A clinical ethics consultant may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.

A call to advance integrative teaching and learning in higher education. From Parker Palmer, best-selling author of The Courage to Teach, and Arthur Zajonc, professor of physics at Amherst College and director of the academic program of the Center for Contemplative Mind in Society, comes this call to revisit the roots and reclaim the vision of higher education. The Heart of Higher Education proposes an approach to teaching and learning that honors the whole human being--mind, heart, and spirit--an essential (...) integration if we hope to address the complex issues of our time. The book offers a rich interplay of analysis, theory, and proposals for action from two educators and writers who have contributed to developing the field of integrative education over the past few decades. Presents Parker Palmer's powerful response to critics of holistic learning and Arthur Zajonc's elucidation of the relationship between science, the humanities, and the contemplative traditions. Explores ways to take steps toward making colleges and universities places that awaken the deepest potential in students, faculty, and staff. Offers a practical approach to fostering renewal in higher education through collegiality and conversation. The Heart of Higher Education is for all who are new to the field of holistic education, all who want to deepen their understanding of its challenges, and all who want to practice and promote this vital approach to teaching and learning on their campuses. (shrink)

In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, (...) I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation. (shrink)

Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not (...) a necessary condition for objective meaning in life. (shrink)

Religions often operate as comprehensive worldviews, attempting to answer the deepest existential questions that human beings can ask: Who am I? Where do I come from? Where am I going after I die? How should I live? Often ethical systems are embedded and justified within these broader narratives. Inevitably, the clinical ethics consultant will encounter and engage with religiously based ethical systems. In this issue, the authors reflect seriously and deeply on the implications of such engagement.

Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the definition and modeling (...) of complex disease states. (shrink)

Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.

This primer on authentic education explores how mind and heart can work together in the learning process. Moving beyond the bankruptcy of our current model of education, Parker Palmer finds the soul of education through a lifelong cultivation of the wisdom each of us possesses and can share to benefit others.

An important role of the philosopher is to critically reflect on what is often taken for granted, using the tools of argument and analysis. This article engages with six different papers that offer critical reflections on conventional concepts and beliefs in bioethics regarding informed consent, continuous deep sedation, traditional moral theories underlying bioethical thinking, the definition of mental disease, and codes of ethics for particular medical specialties.

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

Recent debates have led some to question the legitimacy of physicians refusing to provide legally permissible services for reasons of conscience. In this paper, I will explore the question of whether medical professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all medical services. I will argue that they do not. I will also argue for an approach to dealing with intractable moral disagreements between patients and physicians that gives both parties veto power with regards (...) to participation. Finally, I will respond to three objections to allowing physicians broad freedom to act on their consciences: such allowances would violate the conscience of the patient, would lead to unfairness, and would thwart important societal goals. (shrink)

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

Society and social structures play an important role in the formation and evaluation of concepts and practices in clinical ethics. This is evident in the ways the authors in this issue explore a wide range of arguments and concepts in clinical ethics including moral distress and conscience based practice, phenomenological interview techniques and gender dysphoria, continuous deep sedation (CDS) at the end of life, the notion of patient expertise, ethically permissible medical billing practices, the notion of selfhood and patient centered (...) care in dementia patients, and the definition of minimal risk as used in research regulations. (shrink)

Often lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and (...) promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources. (shrink)

A call to advance integrative teaching and learning in higher education. From Parker Palmer, best-selling author of The Courage to Teach, and Arthur Zajonc, professor of physics at Amherst College and director of the academic program of the Center for Contemplative Mind in Society, comes this call to revisit the roots and reclaim the vision of higher education. The Heart of Higher Education proposes an approach to teaching and learning that honors the whole human being--mind, heart, and spirit--an essential (...) integration if we hope to address the complex issues of our time. The book offers a rich interplay of analysis, theory, and proposals for action from two educators and writers who have contributed to developing the field of integrative education over the past few decades. Presents Parker Palmer's powerful response to critics of holistic learning and Arthur Zajonc's elucidation of the relationship between science, the humanities, and the contemplative traditions. Explores ways to take steps toward making colleges and universities places that awaken the deepest potential in students, faculty, and staff. Offers a practical approach to fostering renewal in higher education through collegiality and conversation. The Heart of Higher Education is for all who are new to the field of holistic education, all who want to deepen their understanding of its challenges, and all who want to practice and promote this vital approach to teaching and learning on their campuses. (shrink)

This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics with essays addressing clinician participation in state sponsored execution, duties to decrease ecological footprints in medicine, the concept of caring and its relationship to conscientious refusal, the dilemmas involved in dual use research, a philosophical and practical critique of principlism, conundrums that arise when applying surrogate decision-making models to patients with moderate intellectual disabilities, the phenomenology of chronic disease, and ethical concerns surrounding the use (...) of artificial intelligence in medicine. Throughout the issue, the themes of conceptual and moral boundaries in bioethics, critiques of current clinical ethics paradigms, and the importance of transparency are prominent. (shrink)

(1979). The Effect of Extraversion, Detail Importance and Interference on the Recall of Prose by Eleven‐year Old Children. Educational Studies: Vol. 5, No. 1, pp. 15-22.

Decision-making capacity (DMC) is, in many ways, a central organizing concept of modern health care ethics. Patients with DMC have the moral—if not always the legal—authority to make all manner of...

