For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining (...) thefield, training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education. (shrink)

Focusing on the notion of competencies, the address explores important dimensions of human infrastructure for negotiating alternative agrifood systems. The analytical competencies emphasized are those of making connections and evaluating contradictions. Farm structure and food system connections with human health and consumer culture are chosen as examples. Examined in the context of social change strategies, relational competencies focus on new forms of food citizenship involving alternative organizational relationships between farmers, retailers, and customers. Ethical competencies are framed in (...) relationship to the entire food system, to the valuing of non-market goods, and to linkages between ethics and emotions. Finally, aesthetic and spiritual competencies are considered as human capacities to connect agriculture and food with beauty and with sacramental living. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This (...) revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

We can make a difference in shaping the future by ensuring that computers "serve human needs." By making explicit the enduring values that we hold dear we can guide computer system designers and developers for the next decade, century, and thereafter. After setting our high-level goals we can pursue the components and seek the process for fulfilling them. High-level goals might include peace, excellent health care, adequate nutrition, accessible education, communication, freedom of expression, support for creative exploration, (...) safety, and socially constructive entertainment. Computer technology can help attain these high-level goals if we clearly state measurable objectives, obtain participation of professionals, and design effective human-computer interfaces. Design considerations include adequate attention to individual differences among users, support of social and organizational structures, design for reliability and safety, provision of access by the elderly, handicapped, or illiterate, and appropriate user controlled adaptation. With suitable theories and empirical research we can achieve ease of learning, rapid performance, low error rates, and good retention over time, while preserving high subjective satisfaction. To raise the consciousness of designers and achieve these goals, we must generate an international debate, stimulate discussions within organizations, and interact with other intellectual communities. This paper calls for a focus on the "you" and "I" in developing improved user interface research and systems, offers a Declaration of Responsibility, and proposes a Social Impact Statement for major computing projects. (shrink)

