J. Angelo Corlett’s response to Leigh Turner defends the current practice of anonymous refereeing in scholarly journals. In reply to him: a slightly refined proposal for signed referees’ reports, with temporarily blind refereeing, would restore to the process of publication, in philosophy at least, the sense of responsibility for rational debate, cooperation, mutual criticism, and simple courtesy which is expected among colleagues in public academic relations, and would also allow more credit for the difficult task for refereeing. Personal (...) observation of the quality of referees’ reports suggests that a gathering of anecdotal evidence would show the need for reform. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Francis G. Lu (bio), David Lukoff (bio), and Robert P. Turner (bio)Jackson and Fulford have written an impor-tant paper which addresses an area of increasing interest in the United States—the relationship between religious/spiritual experiences and psychopathology. Using primarily the Present State Examination as the diagnostic framework, the authors describe in rich clinical detail three patients where certain phenomena lead to a possible diagnosis (...) of schizophrenia. However, the patients’ outcomes were uniformly positive—how can this be? The authors argue persuasively for the importance of a contextual assessment “in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned.” In this commentary, we will first present innovations in the DSM-IV relevant to cultural and religious/spiritual issues, which complement the authors’ conclusions, and then comment upon the paper from this perspective.In the DSM-IV Introduction (1994), a section entitled “Ethnic and Cultural Considerations” provides a rationale for innovations in DSM-IV that better enables its use with culturally diverse individuals: “A clinician who is unfamiliar with the nuances of an individual’s cultural frame of references may incorrectly judge as psychopathology those normal variations in behavior, belief, or experience that are particular to the individual’s culture. For example, certain religious practices or beliefs (e.g., hearing or seeing a deceased relative during bereavement) may be misdiagnosed as manifestations of a Psychotic Disorder” (xxiv). In the introduction, three types of information are cited: 1) sections entitled “Age, Gender and Cultural Considerations” in the text of ninety diagnostic categories discuss clinical variations due to these factors; 2) an Outline for Cultural Formulation designed to assist the clinician in systematically evaluating and reporting the impact of the individual’s cultural context; and 3) a Glossary of Culture-Bound Syndromes. These innovations, based on recommendations of the NIMH Workgroup on Culture, Diagnosis and Care to the Task Force on DSM-IV, are described in extensive detail in an important recent book (Mezzich, Kleinman, Fabrega, and Parron 1996).As an example of the importance of the Age, Gender, and Cultural Consideration section relevant to religious and spiritual experiences, consider the section in the text describing schizophrenia, where the following appears: “Clinicians assessing the symptoms of Schizophrenia in socioeconomic or cultural situations that are different from their own must take cultural differences into account. Ideas that may appear to be delusional in one culture (e.g., sorcery and witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a [End Page 75] religious content may be a normal part of religious experience (e.g., seeing the Virgin Mary or hearing God’s voice)” (281). Secondly, in the analogous section of the text describing Brief Psychotic Disorder, the following appears: “It is important to distinguish symptoms of Brief Psychotic Disorder from culturally sanctioned response patterns. For example, in some religious ceremonies, an individual may report hearing voices, but these do not generally persist and are not perceived as abnormal by most members of the person’s community” (303).The Outline for Cultural Formulation provides the clinician a concise tool to specify the following information concerning the cultural context that is relevant to clinical care: cultural identity of the individual, cultural explanations of the individual’s illness, cultural factors related to psychosocial environment and levels of functioning, cultural elements of the relationship between the individual and the clinician, and overall cultural assessment for diagnosis and care. Religion is explicitly mentioned in the third section so as to encourage the assessment of “the role of religion... in providing emotional, instrumental, and information support” (1994, 844). This outline for cultural formulation is more fully explicated in a recent chapter by Lu, Lim, and Mezzich (1995).A major innovation in DSM-IV relevant to this topic is the new diagnostic category entitled Religious or Spiritual Problem defined as follows: “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized... (shrink)

Polemicists and disciplinary puritans commonly make a sharp distinction between the normative, “prescriptive,” philosophical work of bioethicists and the empirical, “descriptive” work of anthropologists and sociologists studying medicine, healthcare, and illness. Though few contemporary medical anthropologists and sociologists of health and illness subscribe to positivism, the legacy of positivist thought persists in some areas of the social sciences. It is still quite common for social scientists to insist that their work does not contain explicit normative analysis, offers no practical recommendations (...) for social reform or policy making, and simply interprets social worlds. (shrink)