Drawing on the influence of primacy and recency effects in processing information about corporate social responsibility, the authors examine how internal and external factors impact the consumer-firm relationship in the presence of contradictory CSR information. Evaluating these factors provides a more comprehensive understanding of how consumers react to unethical and socially irresponsible actions. Contrary to recent research that suggests a reactive CSR communication strategy to be best due to recency effects, the present findings show that past customer experiences with the (...) firm facilitate a ‘primacy effect’. Thus, when corporate social irresponsibility occurs, a customer’s prior experiences mitigate negative consequences. Conversely, a firm’s positive CSR reputation may provide goodwill, although it does not guarantee that consumers will process CSR information differently. Therefore, firms cannot build a strong CSR reputation and expect to be immune from the consequences of CSI. Given these new findings of how consumers process contradictory CSR information, firms should implement a strategic and deliberate communication plan that delivers different messages to different stakeholders. Specifically, these findings suggest that firms benefit most from a proactive communication strategy with their current customers and a reactive communication strategy with the general public. (shrink)

Traditional forms of farming, herding, and fishing are remarkably adapted to African conditions but these traditional approaches are being overtaken by modern pressures, particularly population growth. According to a report published by the Office of Technology Assessment (OTA), a nonpartisan analytical support agency of the U. S. Congress, one promising way to help African farmers and herders would be for development assistance organizations to focus more attention on the various forms of low-resource agriculture that predominate in Africa.In keeping with OTA's (...) mission and primary audience, “Enhancing Agriculture in Africa: A Role for U. S. Development Assistance” (1988) is a policy-oriented synthesis of available technical information. The report provides Congress with a range of options that, if pursued, could help Africans enhance agriculture, increase their food security, and improve their lives.This paper is drawn from the larger OTA report, and it focuses on the role technology might play in enhancing low-resource agriculture. Readers should see the full assessment (OTA, 1988) for more information on policy considerations; the specific technologies mentioned; or a complete list of advisory panel members, workshops and participants, and commissioned papers.OTA's report comes at a critical time: for a variety of reasons—ranging from changing values to increased budget constraints—U. S. foreign assistance policy is undergoing a fundamental reevaluation. This review of the potential of low-resource agriculture, and options the United States might pursue to enhance this approach, was intended to aid in this reevaluation. (shrink)

BackgroundCommunity engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical (...) issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation.MethodsIn this paper, drawing upon interviews with the members of a Community Advisory Board on the Thai-Myanmar border, we describe and critically reflect upon an approach to community engagement which was developed in the context of international collaborative research in the border region.Results and conclusionsDrawing on our analysis, we identify a number of considerations relevant to the development of an approach to evaluating community engagement in this complex research setting. The paper also identifies a range of important ways in which the Community Advisory Board is in practice understood by its members to have morally significant roles and responsibilities beyond those usually associated with the successful and appropriate conduct of research. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

Couples need to make their wishes explicit if we are to allow postmortem gamete donation.

Misattributed paternity or ‘false’ paternity is when a man is wrongly thought, by himself and possibly by others, to be the biological father of a child. Nowadays, because of the progression of genetics and genomics the possibility of finding misattributed paternity during familial genetic testing has increased. In contrast to other medical information, which pertains primarily to individuals, information obtained by genetic testing and/or pedigree analysis necessarily has implications for other biologically related members in the family. Disclosing or not a (...) misattributed paternity has a number of different biological and social consequences for the people involved. Such an issue presents important ethical and deontological challenges. The debate centres on whether or not to inform the family and, particularly, whom in the family, about the possibility that misattributed paternity might be discovered incidentally, and whether or not it is the duty of the healthcare professional to disclose the results and to whom. In this paper, we consider the different perspectives and reported problems, and analyse their cultural, ethical and legal dimensions. We compare the position of HCPs from an Italian and British point of view, particularly their role in genetic counselling. We discuss whether the Oviedo Convention of the Council of Europe can be seen as a basis for enriching the debate. (shrink)

Much philosophical attention has been devoted to “The Land Ethic,” especially by Anglo-American philosophers, but little has been paid to A Sand County Almanac as a whole. Read through the lens of continental philosophy, A Sand County Almanac promulgates an evolutionary-ecological world view and effects a personal self- and a species-specific Self-transformation in its audience. It’s author, Aldo Leopold, realizes these aims through descriptive reflection that has something in common with phenomenology-although Leopold was by no stretch of the imagination a (...) phenomenologist. Consideration of human-animal intersubjectivity, thematized in A Sand County Almanac, brings to light the moral problem of hunting and killing animal subjects. Leopold does not confront that problem, but it is confronted and resolved by Jose Ortega y Gassett, Henry Beston, and Paul Shepard in terms of an appropriate human relationship with wild-animal Others. Comparison with the genuinely Other-based Leopold-Ortega-Beston-Shepard wild-animal ethic shows the purportedly Other-based humanand possibly animal ethic of Emmanuel Levinas actually to be Same-based after all. (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone apps (...) capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks. (shrink)

This special issue arose from a joint conference of the History of Education Society, UK and the Australian and New Zealand History of Education Society, held in Malvern in Worcestershire, England in 2016 on the theme ‘sight, sound and text in the history of education’. The conference drew together media and educational historians, as well as archivists and museum professionals, to examine both methodological issues and a range of examples of sensory and textual histories. The three-day event, as well as (...) being enriching for its international character, proved that although much work has already been done in this area, there is so much more to consider and exploit when it comes to the study of the ‘new’ sonic and visual sources and their intertextual relationship with the documentary, as well as traditional understandings of ‘text’. (shrink)

BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will (...) assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

During the WHO-GloPID COVID-19 Global Research and Innovation Forum meeting held in Geneva on the 11th and 12th of February 2020 a number of different ethical concepts were used. This paper briefly states what a number of these concepts mean and how they might be applied to discussions about research during the COVID-19 pandemic and related outbreaks. This paper does not seek to be exhaustive and other ethical concepts are, of course, relevant and important.

We explore three questions about Earth system modeling that are of both scientific and philosophical interest: What kind of understanding can be gained via complex Earth system models? How can the limits of understanding be bypassed or managed? How should the task of evaluating Earth system models be conceptualized?