From a largely Western phenomenon, the “animal turn” has, in recent years, gone global. Animals and Human Society in Asia: Historical, Cultural and Ethical Perspectives is just such a timely product that testifies to this trend.But why Asia? The editors, in their very helpful overview essay, have from the outset justified the volume's focus on Asia and ensured that this is not simply a matter of lacuna filling. The reasons they set out include: the fact that Asia is (...) the cradle of early human settlement and animal domestication; Asia encompasses an extreme diversity of closely connected ecosystems and human cultures; Asia is the place where the world's major religions originated; and, as in other parts of the world, Asia's use of animals for food and other utilitarian purposes constitutes a prominent feature of its culture. All of these factors, they argue, made Asia a unique lab for the exploration of major developments in human civilization and the complexities of human-animal interactions.Based on these premises, the book is divided into four parts, each concentrating on areas that the editors consider to have paramount significance in world history: Part I, “Hunting and Domestication”; Part II “Animals as Food”; Part III “Animals at War”; and Part IV “Animals in Culture and Religion.” As many good works on animal studies do, the volume adopts a truly cross-disciplinary approach, uniting scholars from disciplines as diverse as archaeology, history, anthropology, art, religion, literature, and cultural studies. It too takes an interregional approach and covers a vast geographical area, stretching from the western edge of Asia in the Levant to Central Asia, where once roamed the horses of the nomadic pastoral tribes, to the other end of Asia, including India, China, and Japan. Temporally impressive as well, the work takes us from the deep history of the Paleolithic period up to the contemporary world, exploring the diverse roles that a wide range of animals—horses, donkeys, camels, elephants, tigers, and so forth—have played in Asia's rich and unique past and present.Strong in archaeology, Part I, “Hunting and Domestication,” responds to the much-called for “deep” or “coevolutionary” history of human-animal relations in recent years. The three chapters discuss, respectively, the roles that proboscideans have played in the diet and culture of early societies in Paleolithic China and beyond; the ways in which animals of all sizes have been increasingly integrated into the diet, daily uses, trade, and warfare in Holocene Negev; and the diversifying roles played by donkeys in the early Bronze Age in Southern Levant as a food source, a means of transport and in ritual sacrifices. Together, they demonstrate, with reference to telling archaeological evidence how the early societies in this region have been highly dependent upon the increasingly sophisticated interactions with and uses of mega-herbivores in the protracted and by no means clear-cut transition from hunting and herding towards the agricultural way of life, affirming the co-existing and co-constituting relations between humans and other animals in the deep past of Asia.The chapters in the section on “Animals at War” equally reveal the crucial roles that animals have played in the military sphere, as either a practical war technology or a show of military power. “Elephants in Mongol History” revisits the thesis of elephant-mounted troops in South and Southeast Asia as a barrier to Mongol expansion. Through its lively account of the pivotal battles in Mongolian history, especially that against India and China, it illustrates with great success the complex interactions between animals (especially elephants, horses, and humans), technology, and the geographical environment, which jointly exercised their influence on the outcome of warfare and degree of success of political rule. Turning away from the dynamic of warfare, the following two chapters explore the biopolitical question of the management of the horse as a bio-resource in the Mamluk Sultanate of Egypt and Syria (1250–1517) and early Ming Dynasty China, respectively. The first one places its focus on the breeding, procurement, and feeding of the horse subjects in question, while the latter concentrates on the human organization of various resources for the upkeep of government horses—a conventional area of study called “horse administration” in the institutional history of the government in China.The last section, “Animals in Culture and Religion,” examines the changing images of apex predators, such as lions and tigers, in Buddhist perceptions from South Asia to East Asia; the cult of the Horse King in late Imperial China; and the significance of animal signs in Mongolian historiography. They represent an established approach in animal studies that seeks to understand different aspects of human culture through symbolic or metaphorical animals. Instead of treating the animals discussed as mere abstractions, which has been a frequent criticism of works that adopt this approach, the relations between the symbolic animals and their prototype in the natural world were attentively explored. The essay on the cult of the Horse King, for example, closely links the wax and wane of the cult since late imperial China with the changing use and subsequent disuse of the actual horses in agriculture, transportation, commerce, and quotidian life. Yet, classic as these essays on symbolic animals are, one does feel slightly unsatiated when coming to the end of this section, which also marks the end of this volume. Having been reminded early in the introductory essay that Asia was “a major site for the emergence of moral teachings and ethical guidance on the treatment of animals” and how this legacy “still affects the lives of billions of humans to this very day,” one feels naturally rather let down that no article in this volume directly addresses this vital ethical dimension, especially since it belongs to a series on “animal ethics.”Indeed, regarding the task of placing either the nonhuman animals or the ethical relations between humans and other animals center stage, the essays in this volume achieve only varying levels of success. Some authors exhibit a more acute awareness of what “animal studies” or “animal ethics” might entail epistemically and methodically and experiment by paying closer attention to the species-specific characteristics, experience, and agency of nonhuman animals in order to cast off the deified anthropocentrism previously ruled in humanist scholarship. However, others have made no such attempt. For example, in Part II of “Animals as Food,” an essay on the production and consumption of milk in contemporary China, albeit alert to the issue of health hazards to consumers, omits any consideration of the subject from the dairy cows’ perspective under the modern intensive farming system. Moreover, otherwise superb research on the tuna-fishing industry in Japan, with its insightful discussion of the nexus between knowledge economies and imperial politics, too passes over any discussion of the fate of the tuna, whether collectively as a group of living organisms containing 15 species or individually as animals with an embodied experience. One does ponder whether these essays would fit better in a volume on the cultural history of food or on the entwining history of knowledge production, economics, and politics, which conventionally position human interests at the center of research.Taken as a whole, this is an impressive volume that directs our attention to the hitherto understudied world of Asia in animal studies. The long durée, with its interdisciplinary and interregional approach, also most powerfully presents a past in Asia that could not have been the same without the participation of animals at every level, from everyday life to the shaping of cultural values, the construction of belief systems, the building of a national identity, and even the rise and fall of regimes. Scholars and students interested in expanding the frontier of our understanding of the world with a more inclusive “we” should find a wealth of interesting subjects on which to build further research. Finally, the volume also presents a fitting occasion for all scholars committed to animal studies to consider the grave challenge confronting the field that arose alongside its growing respectability and rapid expansion: Should it be oriented toward the destabilization of our previously anthropocentric conception of the world? Or should no such perimeter be imposed, as in this volume? The overall breadth and limitations of this volume leave one pondering this issue. (shrink)

The ends and means of public health activities are suggested to be at odds with the values held by human individuals and communities. Although promoting longer lives in better health for all seems like an endeavour that is obviously acceptable, it can be challenged by equally self-evident appeals to autonomy, happiness, integrity and liberty, among other values. The result is that people’s actual concerns are not always adequately dealt with by public health measures and (...) assurances. (shrink)

This is the third of three volumes containing a report from the International Panel on Social Progress. The IPSP is an independent association of top research scholars with the goal of assessing methods for improving the main institutions of modern societies. Written in accessible language by scholars across the social sciences and humanities, these volumes assess the achievements of world societies in past centuries, the current trends, the dangers that we are now facing, and the possible futures in the twenty-first (...) century. It covers the main socio-economic, political, and cultural dimensions of social progress, global as well as regional issues, and the diversity of challenges and their interplay around the world. This particular volume covers topics such as world cultures and religions, families, global health, education, and the contributions of social sciences to institutional change. (shrink)

Use of humanities content in American medical education has been debated for well over 60 years. While many respected scholars and medical educators have purported the value of humanities content in medical training, its inclusion remains unstandardized, and the undergraduate medical curriculum continues to be focused on scientific and technical content. Cited barriers to the integration of humanities include time and space in an already overburdened curriculum, and a lack of consensus on the exact content, pedagogy and instruction. Edmund Pellegrino, (...) physician and scholar of the latter twentieth century, spent much of his professional life promoting the value and importance of the humanities in medical education, seeking the best way to incorporate and teach this content in clinically relevant ways. His efforts included the founding of multiple enterprises starting in the 1960s and 1970s to promote human values in medical education, including the Society for Health and Human Values and its Institute on Human Values in Medicine. Regardless of his efforts and those of many others into the current century, the medical humanities remains a curricular orphan, unable to find a lasting home in medical education and training. (shrink)

