Various kinds of alcohol and drug testing, such as preemployment, routine, and for-cause testing, are commonly performed by employers. While healthcare organizations usually require preemployment drug testing, they vary on whether personnel will be subjected to further testing. Recently, a call has gone out for postincident testing among physicians who are involved in serious, preventable events, especially ones leading to a patient's death. This article will offer a number of counterarguments to that proposal and discuss an alternate approach: that health (...) institutions can better improve patient safety and employees’ well-being by implementing an organizational policy of “speaking up” when system operators notice work behaviors or environmental factors that threaten harm or peril. The article will conclude with a description of various strategies that facilitate speaking up, and why the practice constitutes a superior alternative to mandatory alcohol and drug testing in the wake of serious, harm-causing m.. (shrink)

Sometimes Blumenthal-Barby et al. (2022) discuss the philosopher’s contribution to bioethics as a largely theoretical or apriori one that arrives from out of the blue—like Parfit’s identity theory—...

Provision of adequate nutrition to elderly patients who develop dysphagia after a stroke can be quite challenging, often leading to the placement of a percutaneous entero‐gastrostomy (PEG) tube for nutritional support. This hypothetical case describes the additional challenge of cross‐cultural belief that leads a daughter to provide oral feeding to her mother, an act that the medical team believes is dangerous and the daughter sees as salubrious. In this case, what is the proper balance between patient safety and deference to (...) cultural traditions and norms? Where are the limits? Two commentaries offer insights for conflict resolution, including recommending that the medical team seek to understand the cultural motivations of the family, balancing safety and respect for cultural norms. The second commentary also disagrees with the team's presumption that the daughter's feeding of her mother is a greater threat to the patient than the PEG tube feeding is. (shrink)

Among various kinds of disclosures typically required in research as well as in clinical scenarios, risk information figures prominently. A key question is, what kinds of risk information would the reasonable person want to know? I will argue, however, that the reasonable person construct is and always has been incapable of settling this very question. After parsing the nebulous if not “contentless” character of the reasonable person, I will explain how Western courts have actually adjudicated cases of “negligent nondisclosure,” that (...) is, cases in which patient‐plaintiffs allege that their informed consent rights were violated by the failure of their health providers to inform them of reasonably foreseeable risks that subsequently materialized. To support my argument, I will scrutinize the landmark decision by the United Kingdom's Supreme Court in Montgomery v. Lanarkshire Health Board and, in particular, Justice Brenda Hale's concurrence. (shrink)

Moral conservatives such as the ones who served on George W. Bush’s President’s Councils on Bioethics are known to be cautious about if not categorically opposed to enhancement technologies. This article examines the argumentative styles of two of the best known of these scholars, Leon Kass and Michael Sandel, as gleaned from essays they authored while serving on Bush’s councils. The goal of this essay is to evaluate their argumentative approach opposing enhancement, which I call “virtue essentialism.” Using a critical (...) perspective informed by prototype theory, I argue that the “virtue essentialist” approach of Kass and Sandel, despite its popularity among moral conservatives and the electorate, is remarkably underpowered. I conclude by arguing that despite my reservations, the likelihood of virtue essentialism retaining its popularity nevertheless seems very good indeed. (shrink)

Professor Jecker (2008) argues that a broader conception of justice in allocating health care resources would focus moral attention on how the determinants of socioeconomic marginalization unfairly...

The impression one derives from the target article on “The Duty to Disclose Adverse Clinical Trials Results” is that Liao and colleagues (2009) envision a research platform consisting only of a tea...

Ethical foundations of patient safety -- Vigilance -- Mindfulness -- Compliance -- Humility -- Some theoretical aspects of vigilance and risk acceptability -- Fifty shades of error -- The standard care and medical malpractice law as an ethical achievement -- The present and the future.

Voluntary, employment‐based insurance is afflicted by a variety of internal imbalances: inequities in the way health insurance is paid for, a conflict of interest in the selection of health insurance, the concentration of the healthy and the sick into separate plans, and free‐ridership. But while all these imbalances generate severe problems, those seeking to reform health insurance in the United States should concentrate on the last two.

In this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti, urge ethicists to devote scholarly attention to a wave of troubling artificial intelligence applications affecting health consumers’ rights and the quality of their care. I very much agree. We already have neuroethicists, business ethicists, and genetics ethicists; AI‐related systems in health care present more than enough warrant to herald the appearance of a new ethics specialist—the “intel‐ethicist,” let’s say. Nonetheless, Terrasse and colleagues may have exaggerated (...) some of the potential moral problems of AI. Examining only social media and e‐health programs, the authors produce an impressive array of questions to consider, but I will argue that two of them are not nearly as worrisome as might be supposed. (shrink)