In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 193-194 [Access article in PDF] A Comment on Christopher Ciocchetti:"The Responsibility of the Psychopathic Offender" Daniel W. Shuman Questions of responsibility for serious harm are complex and potentially divisive. The way in which we frame these questions and the criteria by which we assess answers to them are colored, in part, by the lens though which we view them. I am a (...) law professor whose writings includes issues relating to criminal responsibility of person with mentally disabilities and I come to this commentary from that perspective. For me questions of moral responsibility raise psychological and philosophical, as well as legal, questions.Ciocchetti's (2003) paper addressees the criminal responsibility of the psychopathic offender. Not sure quite what the author meant by this label, I began to try to understand the concept of psychopathic offender by picking up my DSM-IV-TR and found no reference to such a diagnostic category. Absent a handy reference in the DSM, I looked in the paper for some other definition or recognition of the category of psychopathic offender and found no satisfactory grounding in any body of sound research. Left with the author's unsupported assertions that such a category of persons exists and that they behave in ways the author asks me to accept without support, my lawyer instincts cautioned me to proceed carefully. The psychopathic offender the author describes might well exist, but I am not persuaded of that, nor would be my legal colleagues, absent proof.Next, to the author's thesis that "[t]he offender must have the capacities necessary to understand relationships to justify holding that offender responsible" (p. 176) and that because psychopaths lack this capacity they should not be held criminally responsible. Is the author proposing a new test for criminal responsibility? Certainly no test for criminal nonresponsibility based on mental disability (i.e., insanity defense) in Anglo-American jurisprudence, or any other with which I am familiar, makes status (i.e., a diagnostic category) exculpatory for criminal responsibility. Rather, every test addresses the impact of a mental illness or disorder on the cognitive or volitional capacity of the offender at the time of the offense. The author offers no reason to reject the approach taken for the last several hundred years [End Page 193] by Anglo-American jurisprudence. Moreover, to the extent that status or diagnostic category is relevant in the insanity defense in Anglo-American jurisprudence, character or personality disorders (the genus to which I take it that psychopathy belongs) are often specifically excluded from consideration. For example, the Texas Penal Code (Tex. Penal Code Ann. § 8.01 (Vernon 1994)) states that:It is an affirmative defense to prosecution that, at the time of the conduct charged, the actor, as a result of a severe mental disease or defect, did not know that his conduct was wrong. The term "mental disease or defect" does not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.The federal Insanity Defense Reform Act raises the same issue: The government relies on the legislative history of 18 U.S.C. § 17, which states: "The concept of severity was added to emphasize that non-psychotic behavior disorders or neuroses such as an 'inadequate personality,' 'immature personality,' or a pattern of 'antisocial tendencies' do not constitute the defense.".... The government argues that because Dr. Lorenz would have testified that Salava was not psychotic but suffered from antisocial personality disorder, his testimony was not relevant to either prong of the insanity defense under the statute.... As a general matter, the government's point is well-taken. It seems clear that Congress intended by its inclusion of the modifier "severe" to place certain "disorders" outside the purview of the insanity defense altogether. United States v. Salava, 978 F.2d 320, 323 (7th Cir. 1992) Nowhere in the paper does Chiochetti acknowledge or address these societal judgments of moral responsibility that have already rejected a far more modest version of his proposal in categorically ruling out character or personality disorders from inclusion as... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Multiple Personality and Moral Responsibility”Daniel W. Shuman (bio)Stephen Braude’s essay, “Multiple Personality and Moral Responsibility,” discusses a number of important issues about the moral and legal responsibility of persons diagnosed with multiple personality disorder (MPD), known in DSM-IV as Dissociative Identity Disorder (DID). One issue that is fundamental to this debate, which Braude does not address, however, is the empirical reality underlying the debate. Does MPD/DID (...) exist? A prerequisite to a debate about the legal consequences of MPD/DID is legally sufficient proof of its existence and its behavioral consequences.Proof that MPD/DID exists, its impact on legal standards of responsibility, and that the defendant suffers from it, must come from expert testimony; it is not part of the common knowledge or experience of the typical judge or juror. Courts are, however, increasingly, unwilling to assume that because an expert has impressive qualifications, he or she will necessarily present scientifically valid evidence. Particularly in cases of psychiatric and psychological evidence, courts that once looked solely at the expert’s qualifications to determine the admissibility for expert scientific evidence, now understand that the expert’s qualifications are a necessary but not a sufficient condition for the presentation of accurate expert testimony. Courts increasingly want to know how experts know what they claim to know and whether their methods of knowing meet the hallmarks of good science.Thus, from a legal standpoint, a prerequisite to admissibility of the evidence that serves as a basis for a discussion of the legal implications of MPD/DID is rigorous scientific proof of its existence. Proof of the existence of MPD/DID has not, however, been the subject of rigorous scientific research, but instead has consisted of non-falsifiable clinical experience where the risk of iatrogenesis (i.e., hypnosis and suggestion) is ever present. While these clinical observations and opinions may ultimately be proven valid by subsequent research, there is simply no way to know whether that is so in the absence of rigorous scientific research. If proof of the existence of MPD/DID is clinically but not scientifically grounded, legal rules based upon it are suspect. Moreover, claims of MPD/DID often arise in a legal context where there are significant benefits to be gained from receiving the diagnosis which heightens the importance of rigorous scientific scrutiny.Diagnostic validity and reliability matters in different ways in the forensic context than it does in the therapeutic context. These contextual differences [End Page 59] are reflected in disparate standards for scrutinizing each. There is no threshold requirement, for example, that a psychotherapist prove that a diagnostic category is valid or that a psychotherapeutic treatment used for a person suffering from it is generally recognized as safe and effective before using it; however, there is a threshold requirement of rigorous scientific scrutiny before admission of this information in evidence. If a therapist’s diagnostic hypothesis that there are two personality states influencing a patient’s behavior is not borne out, it can be revised in later sessions. Even if MPD/DID does not exist, treatment that assumes it does may nonetheless be effective because therapeutic outcome is more closely tied to the nature of the therapist-patient relationship than the content of therapy, or because multiple personality states is an effective therapeutic metaphor. Moreover, if the patient is not satisfied that the diagnosis or treatment rendered is helpful, the patient can leave therapy or seek another therapist.In contrast, judicial determinations are a one-shot determination which cannot be revisited in light of subsequently acquired knowledge. The defendant/patient is not free to change courts, or withdraw from the legal proceedings. Thus, it would be entirely appropriate for psychiatrists and psychologists to treat patients presenting symptoms of what they label MPD/DID and for courts to reject exculpatory evidence from psychiatrists and psychologists of that disorder.Related ArticlesFeature Article: Multiple Personality and Moral ResponsibilityCommentary: Commentary by ClarkCommentary: Commentary by ShumanDaniel W. Shuman Daniel W. Shuman, Professor of Law, Southern Methodist University, Dallas, TX 75235, USA.Copyright © 1996 The Johns Hopkins University Press... (shrink)