A clear understanding of the concept of health plays a key role in defining what health care should comprise and in developing adequate strategies for overcoming the current "health care crisis". This volume is the result of an international and interdisciplinary cooperation between medicine and philosophy on the current debate on the concept of health.Besides offering a critical analysis of the WHO definition and a review of both ancient and contemporary conceptions of health, the cooperative (...) effort of physicians and philosophers presented in this book works through the challenges which any definition of health faces, if it is to be both truly personalist, and at the same time operational.The overall purpose of this book is to capture the essentials of human health and to propose the outlines for a personalist understanding of this concept, i.e., a conception that does justice to the personal nature of human beings by introducing dimensions that are essential to personal life and well-being, such as the realms of rationality, affectivity and freedom, the realms of meaning, values, morality, and spirituality, the realms of social and interpersonal relations. To grasp the uniqueness of the human person is not yet to grasp the specific nature of personal health. But it is certainly a first step, and it becomes evident that every theory of human health presupposes a theory of the person. Accordingly, the debate presented in this book is no less a debate about the nature of the human person than it is a debate about the nature of health.The investigations offered in this volume intend to provide an impetus for new conceptions of personhood and human health. The phenomenological approach has the advantage of advocating a systematic conception of the total person which combines surface experiences (subjective experiences of well-being) with deeper dimensions of the person (value and being). An adequate conception of the human person has enormous implications not only for our understanding of what constitutes the health and well-being of the person, but also for our conception of what health care should comprise. Hence, answering the philosophical questions, such as those raised in this volume about health, is crucial for the solution of political problems such as how to legislate health care policy. (shrink)

The American Society for Bioethics and Humanities poses a chal­lenge in Core Competencies for Healthcare Ethics Consultation: health care ethics consultation services “should be able to demonstrate their value to those who pay for the service, as well as to those whom the service is intended to serve.” To respond to this challenge, this article provides a brief review of the literature on evaluating ethics consultation in its traditional frameworks of quality outcomes. The author follows this discussion with (...) a new methodology to evaluate ethics consultation on the basis of the intrinsic good of the service. He ends with a novel risk-based assessment to complement the evaluation of clinical ethics services grounded in the Ethical and Religious Directives for Catholic Health Care Services. (shrink)

Risks, including health and technological, attract a lot of attention in modern societies, from individuals as well as policy-makers. Human beings have always had to deal with dangers, but contemporary societies conceptualise these dangers as risks, indicating that they are to some extent controllable and calculable. Conceiving of dangers in this way implies a need to analyse how we hold people responsible for risks and how we can and should take responsibility for risks. Moral Responsibility and Risk in (...) Societycombines philosophical discussion of different concepts and notions of responsibility with context-specific applications in the areas of health, technology and environment. The book consists of two parts addressing two crucial aspects of risks and responsibility: holding agents responsible, i.e. ascribing and distributing responsibility for risks and taking responsibility for risk. More specifically, the book discusses the values of fairness and efficacy in responsibility distributions and makes distinctions between backward-looking and forward-looking responsibility as well as individual and collective responsibility. Additionally, it analyses what it means to take responsibility for technological risks, conceptualizing this kind of responsibility as a virtue, and furthermore, explores the notion of responsible risk communication and the implications for adult-child relationships. This book will be of great interest to students and scholars of environmental ethics, bioethics, public health ethics, engineering ethics, philosophy of risk and moral philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Origins and Evolution of Bioethics: Some Personal ReflectionsEdmund D. Pellegrino (bio)AbstractBioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a (...) perceived “dehumanization” of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human “values” into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third—and present—period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise—e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.I have been invited to give a “personal recollection” of the early development of bioethics. Such invitations are notoriously hard to resist, but also problematic when they are the recollections of a participant [End Page 73] in the events to be described. We need only be reminded of the vagaries common to the plethora of memoirs on the book stands today. Few have escaped the perils of selective memory, self-promotion, or the settling of old scores. Yet their perils notwithstanding, memoirs may serve some useful purpose. They are the raw material—verbal kitchen middens so to speak—out of which historians can later sift fact from fancy. They enable “tribal elders” to give witness to the past from which the present can fashion some sense of continuity.I will organize my reflections around three very arbitrary time periods that represent my own way of thinking about the evolution of bioethics: (1) an era of “proto-bioethics” (1960–1972), (2) an era of philosophical bioethics (1972–1985), and (3) an era of global bioethics (1985-present). Each era, of course, overlaps with the others, and the dominant strand of each runs through the others as well.In the proto-bioethics period, the language of human values predominated; in the era of bioethics philosophically construed, it was the language of philosophical ethics; and in the era of bioethics globally construed, the social and behavioral sciences have gained greater prominence. In each period, interest in the traditional humanities other than philosophy waxed and waned. In the earlier years, religion and theology predominated. Beginning in the 1970s, philosophy took a dominant role. In the last two decades, other disciplines, like law, literature, and the social sciences, have exerted more and more influence (McNeur 1963; Pellegrino 1997; Barker 1987).I make no pretense here of writing any part of the formal “history” of bioethics. Works of this nature are beginning to appear (Rothman 1991; Jonsen 1998 ; Dell’Oro and Viafora 1996). Thomas McElhinney and I are preparing our own account of the work and influence of the Institute on Human Values in Medicine, one of the influential programs of the Society for Health and Human Values (Pellegrino and McElhinney, n.d.). Space limitations as well as prudence preclude any attempt to do justice to all the events, institutions, and people who have made the field of bioethics what it is today. I apologize for these omissions, for any unintentional lapses of... (shrink)

