A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send (...) a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such high-tech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent patients, (...) rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics. The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development. Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions. (shrink)

Both communitarianism and casuistry have sought to restore ethics as a practical science—the former by incorporating various traditions into a shared definition of the common good, the latter by considering the circumstances of each situation through critical reasoning. Mark G. Kuczewski analyzes the origins and methods of these two approaches and forges from them a new unified approach. This approach takes the communitarian notion of the person as its starting point but also relies upon the narrative and analogical tools (...) of case-based reasoning. He separates out the rhetoric that is incongruent with the Aristotelian aspirations of each method to show that the two are complementary, and that consensus can emerge from fragmentation. He then applies his resulting method to three major problems in bioethics: the difficulties that the issue of personal identity poses for advance directives, the role of the family in medical decision making, and the refusal of treatment because of religious beliefs. He analyzes the need to assume a communitarian notion of the person as a starting point for the application of casuistic insights. Combining theoretical, practical, and scholarly insights, this book will be of interest to philosophers, political and social scientists, and bioethicists. (shrink)

This dissertation examines the two most popular contemporary revivals of Aristotelian ethics, communitarianism and casuistry. I consider how these two schools of thought which take Aristotle's ethics as their starting point, can seem to be so diametrically opposed. The communitarian approach to ethics, personified by Alasdair MacIntyre, Michael Sandel, and Ezekiel J. Emanuel argues that a shared notion of the self or the good life must be sought prior to resolving ethical problems. Conversely, the new casuistic movement, exemplified by the (...) recent work of Albert Jonsen, Stephen Toulmin, and Carson Strong eschews such theoretical baggage in favor of a case-based ethics. By examining each school of thought in the light of their Aristotelian aspirations, namely, their desire to re-establish an ethics based upon prudence that overcomes the fact/value distinction, spurious elements of their rhetoric are rejected. This allows us to see the compatible strains in communitarianism and casuistry and to demonstrate the elements they must borrow from each other in order to be viable approaches to ethical and political philosophy. (shrink)

Spirituality or religion often presents as a foreign element to the clinical environment, and its language and reasoning can be a source of conflict there. As a result, the use of spirituality or religion by patients and families seems to be a solicitation that is destined to be unanswered and seems to open a distance between those who speak this language and those who do not. I argue that there are two promising approaches for engaging such language and helping patients (...) and their families to productively engage in the decision-making process. First, patient-centered interviewing techniques can be employed to explore the patient's religious or spiritual beliefs and successfully translate them into choices. Second, and more radically, I suggest that in some more recalcitrant conflicts regarding treatment plans, resolution may require that clinicians become more involved, personally engaging in discussion and disclosure of religious and spiritual worldviews. I believe that both these approaches are supported by rich models of informed consent such as the transparency model and identify considerations and circumstances that can justify such personal disclosures. I conclude by offering some considerations for curbing potential unprofessional excesses or abuses in discussing spirituality and religion with patients. (shrink)

Introduction: Foucault and political philosophy -- Marx: antinormative critique -- Lenin: the invention of party governmentality -- Althusser: the failure to denormativise Marxism -- Deleuze: denormativisation as norm -- Rorty: relativising normativity -- Honneth: the poverty of critical theory -- Geuss: the paradox of realism -- Foucault: the lure of neoliberalism -- Conclusion: What now?

This book outlines and evaluates the principal strands of critical legal studies, and achieves much more as well.

Immigrants lacking health insurance access the health care system through the emergency departments of non-profit hospitals. Because these persons lack health insurance, continued care can pose challenges to those institutions. I analyze the values of our health care institutions, utilizing a Walzerian approach that describes its appropriate sphere of justice. This particular sphere is dominated by a caring response to need. I suggest that the logic of this sphere would be best preserved by providing increased access to health insurance to (...) this population. This access would marry the rights of these members of our community to access care to our responsibility to contribute to financing of the system. I close with some considerations on what it means to be a member of the community. (shrink)

This is a clear and critical account of Foucault's political thought: what he said, how it's been used and its influence today. Michel Foucault, French philosopher, social theorist, historian of ideas and literary critic, is primarily known as a radical thinker who disturbs our understanding of society, yet little attention has been paid to his politics. Now, Mark Kelly details and criticises all of Foucault's major political ideas: the historical relativity of knowledge; exclusion and abnormality; his radical reconception of (...) power; his historical analysis of biopolitics in terms of discipline and biopower; his concept of governmentality; and his late work around ethics and subjectivity. Kelly shows how Foucault's positions changed over time, how his thought has been used in the political sphere and examines the importance of his work for politics today. It engages with Foucault's entire corpus, from his first works right up to his posthumously published College de France lectures and the unabridged version of the History of Madness. It looks at the theoretical reception of Foucault's thought and how it has been applied to real-world problems. (shrink)