Contemporary liberal democracies contain multiple cultural, religious, and philosophical traditions. Within these societies, different interpretive communities provide divergent models for understanding health, illness, and moral obligations. Bioethicists commonly draw upon models of moral reasoning that presume the existence of shared moral intuitions. Principlist bioethics, case-based models of moral deliberation, intuitionist frameworks, and cost-benefit analyses all emphasise the uniformity of moral reasoning. However, religious and cultural differences challenge assumptions about common modes of moral deliberation. Too often, bioethicists minimize or ignore the (...) existence of multiple traditions of moral inquiry. Careful consideration of the presence of multiple horizons for moral deliberation generates challenging questions about the capacity of bioethicists to effectively resolve complex cases and social policy disputes. (shrink)

For many individuals, religious traditions provide important resources for moral deliberation. While contemporary philosophical approaches in bioethics draw upon secular presumptions, religion continues to play an important role in both personal moral reasoning and public debate. In this analysis, I consider the connections between religious traditions and understandings of morality, medicine, illness, suffering, and the body. The discussion is not intended to provide a theological analysis within the intellectual constraints of a particular religious tradition. Rather, I offer an interpretive analysis (...) of how religious norms often play a role in shaping understandings of morality. While many late 19th and early 20th century social scientists predicted the demise of religion, religious traditions continue to play important roles in the lives of many individuals. Whether bioethicists are sympathetic or skeptical toward the normative claims of particular religious traditions, it is important that bioethicists have an understanding of how religious models of morality, illness, and healing influence deliberations within the health care arena. (shrink)

Peer review is an important component of scholarly research. Long a “black box” whose practical mechanisms were unknown to researchers and readers, peer review is increasingly facing demands for accountability and improvement. Numerous studies address empirical aspects of the peer review process. Much less consideration is typically given to normative dimensions of peer review. This paper considers what authors, editors, reviewers, and readers ought to expect from the peer review process. Integrity in the review process is vital if various parties (...) are to have trust, or faith, in the credibility of peer review mechanisms. Trust in the quality of peer review can increase or diminish in response to numerous factors. Five core elements of peer review are identified. Constitutive elements of scholarly peer review include: fairness in critical analysis of manuscripts; the selection of appropriate reviewers with relevant expertise; identifiable, publicly accountable reviewers; timely reviews, and helpful critical commentary. The F.A.I.T.H. model provides a basis for linking conceptual analysis of the core norms of peer review with empirical research into the adequacy and effectiveness of various processes of peer review. The model is intended to describe core elements of high-quality peer review and suggest what factors can foster or hinder trust in the integrity of peer review. (shrink)

Scientists, bioethicists, and policy makers are currently engaged in a contentious debate about the scientific prospects and morality of efforts to increase human longevity. Some demographers and geneticists suggest that there is little reason to think that it will be possible to significantly extend the human lifespan. Other biodemographers and geneticists argue that there might well be increases in both life expectancy and lifespan. Bioethicists and policy makers are currently addressing many of the ethical, social, and economic issues raised by (...) life extension research. However, the emphasis on philosophical argument supporting or condemning efforts to increase human longevity means that much less attention is currently being given to the factors that might play a role in generating interest in efforts to increase human longevity. This analysis considers three factors that might play a role in heightening public interest in efforts to develop biomedical technologies capable of retarding or reversing aging processes. While discussions of life extension research can seem quite futuristic and impractical, there are some powerful existential factors that might well generate considerable public support for life extension strategies if effective biomedical interventions emerge. Rather than providing philosophical justifications supporting or condemning efforts to increase human longevity, this essay seeks to promote a better understanding of the factors generating contemporary interest in prolonging life and postponing death. (shrink)

Bioethicists recognize the conflicts of interest that can arise for clinicians and scientists. However, few scholars exploring the moral dimensions of medicine and the sciences publicly address potential conflicts of interest concerning their own research. Increasingly, however, bioethicists will be confronted with difficult choices in which opportunities to obtain funding will sometimes conflict with the pursuit of critical, rigorous scholarship conducted without regard for corporate interests.

