Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.

Background Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety-related behaviours. Objective To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Design Cross-sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two (...) randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Setting Twelve hospitals in Switzerland. Participants A total of 1141 HCPs (response rate 45%). Measurements Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient–HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7-point scales. Results Approval of patients' safety-related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient–HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Conclusions This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues. (shrink)

L B Daniels; Some Comments on ‘Value in Education’ by Johanna Burgess1, Journal of Philosophy of Education, Volume 8, Issue 2, 30 May 2006, Pages 237–250, https.

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and (...) English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)

The papers in the 2010 “Clinical Ethics” number of the Journal of Medicine and Philosophy explore issues along La Frontera, the borders and boundaries of clinical ethics. The first three papers in this “Clinical Ethics” number of the Journal explore borders and boundaries drawn within clinical ethics, concerning the moral standing of complementary and alternative medicine, palliative sedation, and induced abortion and feticide. The fourth and fifth papers explore the borders and boundaries between research ethics and clinical ethics.

The paper illustrates how organic chemists dramatically altered their practices in the middle part of the twentieth century through the adoption of analytical instrumentation - such as ultraviolet and infrared absorption spectroscopy and nuclear magnetic resonance spectroscopy - through which the difficult process of structure determination for small molecules became routine. Changes in practice were manifested in two ways: in the use of these instruments in the development of 'rule-based' theories; and in an increased focus on synthesis, at the expense (...) of chemical analysis. These rule-based theories took the form of generalizations relating structure to chemical and physical properties, as measured by instrumentation. This 'Instrumental Revolution' in organic chemistry was two-fold: encompassing an embrace of new tools that provided unprecedented access to structures, and a new way of thinking about molecules and their reactivity in terms of shape and structure. These practices suggest the possibility of a change in the ontological status of chemical structures, brought about by the regular use of instruments. The career of Robert Burns Woodward (1917-1979) provides the central historical examples for the paper. Woodward was an organic chemist at Harvard from 1937 until the time of his death. In 1965, he won the Nobel Prize in Chemistry. (shrink)

It is well-recognized that uncertainty is an endemic feature and limitation of clinical judgment and practice that cannot be eliminated in many cases. Among the tasks of clinical ethics is the responsible management of uncertainties, first articulated in E. Haavi Morreim’s very nice concept of the "moral management of medical uncertainty." The papers in the 2012 Clinical Ethics issue of the Journal provide philosophically innovative and clinically applicable accounts of the varieties of uncertainty in clinical medicine and therefore in clinical (...) ethics: epistemic uncertainty, metaphysical uncertainty, and relational uncertainty. (shrink)

This paper introduces the 2011 number of the Journal on Clinical Ethics. Philosophical critical appraisal is essential for the success of philosophical analysis and argument in clinical ethics. To clear away conceptual underbrush, papers in this Clinical Ethics number of the Journal address genetic engineering, conscience-based objections to forms of health care, placebos, and preventing exploitation of patients to be recruited to become research subjects.

The five papers in the 2008 “Clinical Ethics” number of the journal address the conceptual and empirical foundations of clinical ethics. Three articles take up the concept of professionalism in medicine, exploring its possibilities and implications. The fourth article provides a distinctive, phenomenological account of the “placebo effect,” a vexing topic of surprising durability in the clinical setting. The final article, a systematic review of the qualitative literature on bedside rationing of resources, creates an empirical foundation for philosophical analysis and (...) argument of a distinctive kind. (shrink)

Central concepts and consensus views in clinical ethics are marked by instability. The papers in this number of the Journal take up two such central concepts, quality of life and moral status, and two such consensus views, that germ-line gene transfer should not be undertaken for the purposes of enhancement of human traits and that the ethical obligation of physicians to treat HIV infected patients rests on consent of the physician. One outcome of these philosophical investigations is that these two (...) concepts and consensus views are less stable than one might have thought. I explore the possibility of generalizing this outcome in a reflection on clinical ethics as the management of instability and incompleteness, including the instability and incompleteness of clinical ethics itself. In the course of this reflection I liken clinical ethics to abstract expressionism in mid-twentieth century Western art. (shrink)

