In lieu of an abstract, here is a brief excerpt of the content:Hume on Human Excellence Marie A. Martin Hume was, in important respects, still verymuch a part ofthe classical ethical tradition. This is something we tend to overlook because we come out of a distinctly modern moral tradition, and we normally approach Hume looking for answers to a set of questions that are distinct, and often far removed, from the central questions of the classical tradition. Yet, the (...) classical aspects of Hume's ethics are not irrelevant to contemporary moral debates. There is evidence in recent years of a growing discontent with all the permutations of the two dominant strands of contemporary moral thought, Kantianism and utilitarianism. The sort of radical critique found in the works of Maclntyre, the increasing popularity of communitarian theories, and the resurgence of interest in virtue ethics in general, and Aristotelianism in particular, are all indications of this discontent. What I wish to suggest is that Hume's moral thought might prove a rich source for those who are dissatisfied with the direction ofmodern moral theory, and especially for those who believe that there is something within the classical tradition of virtue ethics worth salvaging. For Hume is a virtue ethicist, albeit one in modern dress, who, poised between the ancients and moderns, self-consciously chose to align himself with the ancient tradition, asserting its superiority over the modern. The ancient moralists are, Hume claims, the "best models,"1 morals being the one science "inwhich theyare not surpassed by the moderns" (E 330). The aim of this paper is to take an initial step towards refocusing our view on the largely neglected classical aspects of Hume's moral thought. The relationship between Hume's moral thought and the classical tradition is both extensive and complex, and I do not pretend to do anything more in this paper than present the tip of the iceberg. But the tip I shall examine is central to all that lies below; it is Hume's conception ofhuman excellence. Virtue or Human Excellence Perhaps Hume's most complete description ofhuman excellence occurs in the conclusion ofAn Enquiry Concerning the Principles ofMorals. Hume presents us with the fictional character, Cleanthes, as one whom "a philosopher might select... as a model ofperfect virtue" (E 270). He is, Hume claims, "a man ofhonour andhumanity," one ofwhom "[e]very one, who has anyintercourse... is sure offair and kind treatment." His Volume XVIII Number 2 383 MARIE A. MARTIN "assiduous application... [and] quick penetration... prognosticate the greatest honours and advancement." His company is enjoyed by all because he has "so much wit with good manners; so much gallantry without affectation" and "so much ingenious knowledge." His "cheerfulness... runs through the whole tenor ofhislife, and preserves a perpetual serenity on his countenance, and tranquillity ofhis soul." Finally, "[h]e has met with severe trials, misfortunes as well as dangers; and by his greatness ofmind, was still superior to all ofthem" (E 269-70). In the Treatise, Hume offers a less specific, yet similar portrait of human excellence: when we enumerate the good qualities of any person, we always mention those parts ofhis character, which renderhim a safe companion, an easy friend, a gentle master, an agreeable husband, or an indulgent father. We consider him with all hisrelations in society; andlove orhate him, according as he affects those, who have any immediate intercourse with him. And 'tis a most certain rule, that if there be no relation oflife, in which I cou'd not wish to stand to aparticular person, his character must so far be allow'd to be perfect. If he be as little wanting to himselfas to others, his character is entirely perfect.2 Although there are numerous passages throughout Hume's works that paint the same general picture, I will offer only one more, his description of an ideally virtuous disposition from his essay, The Sceptic: that which leads to action and employment, renders us sensible to the social passions, steels the heart against the assaults offortune, reduces the affections to ajustmoderation, makes our own thoughts an entertainment to us, and inclines us rather to the pleasure of society and conversation, than to those ofthe senses.3 What is common to all these descriptions... (shrink)

The idea of Hume as a philosopher of culture has only recently gained general acceptance; yet as far back as 1941 the Journal of the History of Ideas was publishing essays on Hume which reflected this aspect of his work. The essays selected for this volume range back as far as 1941, but they may be viewed as more timely than ever, given the recent interest in Hume as a philosopher of society, politics and history.