Countries throughout Asia promote themselves as leading destinations for international travelers seeking inexpensive healthcare. India, Indonesia, Malaysia, Singapore, the Philippines, and Thailand are all trying to attract greater numbers of what their promotional campaigns call “medical tourists.” Government tourism initiatives, hospital associations, medical tourism companies, and individual hospitals advertise hip and knee replacements, spinal surgery, cosmetic surgery, and other medical procedures. In contrast to most nations marketing treatments to international patients, the Philippines differentiates itself by selling “all inclusive” kidney transplant (...) packages. Patients from other countries travel to the Philippines and receive kidneys purchased from poor individuals. (shrink)

: Many bioethicists assume that morality is in a state of wide reflective equilibrium. According to this model of moral deliberation, public policymaking can build upon a core common morality that is pretheoretical and provides a basis for practical reasoning. Proponents of the common morality approach to moral deliberation make three assumptions that deserve to be viewed with skepticism. First, they commonly assume that there is a universal, transhistorical common morality that can serve as a normative baseline for judging various (...) actions and practices. Second, advocates of the common morality approach assume that the common morality is in a state of relatively stable, ordered, wide reflective equilibrium. Third, casuists, principlists, and other proponents of common morality approaches assume that the common morality can serve as a basis for the specification of particular policies and practical recommendations. These three claims fail to recognize the plural moral traditions that are found in multicultural, multiethnic, multifaith societies such as the United States and Canada. A more realistic recognition of multiple moral traditions in pluralist societies would be considerably more skeptical about the contributions that common morality approaches in bioethics can make to resolving contentious moral issues. (shrink)

Last year I published a short article urging bioethicists to carefully examine the question of what ought to constitute the canonical issues topics and questions driving research and teaching in bioethics. Why some subjects dominate the field whereas other topics are regarded as matters for scholars in other disciplines is a question that has intrigued me for nearly a decade. How are the boundaries of bioethics established? What factors influence research agendas and the creation of bioethics curricula? How do funding (...) agencies, editors, and leading scholars shape the field of bioethics? These questions are increasingly receiving scrutiny from Charles Bosk, Raymond De Vries, and other researchers as they explore the sociology of bioethics and the “construction” of the “ethical enterprise.". (shrink)

Anthropologists and sociologists offer numerous critiques of bioethics. Social scientists criticize bioethicists for their arm-chair philosophizing and socially ungrounded pontificating, offering philosophical abstractions in response to particular instances of suffering, making all-encompassing universalistic claims that fail to acknowledge cultural differences, fostering individualism and neglecting the importance of families and communities, and insinuating themselves within the “belly” of biomedicine. Although numerous aspects of bioethics warrant critique and reform, all too frequently social scientists offer ungrounded, exaggerated criticisms of bioethics. Anthropological and sociological (...) critiques of bioethics are hampered by the tendency to equate bioethics with clinical ethics and moral theory in bioethics with principlist bioethics. Also, social scientists neglect the role of bioethicists in addressing organizational ethics and other “macro-social” concerns. If anthropologists and sociologists want to provide informed critiques of bioethics they need to draw upon research methods from their own fields and develop richer, more informed analyses of what bioethicists say and do in particular social settings. (shrink)

Cultural models of health, illness, and moral reasoning are receiving increasing attention in bioethics scholarship. Drawing upon research tools from medical and cultural anthropology, numerous researchers explore cultural variations in attitudes toward truth telling, informed consent, pain relief, and planning for end-of-life care. However, culture should not simply be equated with ethnicity. Rather, the concept of culture can serve as an heuristic device at various levels of analysis. In addition to considering how participation in particular ethnic groups and religious traditions (...) can shape moral reasoning, bioethicists need to consider processes of socialization into professional cultures, organizational cultures, national civic culture, and transnational culture. From the local world of the community clinic or oncology unit to the transnational workings of human rights agencies, attentiveness to the concept of culture can illuminate how patients, family members, and health care providers interpret illness, healing, and moral obligations. (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they neglect issues (...) of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they neglect issues (...) of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

When journalists and health researchers address the subject of patients in the United States undergoing unproven stem cell–based interventions, they have historically crafted narratives about "stem cell tourism" to facilities located in such countries as China, India, Mexico, Panama, and Thailand. These latter nations often are depicted as jurisdictions where clinics providing access to SCBIs operate without meaningful oversight, relevant regulations are nonexistent or have significant loopholes, and regulatory bodies are underfunded, understaffed, corrupt, or otherwise unable to provide effective oversight (...) (Caul-field et al. 2009;... (shrink)

Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer‐reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article (...) identifies and describes twenty‐six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer‐reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of ‘medical tourism’ will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. (shrink)