Introduction The paradigm shift to a knowledge‐based economy has incremented the use of personal information applied to health‐related activities, such as biomedical research, innovation, and commercial initiatives. The convergence of science, technology, communication and data technologies has given rise to the application of big data to health; for example through eHealth, human databases and biobanks. Methods In light of these changes, we enquire about the value of personal data and its appropriate use. In order to illustrate the (...) complex ground on which big data applied to health develops, we analyse the current situation of the European Union and two cases: the Catalan VISC+/PADRIS and the UK Biobank, as perspectives. Discussion and conclusions Personal health‐related data in the context of the European Union is being increasingly used for big data projects under diverse schemes. There, public and private sectors participate distinctively or jointly, pursuing very different goals which may conflict with individual rights, notably privacy. Given that, this paper advocates for stopping the unjustified accumulation and commercialisation of personal data, protecting the interests of citizens and building appropriate frameworks to govern big data projects for health. A core tool for achieving such goals is to develop consent mechanisms which allow truly informed but adaptable consent, conjugated with the engagement of donors, participants and society. (shrink)

The successes of the human genome project and genomics research programs portend great potential to improve upon health and enhance life. As scientific advancements continue, bioethicists and policy makers deliberate over the social and ethical implications of genetic and genomic technologies and information (ggT/I). The application of ggT/I to human reproduction raises conceptual and moral questions about being human and the links between offspring, parents, and society. Given ggT/I’s ability to significantly affect the biological constitution (...) of humans and future human generations thinking through such issues is fundamental to ethical and policy analysis. By means of a systematic literature review and accompanying content analysis, this paper highlights the dominant ethical concerns raised within recent bioethics discourse over the use of ggT/I for human reproduction. Based on these findings it aso offers a framework through which, and demarcates where, religious perspectives can add value to genethics debates and policy deliberation. (shrink)

This volume addresses whether, how, and where laws (variously defined) teach values and shape moral character in late modern liberal societies. Each author recognizes the essential value of state law in fostering peace, security, health, education, charity, trade, democracy, constitutionalism, justice, and human rights, among many other moral goods. Each author also recognizes, however, the grave betrayals of law in supporting fascism, slavery, apartheid, genocide, persecution, violence, racism, and other forms of immorality and injustice. They thus call (...) for state laws that set a basic civil morality of duty for society and for robust freedoms that protect private individuals and private groups to cultivate a higher morality of aspiration"--Back cover. (shrink)

Pellegrino was there at the beginning of the field. In the 1950s and 60s, before there was a Kennedy Institute of Ethics or a Hastings Center; before the word ‘bioethics’ itself was coined, Pellegrino was writing articles such as "Ethical Considerations in the Practice of Medicine and Nursing," published in 1964. He was among those who started the Society for Health and Human Values—a precursor organization to the American Society for Bioethics and Humanities. He was (...) the founding editor of the Journal of Medicine and Philosophy at a time when the notion that there was a relationship between philosophy and medicine was foreign to both physicians and philosophers. The authors of the articles published in the very .. (shrink)

The Ageing of societies is a unique historical development of mankind. Today, such ageing is recognized as a threat for developed societies. There is fear of increasing inequality in health and in access to health care. Apart from the costs of ageing and care, such fear creates intergenerational conflicts. This paper explores what values are at stake when a society ages. At issue here is the social position of the old citizens and the way in which (...) they are regarded by their fellow citizens. Findings indicate the need to contemplate the consequences of ageing for societies and to discuss the impact these have for the values dominating contemporary post-welfare states. European welfare states were based on a balanced combination of three values: freedom, equality, and solidarity. Because these values are misbalanced now, equal accessibility of care and conditions for social participation are disappearing. Therefore, we shall have to think about new ways in which our societies can reaffirm basic human values. (shrink)

Current patterns of global economic activity are not only unsustainable, but unethical - this claim is central to Materialist Ethics and Life-Value. Grounding the definition of ethical value in the natural and social requirements of life-support and life-development shared by all human beings, Jeff Noonan provides a new way of understanding the universal conception of "the good life." Noonan argues that the true crisis affecting the world today is not sluggish rates of economic growth but the model of measuring (...) economic and social health in terms of money-value. In response, he develops an alternative understanding of good societies where the breadth and depth of life-activity and enjoyment are dependent on dominant institutions. The more social institutions satisfy the necessary requirements of human life, the more they empower each person to develop and enjoy the capacities that make human life valuable and meaningful. A well-reasoned synthesis of traditional philosophical concerns and contemporary critiques of global capitalism, this book is a forward-looking treatise that defends political struggle and reconsiders what is most important for a happy life. (shrink)