In lieu of an abstract, here is a brief excerpt of the content:Utility and Morality: Adam Smith's Critique of Hume Marie A. Martin Reading Smith's Theory ofMoral Sentiments one cannot help but note that, in spite ofthe obvious similarities between Smith and Hume and the equally obvious borrowings and adaptions Smith makesofportions of Hume's theory, the two differ substantially on the role of utility in morality. The difference is, in fact, practically diametrical opposition. Hume believed that utility was (...) the "foundation of the chief part of morals." Smith, on the other hand, believed that, while utility may contribute an additional beauty to virtue, it is never the source oftheir virtue and rarely the source of moral approbation. Given their agreement in so many other respects, why the difference regarding utility? To answer this question I shall examine both Smith's specific criticisms ofHume regarding the role ofutility in morals and his more general objections to any theory that makes an appeal to utility a foundation ofmoral approval. I shall show that, while Smith does raise anumber ofgenuine difficulties for Hume's theory, he does not succeed in his most serious criticism, that is, that Hume's theory does not adequately capture the essentially social nature ofmorality. Hume's View ofthe Role ofUtility AccordingtoHume, the sentimentofmoral approbation arisesfrom the perception ofqualities ofcharacter or mind which are either useful or agreeable to ourselves or others. Examples of qualities agreeable to ourselves include cheerfulness, confidence, self-respect, and taste. Examples of qualities agreeable to others include manners, wit, eloquence, andmodesty. But themajorityofourmoral sentiments arise from the perception of the usefulness of qualities, that is, "from reflexions on their tendency to the happiness of mankind, and of particularpersons."2 Utility or usefulness is nothing but a tendency to a certain end. But, Hume claims, "itis acontradictioninterms, thatany thingpleases as means to an end, where the end itself no wise affects us" (E 219). Thus, ifwe approve ofthose qualities thathave a tendency to promote the happiness or well-being of either the possessor or others, it must be eitherbecause we value theirhappinessin itselforbecause we value it as a means to our own interests. Volume XVI Number 2 107 MARIE A. MARTIN Hume rejects the second alternative as contrary to experienced fact. The "selfish systems" which attempt to reduce all moral approbation to self-interest cannot account for our praise and admiration ofthe courage and fortitude ofour enemies even when their consequences thwart our own interests. Neither can such systems account for the fact that "[w]e frequently bestow praise on virtuous actions, performed in very distant ages and remote countries; where the utmost subtilty ofimagination would not discover any appearance ofself-interest" (E 215-16). If it is not self-interest that leads us to approve useful qualities, thenitis clear that"[w]e must adopt amore public affection, and allow, that the interests ofsocietyare not, even on their own account, entirely indifferent to us" (E 219). We approve of qualities that promote the well-being of others because we have a natural concern for their welfare. In general, it is certain, that, wherever we go, whatever we reflect on or converse about, every thing still presents us with the view of human happiness or misery, and excites in our breast a sympathetic movement of pleasure or uneasiness. (E 221) Thus, our approval of useful qualities rests on their tendency to promote the happiness of those who possess or are affected by them, and this, in turn, rests on sympathy, the communication of passions, whereby we "feel" for others—happiness for theirjoys, sorrow for their miseries. So, althoughtheutilityofqualitiesofcharacteris notthe solecause ofour approbation, it is the most extensive and important one. It appears tobe matter offact, that the circumstance oíutility, in all subjects, is a source ofpraise and approbation: That it is constantly appealed to in all moral decisions concerning the merit and demerit ofactions: That it is the sole source ofthat high regard paid to justice, fidelity, honour, allegiance, and chastity: That it is inseparable from all the other social virtues, humanity, generosity, charity, affability, lenity, mercy, and moderation: And, in a word, that it is the foundation ofthe chief part of morals, which has a reference to mankind and our fellow-creatures. (E... