes the local public, rather than a globally conceived antivaccination public, enables medical humanists and rhetoricians to offer important considerations for improving communications about vaccinations in clinical settings. (shrink)

Fictional names present unique challenges for semantic theories of proper names, challenges strong enough to warrant an account of names different from the standard treatment. The theory developed in this paper is motivated by a puzzle that depends on four assumptions: our intuitive assessment of the truth values of certain sentences, the most straightforward treatment of their syntactic structure, semantic compositionality, and metaphysical scruples strong enough to rule out fictional entities, at least. It is shown that these four assumptions, taken (...) together, are inconsistent with referentialism, the common view that names are uniformly associated with ordinary individuals as their semantic value. Instead, the view presented here interprets names as context-sensitive expressions, associated in a context of utterance with a particular act of introduction, or dubbing, which is then used to determine their semantic value. Some dubbings are referential, which associate names with ordinary individuals as their semantic values; others are fictional, which associate names, instead, with sets of properties. Since the semantic values of names can be of different sorts, the semantic rule interpreting predication must be complex as well. In the body of the paper, I show how this new treatment of names allows us to solve our original puzzle. I defend the complexity of the semantic predication rule, and address additional worries about ontological commitment. (shrink)

For over 80 years, the National Society of Professional Engineers (NSPE) has been a leader in the promotion of ethical practice within the field of engineering. One of the Society's greatest contributions is the formation and adoption of the NSPE Code of Ethics. But the code, with its six "Fundamental Canons," is only truly instructive if engineers can bridge the gap between principles and action. Here there is no substitute for personal reflection on the ethical and philosophical issues that underlie (...) the code. If done well, such reflection provides an indispensable basis for moral problem solving. Beyond the Code: A Philosophical Guide to Engineering Ethics is designed to complement the NSPE Code of Ethics by helping readers "go beyond" in their understanding of the philosophical issues bound up in the code. Each chapter addresses one of the Fundamental Canons of the NSPE code, and provides a philosophical analysis of the various parts of each canon by employing contemporary and classical texts. This unique approach to engineering ethics guides students and professionals in their readings of the appended selections to refine their understanding of the code in order to apply it to the practical challenges of today's engineers. Key Features: Is the first introduction to engineering ethics that helps students understand and apply the NSPE Code of Ethics to engineering practice Includes a Preface from Arthur E. Schwartz, NSPE Deputy Executive Directorand General Counsel, and NAFE Executive Director As a hybrid text, includes primary philosophical texts with extensiveintroductions and guided reading questionsfrom the book's three authors Offers case studies from the NSPE Board of Ethical Review, allowing students to see a direct connection between the issues discussed in the text and real-world engineering practice Includes the following pedagogical aids: "Key Terms and Concepts" for each chapter "Preparing to Read" sections before each primary source reading "Guided Reading Questions" after each primary source reading "Going Beyond--Our Questions for a Deep Dive" after each case study. (shrink)

In modern urbanized and densely populated societies - such as the contemporary Netherlands, which forms the geographical setting of the present analysis - hunting has lost its meaning as a mode of subsistence to become a symbolic strategy. Hunting is a cultural enclave in which the boundaries between humans and animals are blurred and the relations of dominance and submission symbolically reversed. Hunting challenges the legitimacy of apparently "given" power relations between humans and animals. Hunters construct, reproduce and legitimize hunting (...) by crossing the boundaries between humans and animals. Hunting "for pleasure" is regarded as truly pleasurable only if it allows a reversal of the asymmetrical power relations between humans and animals, attributing almost human characteristerics to the game-species. In theircognitive schemes hunters measure their power and abilities with strong, cunning and preferably male opponents. Game-species share an ambivalent status between the human and the animal realms, the tame and the wild, and between their instrumental and expressive signifccance. Hunting "for pleasure" is justified by this very ambivalence. (shrink)

Among theory theorists, it is commonly thought that folk psychological theory is tacitly known. However, folk psychological knowledge has none of the central features of tacit knowledge. But if it is ordinary knowledge, why is it that we have difficulties expressing anything but a handful of folk psychological generalisations? The reason is that our knowledge is of theoretical models and hypotheses, not of universal generalisations. Adopting this alternative view of (scientific) theories, we come to see that, given time and reflection, (...) we can say what we know. (shrink)

Some people are now quite optimistic about the possibility of treating psychopathy with drugs that directly modulate brain function. I argue that this optimism is misplaced. Psychopathy is a global disorder in an individual’s worldview, including his social and moral outlook. Because of the unity of this Weltanschauung, it is unlikely to be treatable in a piecemeal fashion. Recent neuroscientific methods do not give us much hope that we can replace, in a wholesale manner, problematic views of the world with (...) more socially desirable ones. There are, therefore, principled reasons that psychopathy is so singularly treatment resistant. (shrink)

Among theory theorists, it is commonly thought that folk psychological theory is tacitly known. However, folk psychological knowledge has none of the central features of tacit knowledge. But if it is ordinary knowledge, why is it that we have difficulties expressing anything but a handful of folk psychological generalisations? The reason is that our knowledge is of theoretical models and hypotheses, not of universal generalisations. Adopting this alternative view of (scientific) theories, we come to see that, given time and reflection, (...) we can say what we know. (shrink)