We surveyed selected physician members of the Society for Health and Human Values (SHHV) to study the benefits and problems of combining a medical career with a strong scholarly interest in the humanities. The 19 usable narrative responses characterized major benefits as experiential base and teaching opportunities. Barriers were numerous and fell under the general headings of: lack of time; lack of institutional rewards; lack of money for research and scholarship; lack of support from humanities peers; (...) lack of suport from medical colleagues; personal financial sacrifice; and lack of training. Some respondents offered creative solutions to these problems, including assertive negotiation of a job description, identification of helpful mentors, and various networking and administrative strategies. The survey results, while preliminary, suggest ways in which SHHV can assist clinicians who wish to develop a serious commitment to humanities study and teaching. (shrink)

Several influential ethical guidelines and frameworks endorse the view that research with human participants is ethically acceptable only when it has “social value,” meaning that it generates knowledge which can be used to benefit society. For example, the Nuremberg Code requires that medical experiments on human beings “yield fruitful results for the good of society, unprocurable by other methods or means of study”. The Council for International Organizations of Medical Sciences guidelines hold that “health-related research (...) with humans... must have social value” or the “prospect of generating the knowledge and the means necessary to protect and promote people’s health” (CIOMS... (shrink)

Reason and Rationality in Health and Human Services Delivery is the first book to discuss the topic of decisionmaking and services from a multidisciplinary approach. It uses theory and social considerations, not just technology, as a basis for improved services. Health and human service students and professionals will learn how to form rational and reasonable decisions that take their clients'cultural backgrounds into consideration when identifying an illness or appropriating any kind of intervention. With a particular emphasis (...) on theories, models, organizational settings, technologies, and practitioner training methods that lead to culturally sensitive decisions, Reason and Rationality will help you deliver efficient and improved medical and social services to clients from all ethnic backgrounds. Recognizing reason as the centerpiece of most of Western philosophy, this text reveals how our idea of truth, fact, and order are wrongly thought to be universal; yet, Western principles are continually used in the decision-making process for health and social services. Focusing on the policy implications of decisionmaking in medical and social service settings, this text works to incorporate a broad range of factors into the reasoning process, such as cultural traditions and beliefs, that will result in better treatment for patients. Giving you suggestions and strategies for upgrading reasoning and decision-making processes and applying them to every area of service, Reason and Rationality discusses different themes that will help you improve services to patients, such as: the rationale currently used to justify decision-making strategies concerning medical and human services using computer technology to make clinical assessments revising administrative structure, management theories, and organizational strategies so that decision-making processes enhance the overall quality of service delivery how the practitioner/patient relationship is important in choosing the proper treatment soliciting community-based input to assess the public's health and human service needs in order to lessen political involvement in decision-making stages In addition, Reason and Rationality provides information and examples that show why you should consider the "life-world"--the values, beliefs, and commitments of a culture's history-- as the key to understanding the powers of reasoning that specify parameters of health and illness. (shrink)

Capitalism is not enough. It has brought us prosperity and no other economic system can match its energy and innovation, but it has a dark side of exploitation and instability. Capitalism needs to be bounded by values. But which values? What indeed are values anyway and how do we locate and share values strong enough to balance the power of capitalism in society? Relativism has swept away old certainties and we struggle to agree what should (...) lie at the centre of our lives. In this book we construct a foundation for values based on our common humanity and explore personal, social and political values from a fresh perspective. We show how with values placed on a strong foundation individual lives can reacquire meaning and purpose. Politics can be transformed from the half-corrupted subject of popular indifference it has become. Above all, capitalism can be a tool for good, a servant rather than a master. (shrink)

This article presents the framework Capability Sensitive Design (CSD), which consists of merging the design methodology Value Sensitive Design (VSD) with Martha Nussbaum's capability theory. CSD aims to normatively assess technology design in general, and technology design for health and wellbeing in particular. Unique to CSD is its ability to account for human diversity and to counter (structural) injustices that manifest in technology design. The basic framework of CSD is demonstrated by applying it to the hypothetical design case (...) of a therapy chatbot for mental health. By applying CSD to a design case, the merits of this new framework over the standard VSD approach become apparent. Also, the application demonstrates what a technology design would look like when attention is paid to capabilities right from the start of the design process. (shrink)

Do doctors fix patients? Or do they heal them? For all of modern medicine’s many successes, discontent with the quality of patient care has combined with a host of new developments, from aging populations to the resurgence of infectious diseases, which challenge medicine’s overreliance on narrowly mechanistic and technical methods of explanation and intervention, or “fixing’ patients. The need for a better balance, for more humane “healing” rationales and practices that attend to the social and environmental aspects of health (...) and illness and the experiencing person, is more urgent than ever. Yet, in public health and bioethics, the fields best positioned to offer countervailing values and orientations, the dominant approaches largely extend and reinforce the reductionism and individualism of biomedicine. The collected essays in To Fix or To Heal do more than document the persistence of reductionist approaches and the attendant extension of medicalization to more and more aspects of our lives. The contributors also shed valuable light on why reductionism has persisted and why more holistic models, incorporating social and environmental factors, have gained so little traction. The contributors examine the moral appeal of reductionism, the larger rationalist dream of technological mastery, the growing valuation of health, and the enshrining of individual responsibility as the seemingly non-coercive means of intervention and control. This paradigm-challenging volume advances new lines of criticism of our dominant medical regime, even while proposing ways of bringing medical practice, bioethics, and public health more closely into line with their original goals. Precisely because of the centrality of the biomedical approach to our society, the contributors argue, challenging the reductionist model and its ever-widening effects is perhaps the best way to press for a much-needed renewal of our ethical and political discourse. (shrink)