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Utility and Morality: Adam Smith's Critique of Hume Marie A. Martin Reading Smith's Theory ofMoral Sentiments one cannot help but note that, in spite ofthe obvious similarities between Smith and Hume and the equally obvious borrowings and adaptions Smith makesofportions of Hume's theory, the two differ substantially on the role of utility in morality. The difference is, in fact, practically diametrical opposition. Hume believed that utility was (...) the "foundation of the chief part of morals." Smith, on the other hand, believed that, while utility may contribute an additional beauty to virtue, it is never the source oftheir virtue and rarely the source of moral approbation. Given their agreement in so many other respects, why the difference regarding utility? To answer this question I shall examine both Smith's specific criticisms ofHume regarding the role ofutility in morals and his more general objections to any theory that makes an appeal to utility a foundation ofmoral approval. I shall show that, while Smith does raise anumber ofgenuine difficulties for Hume's theory, he does not succeed in his most serious criticism, that is, that Hume's theory does not adequately capture the essentially social nature ofmorality. Hume's View ofthe Role ofUtility AccordingtoHume, the sentimentofmoral approbation arisesfrom the perception ofqualities ofcharacter or mind which are either useful or agreeable to ourselves or others. Examples of qualities agreeable to ourselves include cheerfulness, confidence, self-respect, and taste. Examples of qualities agreeable to others include manners, wit, eloquence, andmodesty. But themajorityofourmoral sentiments arise from the perception of the usefulness of qualities, that is, "from reflexions on their tendency to the happiness of mankind, and of particularpersons."2 Utility or usefulness is nothing but a tendency to a certain end. But, Hume claims, "itis acontradictioninterms, thatany thingpleases as means to an end, where the end itself no wise affects us" (E 219). Thus, ifwe approve ofthose qualities thathave a tendency to promote the happiness or well-being of either the possessor or others, it must be eitherbecause we value theirhappinessin itselforbecause we value it as a means to our own interests. Volume XVI Number 2 107 MARIE A. MARTIN Hume rejects the second alternative as contrary to experienced fact. The "selfish systems" which attempt to reduce all moral approbation to self-interest cannot account for our praise and admiration ofthe courage and fortitude ofour enemies even when their consequences thwart our own interests. Neither can such systems account for the fact that "[w]e frequently bestow praise on virtuous actions, performed in very distant ages and remote countries; where the utmost subtilty ofimagination would not discover any appearance ofself-interest" (E 215-16). If it is not self-interest that leads us to approve useful qualities, thenitis clear that"[w]e must adopt amore public affection, and allow, that the interests ofsocietyare not, even on their own account, entirely indifferent to us" (E 219). We approve of qualities that promote the well-being of others because we have a natural concern for their welfare. In general, it is certain, that, wherever we go, whatever we reflect on or converse about, every thing still presents us with the view of human happiness or misery, and excites in our breast a sympathetic movement of pleasure or uneasiness. (E 221) Thus, our approval of useful qualities rests on their tendency to promote the happiness of those who possess or are affected by them, and this, in turn, rests on sympathy, the communication of passions, whereby we "feel" for others—happiness for theirjoys, sorrow for their miseries. So, althoughtheutilityofqualitiesofcharacteris notthe solecause ofour approbation, it is the most extensive and important one. It appears tobe matter offact, that the circumstance oíutility, in all subjects, is a source ofpraise and approbation: That it is constantly appealed to in all moral decisions concerning the merit and demerit ofactions: That it is the sole source ofthat high regard paid to justice, fidelity, honour, allegiance, and chastity: That it is inseparable from all the other social virtues, humanity, generosity, charity, affability, lenity, mercy, and moderation: And, in a word, that it is the foundation ofthe chief part of morals, which has a reference to mankind and our fellow-creatures. (E... (shrink)