This article uses Public Use Microsample data drawn from the 1990 census to explore the relationship between military presence, defined as the percentage of the local labor force in the active-duty armed forces, and women's employment and earnings across local labor market areas in the United States. Comparisons of local rates of unemployment and mean women's earnings are made between those LMAs in which the military plays a disproportionate role in the local labor market and those in which military presence (...) is low. Results suggest that women who live in labor market areas with a substantial military presence have, on average, lower annual earnings and higher rates of unemployment than their counterparts who live in nonmilitary LMAs. The argument is made that through the interaction of several socially situated conditions—including gender, family, labor markets, human capital, and place—the military emerges as a source of inequality in labor market outcomes for women working on or around military installations. (shrink)

This article outlines a theory of what affects the degree and nature of women's participation in the armed forces throughout history and across nations. Examining national security situations, military technology, military accession policies, demographic patterns, cultural values regarding gender, and structural patterns of gender roles, the article proposes a systematic theory of the conditions under which women's military roles expand and contract. The theory is then applied to analyze women's likely future role in armed forces. The military's need for personnel (...) has been the driving force behind expansion of women's military roles through history and across nations, but cultural values supporting gender equality also contribute and seem likely to have increased influence in the future. (shrink)

BackgroundThe quality of ethics consults is notoriously difficult to measure. Survey-based assessments cannot capture nuances of consultations. To address this gap, we conducted interviews with health professionals who requested ethics consults during the initial phase of the COVID-19 pandemic.MethodHealthcare professionals requesting ethics consultation between March 2020 and May 2020 at a tertiary academic medical centre were eligible to participate. We asked participants to comment on the consults they called and thematically analysed responses to identify features associated with optimal quality consultations.ResultsOf (...) 14 healthcare providers, 8 (57%) were women and professions were as follows: 11 (79%) medical doctors, 1 (7%) social worker, 1 (7%) physician assistant and 1 (7%) nurse practitioner. Two aspects of quality emerged: satisfaction and value. Themes within the domain of satisfaction included: responsiveness of the ethics consultant, willingness to consult, institutional role of the ethics service and identifying areas for improvement. When describing value, respondents spoke of the intrapersonal and interpersonal worth of consultation.ConclusionParticipants were generally satisfied with ethics consultation services, similar to opinions of those found in pre-COVID-19 survey studies. Our qualitative approach allowed for a richer exploration of the value of ethics consultation during the pandemic and has implications for ethics consultation services more broadly. Ethics consultation—emphasising both the process and outcome—created valuable moral spaces, promoting thoughtful and ethical responses to dilemmas in patient care. Future assessments should incorporate patient and family/surrogate perspectives and explore the domain of education as an additional quality measure. (shrink)