Artificial intelligence (AI) is increasingly relied upon by clinicians for making diagnostic and treatment decisions, playing an important role in imaging, diagnosis, risk analysis, lifestyle monitoring, and health information management. While research has identified biases in healthcare AI systems and proposed technical solutions to address these, we argue that effective solutions require human engagement. Furthermore, there is a lack of research on how to motivate the adoption of these solutions and promote investment in designing AI systems that align (...) with values such as transparency and fairness from the outset. Drawing on insights from psychological theories, we assert the need to understand the values that underlie decisions made by individuals involved in creating and deploying AI systems. We describe how this understanding can be leveraged to increase engagement with de-biasing and fairness-enhancing practices within the AI healthcare industry, ultimately leading to sustained behavioral change via autonomy-supportive communication strategies rooted in motivational and social psychology theories. In developing these pathways to engagement, we consider the norms and needs that govern the AI healthcare domain, and we evaluate incentives for maintaining the status quo against economic, legal, and social incentives for behavior change in line with transparency and fairness values. (shrink)

Despite powerful strategic approaches in the health systems in many afTluent countries, the pandemic that has hit us has cascaded beyond the imagination of many civil societies around the world. There is a call for a higher understanding and practice as the contents in the social media reTlected an urgency to understand more on the healing effects of the body, mind and spirit. In fact, contents in social media highlighted many coping mechanisms which were related to religious, cultural and (...) spiritual values. The public expressed information that included remedies for the body, mind and the spiritual aspects of humanity and their interconnectedness with the environment. These narratives were equally as signiTicant as the logistic arrangements, professional and political decision making among the healthcare professions and members of other inter-related health networks. The results of the COVID-19 outbreak has crea ted a deeper unders tanding, o f a higher consciousness as populations around the world recognize that the world works as one large organism trying to balance the ethical and unethical practices rampant in our societies. This paper proposes the integration of “change theory” to explore the various existing elements in narratives of the public and research studies from healthcare practices. An exploratory analysis of contents in social media and the related literature in healthcare and nursing studies has revealed speciTic patterns which helped put the theory in perspective and to formulate a model for future understanding on what common universal values exist in the commonly existing patterns. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should be (...) developed, used and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

Quality of life is an important outcome measure in mental health care. Currently, QoL is mainly measured with paper and pencil questionnaires. To contribute to the evaluation of treatment, and to enhance substantiated policy decisions in the allocation of resources, a web-based, personalized, patient-friendly and easy to administer QoL instrument has been developed: the QoL-ME. While human values play a significant role in shaping future use practices of technologies, it is important to anticipate on them during the (...) design of the QoL-instrument. The value sensitive design approach offers a theory and method for addressing these values in a systematic and principled manner in the design of technologies. While the VSD approach has been applied in the field of somatic care, we extended the VSD approach to the field of mental healthcare with the aim to enable developers of the QoL-instrument to reflect on important human values and anticipate potential value conflicts in its design. We therefore explored how VSD can be used by investigating the human values that are relevant for the design of the QoL-ME. Our exploration reveals that the values autonomy, efficiency, empowerment, universal usability, privacy, redifinition of roles, of responsibilites, reliability, solidarity, surveillance and trust are at stake for the future users of the technology. However, we argue that theoretical reflections on the potential ethical impact of a technology in the design phase can only go so far. To be able to comprehensively evaluate the usability the VSD approach, a supplementary study of the use practices of the technology is needed. (shrink)

The paper concerns two familiar lines of inquiry. One, stemming from a neo-Aristotelian naturalism associated with Foot and others, asks whether we can derive human excellences from what humans need in order to be some way. The second asks whether virtue is a kind of health, and vice a kind of illness. The first is often seen as a failure to the extent that the list of characteristics derived by this approach does not include familiar moral virtues. However, (...) it is argued that the concept of human excellence is many-layered, so the fact that the approach may not succeed for moral virtues does not show that it is no good for anything. Moreover, the kinds of psychological characteristic derived by a liberalized version of Foot’s approach may also help to give non-trivial answers to the second, Platonic, line of inquiry. (shrink)