This edited text recaptures many of Joe L. Kincheloe's national and international influences. An advocate and a scholar in the social, historical, and philosophical foundations of education, he dedicated his professional life to his vision of critical pedagogy. The authors in this volume found mentorship, as well as kinship, in Joe and express the many ways in which he and his work made profound differences in their work and lives. Joe's research always pushed the limits of what critically reflective and (...) informed teaching entailed, never diluting the import of comprehending the complexity of sociopolitical, cultural, economic, and educational discourses and practices. Dedicated to a praxis of social and political activism rooted in students' development as citizens and workers, the labor of teachers as action researchers, cultural workers, and social mediators is always at the heart of all he achieved. We who were so influenced directly and indirectly by him knew his genius and relished the generosity with which he shared his ideas, advice, encouragement, and art. The world is better because of Joe L. Kincheloe scholarship-inextricably related to "critical" critical thinking and enactment of education that tenaciously interrupts complacency, mediocrity, always responding thoughtfully to particular educational contexts. (shrink)

Family Medicine Groups (FMGs) are the most recently developed primary care organizations in Quebec (Canada). Nurses within FMGs play a central role for patients with chronic diseases (CD). However, this complex role and the nursing activities related to this role vary across FMGs. Inadequate knowledge of nursing activities limits the implementation of exemplary nursing practices. This study aimed to describe FMG nursing activities with patients with CD and to describe the facilitators and barriers to these activities. A multiple‐case study was (...) performed with ten nurses practicing among patients with CD in FMGs. Five data sources were used to provide an in‐depth description of nursing activities and the facilitators and barriers to the development of these activities. After qualitative data analysis, findings show that nursing activities are clustered into five domains: Global assessment of the patient, Care management, Health promotion, Nurse–physician collaboration, and Planning services for patients with CD. Activities vary depending on contextual factors identified in each case. This multiple‐case study provides a clear description of nursing activities with patients with CD. There is a need for improved nursing activities and expertise in domains of activities that are less present in FMGs, such as case management and interprofessional collaboration. (shrink)

Park rangers hold a unique set of knowledge—of science, of publics, of institutional structures, of place, and of self—that should be recognised as valuable. For too long, models of the knowledge of scientists and publics have set people like rangers in an inbetweener position, seeing them as good at communicating, translating or negotiating from one side to the other, but not as making knowledge that is powerful in its own right. In this paper we argue that focus groups with park (...) rangers across regional and conservation parks in Aotearoa/New Zealand reveal the complexity and multiplicity of rangers’ knowledge-making that shows the science-public model as incomplete. We argue further that the model is flawed for its focus on the making and holding of knowledge and not also on how it is enacted. Rangers, we argue, are responsible every day for making knowledgeable decisions for the health and well-being of parks and people. Making good decisions, though, requires not just knowledge but also care. An understanding of the many ways rangers know and enact their knowledge is important for biosecurity practice, especially in models of adaptive governance. (shrink)

Despite recommendations from the Cartwright Report ethical review by health ethics committees has continued in New Zealand without health practitioners ever having to acknowledge their dual roles as health practitioners researching their own patients. On the other hand, universities explicitly identify doctor/research-patient relations as potentially raising conflict of role issues. This stems from the acknowledgement within the university sector itself that lecturer/research-student relations are fraught with such conflicts. Although similar unequal relationships are seen to exist between health researchers and their (...) patients, the patient/subjects are not afforded the levels of protection that are afforded student/subjects. In this paper we argue that the difference between universities and health research is a result of the failure of the Operational Standard Code for Ethics Committees to explicitly acknowledge the vulnerability of the patient and conflict of interests in the dual roles of health practitioner/researcher. We end the paper recommending the Ministry of Health consider the rewriting of the Operational Standard Code for Ethics Committees, in particular in the rewriting of section 26 of the Operational Standard Code for Ethics Committees. We also identify the value of comparative ethical review and suggest the New Zealand's Health Research Council's trilateral relationship with Australia's NHMRC (National Health and Medical Research Council) and Canada's CIHR (Canadian Institute of Health Research) as a useful starting point for such a process. (shrink)

Book reviewed in this article: Censuses, Surveys & Privacy. Edited by Martin Bulmer.

Heidegger and Performance explores convergences, direct or indirect, conscious or unconscious, between Heidegger’s work and ideas of performance and performativity. Its central provocation is to replace the word ‘being’ with ‘performance’ and interpret through Heidegger, new ways of understanding both terms.

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

This paper examines beliefs about four aspects of ethical leadership – Character/Integrity, Altruism, Collective Motivation and Encouragement – in Germany and the United States using data from Project GLOBE (Global Leadership and Organizational Behavior Effectiveness) and a supplemental analysis. Within the context of a push toward convergence driven by the demands of globalization and the pull toward divergence underpinned by different cultural values and philosophies in the two countries, we focus on two questions: Do middle managers from the United States (...) and Germany differ in their beliefs about ethical leadership? And, do individuals from these two countries attribute different characteristics to ethical leaders? Results provide evidence that while German and US middle managers, on average, differed in the degree of endorsement for each aspect, they each endorsed Character/Integrity, Collective Motivation and Encouragement as important for effective leadership and had a more neutral view of the importance of Altruism . The findings are reviewed within the social-cultural context of each country. (shrink)