In the article, the phenomenon of understanding in mathematics is studied. This topic is relevant in contemporary philosophy of science, in which the classic dichotomy of ‘understanding-explanation‘, characteristic of classical science, undergoes serious transformations. One reason for this transformation is a quantitative increase in the flow of information in modern science. It is clear that in such a situation you want to hold a serious understanding of this information in the context of modern scientific picture of the world. As the (...) modern science is inextricably linked to mathematical science, it is required to rely on the results of studies of the phenomenon of understanding in mathematics. Such studies are already under way in the modern philosophical and scientific literature, although this issue is still relatively new. The author identifies the most important, in his view, types of understanding in math, taking into account the situation of the teaching of mathematics, the situation of mathematical discovery, and ‘mathematical symbolism‘. A study of the main types of understanding in math and the identification of its specificity would have been impossible without the support of the concept of tacit knowledge taken as a methodological tool and author’s previously published works taken as a basis. In this article, the author relies on the classic work on the philosophy of mathematics, as well as the works of famous contemporary Russian and foreign scientists and philosophers. The results of the study are summarized in the form of conclusions. (shrink)

We offer a critique of one prominent understanding of the principle of respect for autonomy and of analyses of medical paternalism based on that understanding. Our main critique is that understanding respect for autonomy as respect for freedom from interference is mistaken because it is overly influenced by four-alarm cases, because it fails to appreciate the full dimensions of legal self-determination (one of its main sources), because it conflates the research and therapeutic settings, and because it fails to appreciate themes (...) of authority and power that have historically shaped the principle of respect for freedom from interference. We argue that respect for autonomy involves more than just freedom from interference and, on this basis, offer a critique of prevailing accounts of medical paternalism. (shrink)

S'il est un point que les réflexions contemporaines sur le temps ont mis en relief et inscrit profondément dans notre conscience, c'est que l'avenir qu'on espère dépend directement du présent qu'on réalise. Telle est notre attitude en face du présent, telle elle sera inéluctablement en face de l'avenir; et donc l'avenir lui-même, puisque ce dernier n'est rien sinon un présent caché encore, au cœur d'un présent déjà actuel, et explicite. Il est en effet de l'essence même de notre condition humaine (...) d'avoir un présent structuré et comme stratifié. Certes on peut imaginer le présent comme un point sans épaisseur, comme la limite évanescente entre un segment de ligne qui marque le passé à jamais révolu, et l'avenir qui se meut vers nous pour basculer inexorablement vers le non-être en franchissant ce présent. Mais cette image, utile pour bien des tâches, ne correspond d'aucune manière à la réalité vivante de la conscience humaine et des activités qui lui sont propres. Nous sommes dans le présent ce que nous sommes et ce que, en un sens, nous croyons pouvoir dire que nous avons été. Une grande partie de ce que nous appelons le passé, notre passé personnel et sans doute notre passé spécifique, est présent, non seulement à titre de souvenir, pouvant être, ou non, évoqué, mais à titre de schéma dynamique modifiant notre être-au-monde, notre présente réaction au réel le plus réel, à la situation où nous avons à déployer notre activité. (shrink)

In the article, questions from the field of philosophy of mathematics are studied. The author is driven by the need to achieve a balance between the philosophy of science and the history of science in formation of concepts of the science development. In this regard, the author justifies the reliance on the methodology of implicit knowledge, combined with the epistemology principle of criticism in studying the development of mathematics as the most expedient and effective. The author expresses the necessity of (...) criticizing the methodology of counterexamples typical for mathematical empiricism declared by I. Lakatos. In the article, an explanation of the concept of implicit knowledge, as well as the examples from mathematics are given. The author believes that application of the concept of implicit knowledge in philosophical and mathematical terms allows us to reveal the unique specificity of mathematical science deeper. The author concludes that it is necessary to recognize the fundamental importance of the methodology of implicit knowledge for the epistemology, as well as for the development of philosophy and methodology of science in general. (shrink)

The article is devoted to the nature of the topological intuition and disclosure of the specifics of topological heuristics in the framework of philosophical theory of knowledge. As we know, intuition is a one of the support categories of the theory of knowledge, the driving force of scientific research. Great importance is mathematical intuition for the solution of non-standard problems, for which there is no algorithm for such a solution. In such cases, the mathematician addresses the so-called heuristics, built on (...) the basis of guesswork, obtained by intuition. The author substantiates the conclusion that topological intuition significantly specific compared to a traditional mathematical intuitions of Euclidean geometry. Today topology is a rapidly developing field of modern mathematics, integrates nicely with other sections of mathematical science. In its most general form of the topology can be defined as the branch of mathematics that studies the properties of spatial figures, does not change under deformations. The topological intuition is an instrument for development of topology on the basis of typological heuristics, which is the result of applying topological intuition to the objects topology. The author demonstrates in detail providing with the examples the specificity of topological heuristics and establishes its interconnection with Euclidean geometry. The author draws the conclusion about the fundamentality of topological intuition, and that it, perhaps, is primary in relation to traditionally understood mathematical intuition. (shrink)