Do science and technology create value for society and the economy, and how might one go about measuring it? How do we evaluate its benefits? Can we even be certain that there are benefits? Geisler argues that there are benefits, and that they outweigh in value the negative impacts that inevitably accompany them. His revolutionary new book goes on to show that they can also be measured and evaluated, and in one volume all of the existing knowledge on how (...) to do it is complied--then Geisler's own methods are offered. The result is a compelling argument that the value of science and technology in our lives has indeed been positive, and that the economic well-being of all individuals, organizations, and nations rests upon them. Geisler starts off by describing his conceptual framework for the evaluation of science and technology and the impact and benefits that proceed from them. He discusses the nature of evaluation in general terms, and then in the specific context of science, technology, and innovation together. He reviews the state of our present knowledge and assesses the nature of value creation itself. Throughout, Geisler remains fixed on his driving thesis: Although there are certainly some negative impacts from science and technology, on the whole the results of its outputs are positive. He shows how they have contributed to a range of activities and institutions, particularly to the improvement of health and human welfare worldwide. Finally, after discussing the theories of evaluation, he gets down to the practice, providing readers with a way to assess science and technological innovations for themselves. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 387-394 [Access article in PDF] Psychosis Good and Bad:Values-Based Practice and the Distinction Between Pathological and Nonpathological Forms of Psychotic Experience Mike C. Jackson and K. W. M. Fulford IN TWO PAPERS in this issue of Philosophy, Psychiatry, and Psychology, Marek Marzanski and Mark Bratton (2002) and Caroline Brett (2002) develop important critiques, from the perspectives respectively of Christian theology and Eastern (...) philosophy, of our 1997 analysis of the distinction between pathological and nonpathological forms of psychotic experience (Jackson and Fulford 1997).In this response, we briefly summarize the main points from our 1997 analysis; we consider, separately, the important although very different challenges to that analysis from the perspectives of our two critics; and we briefly indicate the main lines of recent developments in policy, practice, and research in mental health as they relate to this important area of human experience. The Jackson and Fulford (1997) Analysis In our 1997 paper, we presented three case studies from a larger series (Jackson 1991, 1997, 2001) selected with the express aim of bringing into focus the conceptual difficulties that arise at the borderline between psychotic illness and what we called benign spiritual experience. On the basis of these case studies we argued thatspiritual experiences, which are essentially benign, can involve explicitly psychotic phenomenology; traditional psychiatric diagnostic methods, which focus on the form and content of beliefs and experiences, are not capable of distinguishing between pathological and nonpathological forms of such psychotic experiences; [End Page 387]evaluation of such experiences (and claims about "illness" and health more generally) necessarily involves value judgments as well as judgments about matters of fact (specifically, the "facts" of traditional descriptive psychopathology); and more specifically, the distinction between pathological and nonpathological phenomena concerns the way in which they are embedded in the structure of the values and beliefs by which the actions of the subjects concerned are defined: "In the case of pathological psychotic phenomena," we argued, "there is a radical failure of action.... In the case of spiritual psychotic phenomena, action is radically enhanced" (Jackson and Fulford 1997, 55).We then proposed a cognitive problem-solving model of psychotic experiences. This model suggests that such experiences can be a normal and adaptive psychological response to existential crises, such as loss of meaning or purpose in life, coming to terms with death or bereavement, and so on (Batson and Ventis 1982; Jackson, 1991, 1997, 2001). The model is consistent with a subsequent position paper published by the British Psychological Society arguing the case for a psychological formulation of psychotic experiences and cognitive-behavioural methods in their management (2000).In the case of nonpathological psychotic experience, the psychotic elements of the experience promote a paradigm shift in the individual's underlying assumptions, which effectively resolves their impasse and allows them to move forward. This is normally a self-limiting process, in that when the individual is able to utilize their insight, it acts to resolve the stress which triggered it. In pathological psychosis, this process fails for various possible reasons, which were not explored in any depth in that paper (but see Jackson 2001 for a more detailed discussion). The Challenge From Marzanski and Bratton Marek Marzanski and Mark Bratton reexamine the questions raised by our cases from a Christian theological perspective (Marzanski and Bratton 2002). They suggest a theologically based definition of spiritual experience according to which the criteria for "genuine" experience concerns its context within the development of the individual's religious faith. In Bratton and Marzanski's account, these criteria are based on a Christian value system.They present three cases of their own, which, in contrast to the three cases in our 1997 paper, vividly illustrate how phenomena that may be valued negatively from a medical perspective (i.e., as defined by us in terms of their consequences for action), may, at one and the same time, be valued positively from a religious perspective (i.e., in terms of their consequences for the... (shrink)

One intricate and perhaps, divisive task in philosophy is that of gauging growth in societies. The complexity stems from the reality that everyone seems to possess a template for growth, and so people are wont to use different yardsticks for its measurement. For the technically inclined, the index is science; in civil circles, the measure is perhaps, that of political evolution; and in religious spheres, it is increase in membership/physical structures. Ironically, all the advances arising thereof have been marred and (...) sometimes eclipsed by torrid upheavals: violent overthrow of governments and wars; financial meltdowns; scourge of pandemics; prospects of nuclear combat; religious bigotry; chaotic climate, etc., that make life precarious. Human civilization is on the brink of self-destruct. “Ethics in Business” reimagines the interconnectivity of all spheres of human life, and proposes that the opportunity to redeem our broken world is tied to reengineering the values of trust and loyalty. (shrink)

