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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

Stuart Swindle in “Why Feminists Should Take the Phenomenology of Spirit Seriously” accuses me of failing to interpret the passages in the Phenomenology on the family and women in the full context of the progress to absolute spirit. He gives no particular evidence for this claim, but merely asserts it repeatedly and at an ever increasing decibel level. To this general criticism I assert that nothing that I wrote in “Has Hegel Anything to Say to Feminists?” denied that spirit progresses (...) beyond the Hellenic world or any other particular stage of development. In fact, my argument was predicated on just such a development. Women, however, - I argued - do not seem to develop, nor are they capable of development, in their consciousness or social expression according to Hegel from Greek times to modernity. (shrink)

This article focuses on academics’ conceptions of teaching research ethics and integrity. Seventeen academics from a Finnish research intensive university participated in this qualitative study. The data were collected using a qualitative multi-method approach, including think-aloud and interview data. The material was scrutinized using thematic analysis, with both deductive and inductive approaches. The results revealed variation in academics’ views on the responsibility for teaching research integrity, the methods employed to teach it and the necessity of intervening when misconduct occurs. The (...) academics emphasized the responsibility of the individual teacher and the student to foster integrity as well as the shared responsibility of all members of the academic community. However, many academics felt that they themselves needed pedagogical training. Most shared the view that practices of responsible conduct in research can be explicitly and intentionally taught through demonstration, explanation, and practice. However, the academics also noted that learning research integrity and ethics takes place implicitly. A few questioned the need for and the utility of training in the form of courses or through an explicitly addressed topic included in, for instance, methods courses. Their views on the question of how to deal with alleged cases of misconduct varied. While many academics considered a proactive approach the best way to prevent misconduct, some trusted more in a reactive approach. The results show that, while in general academics agree on the importance of research ethics, their conceptions of teaching it vary. The teaching conception bears consequences for the teaching methods chosen, assignment of responsibility for both teaching and students learning, and for the way in which teachers believe that misconduct should be responded to. (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)

: 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)

Empathy is one of the most talked about and widely studied concepts of recent years. Some argue it can help create a more just society, improve medical care and even avert global catastrophe. Others object that it is morally problematic. Who is right? And what is empathy anyway? Is it a way of feeling with others, or is it simply feeling sorry for them? Is it a form of knowledge? What is its evolutionary origin? In this thorough and clearly-written introduction (...) to the philosophy of empathy Heidi Maibom explores these questions and more, examining the following topics: The nature of empathy and key themes in the literature Empathy as a way of understanding others, particularly 'simulation theory' and 'perspective-taking' Empathy, emotional contagion, and sympathy Empathy's role in moral understanding or motivation Empathy and art appreciation, with examples from film, music and fiction Empathy and mental disorder, such as psychopathy and autism. Including chapter summaries, annotated further reading and a glossary, Empathy is an excellent resource for students of philosophy of mind and psychology, psychology, and cognitive science, as well as for those in related subjects such as art, literature and politics. (shrink)

Increasing farmers’ acceptance and adoption of environmentally beneficial farming practices is essential for mitigating negative impacts of agriculture. To support adoption through policy, it is necessary to understand which types of farms or farmers do or do not apply such practices. However, farmers are not a homogeneous group and their behavior is subject to a complex array of structural, socioeconomic, and socio-psychological influences. Reducing this complexity, farmer typologies or archetypes are useful tools for understanding differing motivations for the uptake of (...) sustainable farming practices. Previous investigations of the role of farmer archetypes in the adoption of such practices rely on either purely qualitative or purely quantitative methods in data collection, typology creation, and hypothesis testing. Our study combines both approaches by classifying survey respondents into farmer types based on a previous Q methodological study. We then use these types in a two-part regression model that aims to explain participation in agri-environmental schemes and the level of scheme participation. To control for farm structural factors, we additionally link our questionnaire data to secondary data from the farm accountancy data network. Results indicate that in Austria, AES are attractive to all types of farmers, but the level of participation in these schemes differs between archetypes: Profitability-oriented farmers participate less, and nature-oriented farmers participate more than other types. This suggests that monetary compensations for sustainable farming practices are not perceived as sufficient by certain groups of farmers, and policy makers need to consider additional kinds of incentives. (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)

In his comments on the film version of Schindler’s List, James B. Pinkerton, writing in New York Newsday, blames Hegel - and Hegel above all others - for Nazism. He charges Hegel with undermining “the last bulwark of liberty and safety we have in a world populated by the imperfect: the rule of law.” Pinkerton further suggests, “One can perhaps build a respectable ideology out of a Hegelianism … but it’s much easier to just write ‘totalitarianism’ on such a political (...) blank check.”. (shrink)

Food media have become a formidable part of adolescents’ food environments. This study sought to explore how and why adolescents use food media by focusing on selectivity and motives for consumption. We conducted in-depth, semi-structured interviews with 31 Flemish adolescents aged 12 to 16. Food media were both incidentally consumed and selectively sought for education, social utility, and entertainment. The levels of selectivity and motives for consumption varied among the different food media platforms. Incidental consumption was more prevalent with TV (...) cooking shows compared to online food media. The dominant motives for TV cooking show consumption were companionship and entertainment, while online food media were used for a more diverse range of motives dominated by information/inspiration and social interaction. Some participants consumed food media to get motivation and inspiration to improve health and fitness while others consumed food media to watch appetizing and aesthetically pleasing food content. The social environment in the form of friends and family as well as existing food preferences were dominant psychosocial factors for both traditional and online food media use. Future research is warranted to explore how incidental exposure and the identified motives for use relate to food media effects. (shrink)

Global Corporate Citizenship (GCC) continues to become increasingly popular in large corporations. However, this concept has rarely been considered in small and medium size enterprises (SMEs). A case study of a Norwegian clothing company illustrates how GCC can be also applied to small companies. This case study also shows that SMEs can be very innovative in exercising corporate citizenship, without necessarily following the patterns of large multinational companies. The company studied engages as partner in some voluntary labor initiatives promoted by (...) the government, employs people in marginal situations, and exerts influence for the adoption of good working conditions in its supply chain. Environmental issues and actions of solidarity are also considered within a global scope. Ethics of care and concern for specific aspects of the common good seem crucial as GCC drivers in this company, as do personal values, character, and leadership of the owner-manager of the firm. (shrink)