This paper examines beliefs about four aspects of ethical leadership –Character/Integrity, Altruism, Collective Motivation and Encouragement– in Germany and the United States using data from Project GLOBE (Global Leadership and Organizational Behavior Effectiveness) and a supplemental analysis. Within the context of a push toward convergence driven by the demands of globalization and the pull toward divergence underpinned by different cultural values and philosophies in the two countries, we focus on two questions: Do middle managers from the United States and Germany (...) differ in their beliefs about ethical leadership? And, do individuals from these two countries attribute different characteristics to ethical leaders? Results provide evidence that while German and US middle managers, on average, differed in the degree of endorsement for each aspect, they each endorsed Character/Integrity, Collective Motivation and Encouragement as important for effective leadership and had a more neutral view of the importance of Altruism. The findings are reviewed within the social-cultural context of each country. (shrink)

It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients’ medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees (...) in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation. (shrink)

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the (...) possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses. (shrink)

What does it mean to ‘drop out’ of therapy? Many definitions of ‘dropout’ have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the client’s experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether this refined (...) categorisation of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioural Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11-17 years. 32 were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. 67 cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analysed using ideal type analysis. Three types of dropout were constructed: ‘dissatisfied’ dropout, ‘got-what-they-needed’ dropout, and ‘troubled’ dropout. ‘Dissatisfied’ dropouts reported stopping therapy because they did not find it helpful. ‘Got-what-they-needed’ dropouts reported stopping therapy because they felt they had benefitted from therapy. ‘Troubled’ dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of 'dropout' cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment. (shrink)

The multiplicity of definitions and conceptions of self-regulation that typifies contemporary research on self-regulation in psychology and educational psychology is examined. This examination is followed by critical analyses of theory and research in educational psychology that reveal not only conceptual confusions, but misunderstandings of conceptual versus empirical issues, individualistic biases to the detriment of an adequate consideration of social and cultural contexts, and a tendency to reify psychological states and processes as ontologically foundational to self-regulation. The essay concludes with a (...) consideration of educational research and intervention in the area of students’ self-regulated learning in terms of the scientific and professional interests of psychologists and educators, and the disguised manipulation of student self-surveillance in the service of the institutional mandates of schools. (shrink)

Corporations significantly influence the public and political spheres. In light of this corporate power in society, academics have criticized the lack of legitimization (i.e., the legitimacy gap) and highlighted a potential divergence between corporate resource allocation and the needs and preferences of the public (i.e., the social issues gap). To address these problems, democratizing organizations has been proposed as a potential solution. In line with this, the authors argue that an increase in corporate power outside the economic realm should be (...) counterbalanced by more democratic corporate governance (i.e., an internalization of democracy). While important groundwork exists, academic attention to these topics remains limited. The authors provide an overview of the literature linking corporate power and the claim for democratizing organizations, advocate for legitimization, identify research gaps, and develop a research agenda to inspire and guide future research efforts. The paper's findings suggest the importance of conceptual and empirical research on the micro-, meso-, and macro-levels and the cross-level effects, which is needed to advance this incipient research area. Future research must (1) clearly define corporate power and discuss how democratizing organizations can contribute to more legitimate organizational decisions, (2) unveil novel approaches for more democratic corporate governance, and (3) understand the organizational- and individual-level factors necessary for the successful realization of democratic organizations. (shrink)

In this paper we argue that a dominant view of Humean naturalism involves a fundamental misconception of Hume's naturalist project. We shall show that the naturalist project as Hume conceives it is philosophically much more interesting than the form of naturalism commonly attributed to him. We shall also argue, however, that Hume's commitment to principles of empiricist epistemology prevented him from bringing his naturalist project to a satisfactory conclusion. Finally, we shall suggest that Wittgenstein shares Hume's conception of a philosophically (...) satisfactory form of naturalism, and that, unencumbered by empiricist doctrines, Wittgenstein was able to provide the sort of undogmatic unravelling of the sceptical problem that eluded Hume. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse or (...) child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse or (...) child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's controversial (...) treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy, designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions. (shrink)

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's controversial (...) treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy, designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions. (shrink)