What would be the right way of starting (and developing) a discussion on the subject “What is time?”? Most probably in a number of ways as (paraphrasing Aristotle, 1003a) time has many meanings. Perhaps it would be sensible then not to start at all, think it over once again and limit the theme in an appropriate way. In the following we ask what time is, and follow namely this appeal — we think again and restrict the subject.

Islamic religious educations; Islamic ethics; conduct of life.

The dispute between Sunni and Shia does not only revolve around the problems of theological leadership, ways of worship, but also points to the authenticity of the Quran. Among the Sunnis, the authenticity of the Quran has been conserved since the revelation times. As for the Shiites, some scholars of this school state that there has been a distortion (tahrif) of the Quran. They also allege that several verses and chapters in the Quran have been changed even they were deleted, (...) especially those concerning the leadership. This study aimed to find out the differences in the Sunni-Shia views on the Quran’s authenticity, genealogically, its process, and its legal status. Based on qualitative research methods, this study used a comparative approach to analyze the details of the differences between these theological views. The result indicates that according to the Sunnis, the Quran will always be preserved as words of God. Meanwhile, in the Shiites, there are two different views about the authenticity of the Quran. The first states that the Quran was distorted during the first three caliphate era. The second states that the Quran is forever in its originality. Among Indonesian Shiites, there is no discourse on the distortion of the Quran. (shrink)

The Ganser syndrome, or talking past the point, (originally identifying symptoms of inmates on remand when questioned by prison doctors), is explored as a form of insubordination against the stigmatizing effects of overdetermined diagnostic categories. The strategies of approximation that characterize the syndrome are likened to comedy routines/vaudeville styles and to their employment of punning, clownery, and ambiguity to challenge the more privileged cultural values of clarity, literalness, and precision. The seeming craftiness of Ganserians is related to the aesthetic tactics (...) of the trickster figure and to the physical buffoonery of hysterics. Stylistically, this paper synthesizes the languages of critical theory, Gracie Allen routines, personal narrative, jokes, and poetic reflections on the notion of being approximate. (shrink)

Jamal Al-Banna, the 20 th century reformist and thinker, in his book _Nahwu al-Fiqh al-Jadid,_ outlines ideas about new Islamic jurisprudence, especially about the collection of _hadith_, which he considers to be fabricated _hadith_ because it contained the sayings or interpretations of the companions, not the sayings of the Prophet. Al-Banna offers an alternative to the hadith and sunnah, in line with the Qur'an, not according to the companions’ narration. This study utilized a qualitative research design, with data collected through (...) library and desk research. The primary source was Al-Banna’s _Nahwu al-Fiqh al-Jadid_, the hadiths and the sunnah, while the secondary material comprised books and critical commentaries of religious scriptures. The study found out that Al-Banna vouches for a new Islamic jurisprudence that believes in the Qur'an but rejects the _tafsir_ (exegesis of the Quran) because, they were a kind of deviation from the Quran. Al-Banna’s new Fiqh paid attention to the sunnah, and rejected many fabricated _hadith_s originating from companions’ words, not the Prophet Muhammad's words. He recommends to initiate a new perspective on the sunnah, using the Qur'an paradigm, not the _hadith_ narrators' paradigm. There are implications of these revelations as _Hadith_ experts criticized Al-Banna’s ideas as they thought his narration of the companions was not justified and that caused much controversy. However, Jamal Al-Banna's new version of Islamic jurisprudence has a vision and mission to advance the ummah based on the criteria of the Qur'an and Sunnah, only the words of the Prophet, both of which must be able to answer current problems and must be able to interact with contemporary dynamics. (shrink)

Volume 20, Issue 3, March 2020, Page 35-37.