ABSTRACTI consider objections to the use of living wills based upon the discontinuity of personal identity between the time of the execution of the directive anbd the time the person becomes incompetent. Recent authors, following Derek Parfit's “Complex View” of personal identity, have argued that there is often not sufficient identity interests between the competent person who executes the living will and the incompetent patient to warrant the use of the advance directive. I argue that such critics err by seeking (...) personal identity in a purely descriptive manner. By exploring Buchanan and Brock's concept of “surviving interests”, an argument is developed that certain future‐oriented acts have a normative force that contributes to the narrative unity which is constitutive of personal ideality. This narrative concept of the self is entailed by many of the our ordinary practices and challenges the philosophical consensus to view the self in a more dynamic and communitarian manner. (shrink)

I explore the possible meanings that the notion of the common morality can have in a contemporary communitarian approach to ethics and public policy. The common morality can be defined as the conditions for shared pursuit of the good or as the values, deliberations, traditions, and common construction of the narrative of a people. The former sense sees the common morality as the universal and invariant structures of morality while the second sense is much more contingent in nature. Nevertheless, the (...) communitarian sees both aspects as integral in devising solutions to public policy problems. I outline how both meanings follow from communitarian philosophical anthropology and illustrate how they work together when addressing a question such as that of providing universal health insurance in the United States. The common morality forms the basis of building an implicit consensus that is available to and reaffirmed by the shared reflections of the citizenry. (shrink)

Epistemology -- Power I -- Power II -- Subjectivity -- Resistance -- Critique -- Ethics.

Political philosophers since Hobbes often construe social life in terms of a conflict which is rarely reconciled, but rather is accommodated in politics or adjudicated in law. Yet many think that morality pertains even in a formalized situation of attenuated agreement. Following Rawls, this morality is held to be a minimal, incipient, rudimentary form of justice--in Rawls's case, fairness. I argue from Kierkegaard and Habermas that a minimal, incipient, rudimentary form of love--namely, hospitality, the welcome of strangers--is equiprimordial to fairness (...) in establishing the basic social situation. (shrink)

Bioethicists think about families in terms of conflicting interests. This mistake results from an impoverished notion of informed consent. Only by adequately characterizing the process of informed consent can we capture the phenomenon of shared decisionmaking.

In this article, I consider the interoperation of twin contemporary governmental imperatives, fostering economic growth and ensuring biopolitical security, in the face of the COVID-19 pandemic. At a theoretical level, I thereby consider the question of the applicability of a Marxist analysis vis-à-vis a Foucauldian one in understanding state responses to the pandemic. Despite the apparent prioritization of preserving life over economic activity by governments around the world in this context, I will argue that the basic problem that COVID-19 posed (...) for the state was one of sheer unknowability and that the fundamental motive for the governmental response was a concern for security in Foucault’s sense, that is, ensuring a baseline predictability in the social field, upon which economic activity, like myriad other social activity, is premised. I argue that this drive for security motivated states to appeal to medical experts to determine the direction of their response, who in turn applied a default model of quarantine. While we cannot be certain that the medically-guided response was optimal in terms either of health outcomes or economically, I argue it served its essential purpose by providing a structured framework for social action in the face of the unknown. While this is vital for the maintenance of the basic coordinates of capitalist society, I argue it nonetheless cannot entirely be explained simply by an appeal to Marxist categories and instead requires Foucault’s insights into the medicalization of society. (shrink)

I consider the problem liberalism poses for bioethics.Liberalism is a view that advocates that the state remain neutralto views of the good life. This view is sometimes supported by askeptical moral epistemology that tends to propel liberalismtoward libertarianism. I argue that the possibilities for sharedagreement on moral matters are more promising than is sometimesappreciated by such a view of liberalism. Using two examples ofpublic debates of moral issues, I show that commonly sharedintuitions may ground moral principles even if they may (...) be givendifferent weight by persons of different moral and religioustraditions. Nevertheless, the fact that the intuition andprinciple is widely shared may be sufficient to chart somedirections for public policy or cooperative action even if theydo not lead to complete agreement. As a result, I argue that aliberal communitarianism that presupposes a fairly minimalistepistemology is a legitimate approach to achieving sharedagreement in a pluralistic society. (shrink)

It has become common in medical ethics to discuss difficult cases in terms of the principles of respect for autonomy, beneficence, nonmaleficence, and justice. These moral concepts or principles serve as maxims that are suggestive of appropriate clinical behavior. Because this language evolved primarily in the acute care setting, I consider whether it is in need of supplementation in order to be useful in the long-term care setting. Through analysis of two typical cases involving residents of long-term care facilities, I (...) argue for the additional principles of candor and responsibility for narrative integrity. (shrink)