Numerous major holidays celebrate socially gathering in person. However, in major holidays that happened during the pandemic, desires to nurture relationships and maintain holiday traditions often conflicted with physical distancing and other measures to protect against COVID-19. The current research sought to understand wellbeing during American Thanksgiving in 2020, which happened 8months into the COVID-19 pandemic, after months of physical distancing and stay-at-home orders. American Thanksgiving is a major holiday not limited to any religion. We asked 404 American adults how (...) they spent Thanksgiving Day and to report on their experiences of that day. Predictors of wellbeing that we drew from self-determination theory were satisfaction of the fundamental needs for social connection, for doing what one really wants, and feeling effective. The predictors of wellbeing that we drew from regulatory focus theory were a focus on growth, and a focus on security. We found that feeling socially connected and focusing on growth related most strongly to wellbeing. Additionally, participants who saw even one other person face-to-face reported significantly higher relatedness satisfaction, promotion focus, and wellbeing than those who did not. Our research could help construct persuasive messages that encourage nurturing close relationships at major holidays while remaining safe against the virus. (shrink)

Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the common morality of society supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared common sense. Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple (...) cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation. (shrink)

Philosophers often suggest that their theories of free will are supported by our phenomenology. Just as their theories conflict, their descriptions of the phenomenology of free will often conflict as well. We suggest that this should motivate an effort to study the phenomenology of free will in a more systematic way that goes beyond merely the introspective reports of the philosophers themselves. After presenting three disputes about the phenomenology of free will, we survey the (limited) psychological research on the experiences (...) relevant to the philosophical debates and then describe some pilot studies of our own with the aim of encouraging further research. The data seem to support compatibilist descriptions of the phenomenology more than libertarian descriptions. We conclude that the burden is on libertarians to find empirical support for their more demanding metaphysical theories with their more controversial phenomenological claims. (shrink)

Peer review is an important component of scholarly research. Long a black box whose practical mechanisms were unknown to researchers and readers, peer review is increasingly facing demands for accountability and improvement. Numerous studies address empirical aspects of the peer review process. Much less consideration is typically given to normative dimensions of peer review. This paper considers what authors, editors, reviewers, and readers ought to expect from the peer review process. Integrity in the review process is vital if various parties (...) are to have trust, or faith, in the credibility of peer review mechanisms. Trust in the quality of peer review can increase or diminish in response to numerous factors. Five core elements of peer review are identified. Constitutive elements of scholarly peer review include: fairness in critical analysis of manuscripts; the selection of appropriate reviewers with relevant expertise; identifiable, publicly accountable reviewers; timely reviews, and helpful critical commentary. The F.A.I.T.H. model provides a basis for linking conceptual analysis of the core norms of peer review with empirical research into the adequacy and effectiveness of various processes of peer review. The model is intended to describe core elements of high-quality peer review and suggest what factors can foster or hinder trust in the integrity of peer review. (shrink)

The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care. This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and/or avoiding wait times for care in the patient’s home country. This practice raises numerous ethical concerns, including potentially exacerbating health inequities in destination and source countries and disrupting (...) continuity of care for patients. In this report, we synthesize conference presentations and present three lessons from the conference: 1) Medical tourism research has the potential for cross- or inter-disciplinarity but must bridge the gap between researchers trained in ethical theory and scholars unfamiliar with normative frameworks; 2) Medical tourism research must engage with empirical research from a variety of disciplines; and 3) Ethical analyses of medical tourism must incorporate both individual and population-level perspectives. While these lessons are presented in the context of research on medical tourism, we argue that they are applicable in other areas of research where global practices, such as human subject research and health worker migration, are occurring in the face of limited regulatory oversight. (shrink)

Market participants continue to demand greater transparency from boards of directors, yet little is known about the effect of increased transparency on director decisions. Using a sample of practicing board members, our first experiment provides evidence that increased transparency via disclosure may license directors to make more biased decisions. Guided by rich insights provided by these directors, we examine whether considering a company’s ethical values can deter disclosure-induced licensing by activating a morality mindset. In two additional experiments, we find that (...) exposure to a code of conduct that includes an ethics component does not mitigate the licensing effects we observed; however, considering a separate, concise ethics statement does mitigate these effects. Our findings highlight important differences between the code of conduct and ethics statement for decision-making which can help organizations to mitigate adverse effects of disclosure. Implications for users of financial information and regulators are also discussed. (shrink)