I argue here that the ways we experience, think about, and treat pain are bound up with sociocultural and technological phenomena that shape our desires and expectations. I propose a way of imagining caring for and offering healing to those who suffer pain informed by the Christian theological tradition. This way does not aspire to replace the care and healing made possible by modern medicine, but rather to place it within the common life of a community of mutual love, hospitality, (...) and reciprocal care. (shrink)

In The Body of Compassion, Joel Shuman presents an important, new theological treatment of contemporary bioethics, weaving together personal experience, a critical treatise on contemporary bioethics, and an exploration of a Christian theological alternative.The author first draws the reader into a consideration of the current state of bioethics by relating the story of his grandfather, a hard-working family man who died a solitary death, unaccompanied by loved ones, in the unfamiliar and sterile world of a hospital. Troubled by the (...) way his grandfather died, Shuman takes the reader along as he explores how modern medicine has distanced itself from dealing with people as living beings beyond their immediate physicality. He examines how various approaches to bioethics over the past twenty years have tried to remedy this problem by prescribing certain standards for treatment and how each of these ultimately has fallen short due to the lack of “a teleological concern for the body”—i.e., to trying to understand what the body is actually for in a larger context. From this point, Shuman deftly moves to a discussion of the centrality of the body to Christianity, focusing on how baptism, participation in the liturgy, and the partaking of the Eucharist all serve to unite Christians as one in the body of Christ. For Christians, the author argues, the body does not just belong to the individual but rather is one with the community of the Church. With this in mind, Shuman proposes a new kind of bioethics for Christians, where care for the body of Christ becomes the model of how we should care for and receive care from each other.This fresh and thought-provoking book is sure to be of interest to ethicists, medical professionals, and everyone who is troubled by places where science and religion intersect and seem to conflict. (shrink)

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral (...) sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control. (shrink)

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)

Explores the impact of expert witnessing on the integrity of forensic scientific information. Complaints on the behavior of expert witnesses; Factors stimulating the susceptibility of experts to abandon their scientific integrity; Implications of the reliance of expert witnesses on ethics codes.

Even though boys and girls in childhood perform similarly in math and spatial thinking, after puberty fewer young women pursue majors that emphasize abilities such as science, technology, engineering, and math (STEM) in college. If postpubertal feminization contributes to a lower likelihood of choosing STEM majors, then young women who enter puberty early should be the least likely to pursue those majors later in their education. In this study, we investigate the association between age at menarche and the choice of (...) STEM major. We surveyed 150 undergraduate women from a variety of majors in a large, public university and created logistic regression models to estimate their likelihood of choosing a STEM major. We found that early-maturing girls are less likely to enter STEM majors. We posit that the earlier a young woman enters puberty, the earlier and more extensively she is affected by the “leaky pipeline.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Operating Through HatredAndrew G. Shuman“You’re not cutting my ***ing neck. The cancer is in my ***ing mouth.”While many patient encounters are memorable, Mr. K’s introduction to the head and [End Page 20] neck surgical oncology clinic is indelibly imprinted into the minds of all of the clinicians present on that certain autumn morning. This was, quite simply, a man who resonated hate. He was rude and disruptive. He (...) insisted on an expedited workup “without any waiting.” He questioned the ethnicity and nationality of his care providers. He told me, in no uncertain terms, that he did not appreciate my Jewish heritage—the swastika tattooed on his bicep underscored the point. He bragged about his recent incarceration for armed robbery. While my colleagues and I were tempted to simply refuse to assume his care, Mr. K had a bad problem—his recurrent tongue cancer required a major operation in order to offer him any hope for cure.Mr. K initially received an abbreviated course of radiation at an outside institution, which was limited by his non–compliance. While one might debate the wisdom of this decision in retrospect—in general, surgery is preferred for his type of tumor—the die was already cast. A heroic attempt at surgical salvage was now his only curative option. He previously sought care elsewhere... only to be fired by this original surgeon when Mr. K physically threatened him in the outpatient office during preoperative consultation. [It was the doctor’s fault for insulting him in the first place, Mr. K maintained... and no charges were filed.] We were, indeed, his last resort. Other than his recurrent cancer, Mr. K was robust; he was in his sixth decade, physically fit, and on the whole, fairly healthy. In the classic surgical lexicon, he was a reasonable surgical candidate. But was it reasonable to operate on such a person?I remember thinking, at the time, about our obligation to care for such an individual. Of course, being a medical professional carries with it many obligations, including a judicious assumption of personal risk. And, working in a tertiary care center begets the responsibility to assist referring clinicians in the management of difficult cases. Although professional obligations certainly have their limits, defining their bounds is decidedly more difficult. Paramount is creating an atmosphere of mutual trust and acceptance. Naturally, this was easier said than done in regard to Mr. K.Perhaps against our better judgment, we agreed to operate under the condition that he abide by strict behavioral ground rules, on our terms. We agreed upon the extent of the necessary operation (which indeed involved cutting his ***ing neck, much to his chagrin and reluctant acceptance). Mr. K promised to follow instructions for postoperative care. He assured us that he would not swear or yell (again). And, in the presence of hospital security, who reinforced our institutional policies regarding patient behavior, he guaranteed that he would not be verbally or physically violent or inappropriate, and would not make disparaging comments to other patients or staff. It seemed, at least, that we had an understanding.Needless to say, these rules were broken shortly after he awoke from surgery. I vividly remember being summoned from the OR when he threatened to murder his impressionable and terrified nurse a few days later, who would not acquiesce to his unreasonable demands. From that point onward, hospital security was deployed to his room regularly, and anything resembling a potential weapon was safeguarded. Any semblance of a mutual doctor–patient bond was shattered. At this point, everyone’s goal was simply to get Mr. K home.My visceral reactions to his behavior, while intense, were not unexpected, and fell in line with those of the entire team of clinicians caring for him. His antics brought his healthcare team together in collective unity (and condemnation). However, my surgical colleagues and I also felt somewhat guilty and responsible. While surgeons can choose to assume some degree of inherent personal danger in caring for a violent and angry patient, we also put the safety and soundness of the entire perioperative team in jeopardy, without necessarily seeking their input. But once we had decided to... (shrink)