Medicine is in a very self-reflective mood. There is a revival of interest not only in medical ethics but also in medical history, the Hippocratic corpus, and various kinds of literature that indicate physicians are reexamining the foundations of medicine and what it is that gives meaning to medicine. That is, they are reexamining the physician's vocation, in the true sense of vocation as a calling. This interest has coincided with the concern of third parties such as accreditation agencies about (...) the professionalism of physicians. (shrink)

Communitarian critics have derided case-based reasoning for ignoring the need to arrive at a shared hierarchy of goods prior to case.

Hume's Reception in Early America: Expanded Edition brings together the original American responses to one of Britain's greatest men of letters, David Hume. Now available as a single volume paperback, this new edition includes updated further readings suggestions and dozens of additional primary sources gathered together in a completely new concluding section. From complete pamphlets and booklets, to poems, reviews, and letters, to extracts from newspapers, religious magazines and literary and political journals, this book's contents come from a wide variety (...) of sources published in colonial America and the early United States between 1758 and 1850. As well as classics by Thomas Jefferson, John Adams and Alexander Hamilton, it contains scores of unknown and hard-to-locate items, many of which have not been reprinted since their original publication. These responses are divided into four parts covering Hume's Essays; his Philosophical Writings; his History of England; and his Character and Death. Each of those parts has a separate introductory essay, and every selection is introduced by a short headnote that sets the piece in its historical context and provides bibliographical references. Packed with new insights into Hume and American thought and culture, Hume's Reception in Early America reveals the relevance and impact of Hume on American political, philosophical, historical, religious, and aesthetic debates. (shrink)

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items (...) that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability. (shrink)

In October 2012, the Loyola University Chicago Stritch School of Medicine amended its eligibility requirements for admission. In addition to U.S. citizens and permanent residents, persons who qualify for the Deferred Action for Childhood Arrivals program of the United States Citizenship and Immigration Service are now eligible for admission. Simply put, we extended the educational opportunity of medical school to people who are in a particular category of undocumented immigrants. We became the first medical school in the United States to (...) have an intentional, transparent policy of eligibility for persons eligible for the DACA program. This expanded admissions policy has gained some attention in the popular press and brought us many expressions of support. It has also dismayed a few members of our school's circle of faculty and alumni.We wish to walk you through the history of our policy's development. We believe that viewing it as it developed will make clear three pertinent ideas: this policy flows directly from the mission of medical schools, it suits a positive notion of social justice and is also compelled by a duty not to discriminate on arbitrary grounds, and educators who steward educational institutions must have the moral courage to place considerations of institutional mission and social justice above the political views and negative responses of some alumni and donors. (shrink)

The evaluation of new theories and pedagogical approaches to business ethics is an essential task for ethicists. This is true not only for empirical and applied evaluation but also for metatheoretical evaluation. However, while there is increasing interest in the practical utility and empirical testing of ethical theories, there has been little systematic evaluation of how new theories relate to existing ones or what novel conceptual characteristics they might contribute. This paper aims to address this lack by discussing the role (...) of metatheorising in assessing new approaches to ethics. The approach is illustrated through evaluating a new pedagogy and curriculum for ethics education called Giving Voice to Values (GVV). Our method involves identifying a number of metatheoretical lenses from existing reviews of ethical theories and applying these to examine GVV’s conceptual elements. Although GVV has been explicitly presented as a pedagogy and teaching curriculum, we argue that it has the potential to contribute significantly to the development of ethical theory. We discuss the general implications of this metatheoretical method of evaluation for new approaches to business ethics and for GVV and its future development. (shrink)

I analyze the insights present in Elisabeth Kübler-Ross’s seminal work, On Death and Dying that have laid the foundation for contemporary clinical bioethics as it is practiced by clinical ethics co...

The American Journal of Bioethics, Volume 11, Issue 12, Page 1-3, December 2011.

The ethics consultant attended two of the weekly nursing conferences on this unit to process the feelings that the nurses expressed about the case, to explain the kind of ethical reasoning that has evolved regarding the forgoing of life-sustaining treatment, and to acknowledge some things he could have done better. In particular, this consultant came to believe that he had made a mistake in inferring that his job was only to provide the information to the attending physician that was requested. (...) This physician had suggested that he would prefer to deal directly with the family and only needed information from the consultant. Although the physician continually held open the possibility that at some time in the near future he might ask the consultant to meet with the family, that request never came despite repeated offers of assistance. (shrink)