Clinicians have an obligation to ensure that patients with adequate capacity can make autonomous decisions. Thus, patients who choose to forego treatment and leave hospitals “against medical advice” are typically allowed to do so. But what happens when they require clinicians’ assistance to physically leave? Is it incumbent upon clinicians to not only respect and fulfill patients’ requests with which they disagree, but to physically assist in their fulfillment? We attempt to develop an ethical framework wherein clinicians can honor patients’ (...) wishes without necessarily sacrificing their own moral position. (shrink)

A thirty-year-old single mother with recurrent, metastatic, treatment-refractory cancer presents to the emergency room with severe difficulty breathing due to an obstructive tumor in her neck, compounded by progressive disease in her lungs and a new pulmonary embolism. She cannot be safely intubated and would require an emergent awake tracheotomy. Even if the airway can be successfully secured surgically, the likelihood that she will be able to be weaned from mechanical ventilation is very low. The surgeon, a young mother too, (...) appreciates the patient's desire for more time with her toddler. But the surgeon knows the significant risk of surgery, the massive responsibility she would accept in trying to get the patient through it, and the emotional toll of an intraoperative death on surgical staff. And she can imagine the second-guessing that will come during the inevitable morbidity and mortality conference if the patient should die in the perioperative window. Yet the surgeon does not want to take the “easy” way out; after all, critically ill patients undergo aggressive resuscitation all the time. What should she do? (shrink)

Suzie loves to talk. A successful mid-thirties businesswoman, she is a self-described social butterfly—which made her diagnosis of tongue cancer even more devastating. She came to the clinic complaining of a lump in her throat, which in most young healthy people turns out to be benign and easily treated. But not for Suzie, who had a very rare salivary tumor arising in the back of her tongue. Its slow growth was both a blessing and a curse; such tumors do not (...) kill people quickly, but they typically require surgery. It would slowly and relentlessly grow until and unless we removed most of her tongue. In head and neck surgery, issues of appearance, identity, function, and communication are the foremost considerations when we decide when, and whether, to operate. As the adage goes, knowing when not to operate is the sine qua non of the wise surgeon. But the inverse is also true. (shrink)

The question of what, if anything, Christian theology as theology might contribute to ethical debates about appropriate uses of medical genetics has often been ignored. The answer is complex, and the author argues it is best characterized by an explanation of the analogous aspirations of the two: both have as their goal the perfection of the human being, both assert that the present disposition of the human body is on a fundamental level more often than not other than it ought (...) to be, and both aspire to transform the present state of the body toward a future state in which present imperfections no longer exist. Given these analogous concerns, it would seem that one of the primary moral contributions that Christianity can make to debates about medical genetics is to ask whether and to what extent the Christian vision of embodied human perfection is compatible with the vision of perfection offered by the sciences pertaining to medical genetics. The author pursues a discussion of this analogy and its implications in this essay. (shrink)

This paper compares the accounts of agency, morality, and law presumed by liberal political theory to the account offered by Thomas Aquinas. In Aquinas, law is among the several "principles of human acts" and is presumed always to have a constructive effect on the moral formation of those living under its aegis. One of its purposes, in other words, is to make women and men good. The liberal account, on the other hand, is relatively less attentive to the constructive effects (...) of law. This difference raises a question concerning the viability of the liberal assumption of a distinction between a morally neutral public law and a private morality. (shrink)