The Office of Inspector General, Department of Health and Human Services, has issued a proposed rule under section 5201 of the Omnibus Consolidated and Emergency Supplemental Appropriations Act for Fiscal Year 1999 that would provide a safe harbor from civil sanctions under section 1128A of the Social Security Act for independent dialysis facilities that pay premiums for Supplementary Medical Insurance or Medicare Supplemental Health Insurance Policies for financially needy Medicare beneficiaries with end-stage renal disease.End-stage renal disease is (...) a chronic disease that requires regular dialysis treatments and monitoring of laboratory values, diet and medication. ESRD patients suffer from irreversible renal failure, often accompanied by diabetes, anemia, hypertension and congestive heart failure. (shrink)

This essay suggests some links between concern about the decline of ‘the family’, or of ‘family values’, the use of reproductive technology, and the claim that some people have children for the ‘wrong reasons’. It is argued that where conceiving and bringing a child to term is a matter of choice, a person must have a reason or reasons for doing so and further, that those reasons are of moral significance. By appealing to Kant's Categorical Imperative: ‘Act in such (...) a way that you always treat humanity … never simply as a means, but always at the same time as an end’, a distinction is made between morally desirable and morally undesirable reasons, on the grounds of the extent to which the parent or parents will be able or likely to treat the child as an end in herself. In conclusion it is argued that whilst ‘the family’is vital to the health of children, and to the health of society, it is not so much the form that the family takes that is significant, but the extent to which it allows for the development and maintainance of a certain sort of relationship. (shrink)

Food security policy, programs, and infrastructure have been incorporated into Public Health and other areas of the Provincial Government in British Columbia, including the adoption of food security as a Public Health Core Program. A policy analysis of the integration into Public Health is completed by merging findings from 48 key informant interviews conducted with government, civil society, and food supply chain representatives involved in the initiatives along with relevant documents and participant/direct observations. The paper then (...) examines the results within the context of historic and international trends and theoretical models of food policy, community food security, and applied policy research. Public Health re-emerged as a driver of food security in BC—both as a key player and in positing the public’s health as a driver in food security and food systems. While Public Health’s lead role supported an increase in legitimacy for food security in BC, interviewees described a clash of cultures between Public Health and civil society. The clash of cultures occurred partly as a result of Public Health’s limited food security mandate and top down approach. Consequently civil society voice at the provincial level was marginalized. A social policy movement toward a new political paradigm—regulatory pluralism—calls for greater engagement of civil society, and for all sectors to work together toward common goals. A new, emerging policy map is proposed for analyzing the dynamics of food security and health promotion initiatives in BC. (shrink)

The value of life can be viewed from moral, biologic, and economic perspectives. In connection with the development of genetics, each of these perspectives has gained importance throughout history. Whereas agricultural genetics has always been directed towards having an economic impact, from the beginning genetics research in humans has focused on all dimensions of the value of life. Today, health insurance, employers, politicians, and public health scientists view genetics research as one of the key disciplines to predict costs (...) and economic values of human beings. However, the reasoning cannot go without considering biologic health risks and moral values to the same extent. This paper examines the historical dimensions of current debates surrounding genetics and the value of life. Thus, the paper is conceptual and offers a heuristic model and analytical categories for answering the question, “what is so intriguing about genetics that it can be closely connected with different value concepts,” although the consideration of the moral, biologic, or economic value of life may lead to completely different ideas of man and society. A special emphasis will be placed on the use of genetics for the purposes of the eugenics movement. During the heyday of eugenics, the economic value of life changed the understanding of the moral value, as well as the biologic value of life by referring to genetic principles. It will be argued that an intended intertwinement of the different dimensions of the concept of “value” on the one hand increased the impact of genetics as a key discipline of the eugenics movement, and on the other hand had a lasting impact on debates about the economic usefulness of genetics as a predictive, prophylactic medical discipline. (shrink)

This paper offers the Eastern Mediterranean Region (EMR) viewpoint with Qatar as a case for lasting transformation of health systems. The Qatar case study illustrates the importance of research in the development of health policy. It provides description of a series of projects that have been undertaken in relevant national areas such as autism, dementia, genomics, palliative care and patient safety. The paper discourse draws attention to investment requirement in health research systems to respond to country national (...) health priorities and to strengthen public health policies for improving health and social outcomes by narrowing the gap between research and politics. In short, the discussion highlights the following: i) health is a human right marching towards universal health care, with research underpinning every advance in health care and quality medical services; ii) evidence-based research is emerging as a critical tool to aid policy- and decision-makers; iii) investment necessity in healthcare research/systems to enable responding to a country’s national health priorities and to strengthen public health policies; and iv) need for multi-sectoral involvement of stakeholders to bridge the gap between research and politics. Finally, atypical stakeholders’ engagement and bond to politics is a prerequisite to achieve healthcare objectives and policy success so as to reap the benefits of public health results. (shrink)

Discussions concerning whether there is a natural right to health care may occur in various forms, resulting in policy recommendations for how to implement any such right in a given society. But health care policies may be judged by international standards including the UN Universal Declaration of Human Rights. The rights enumerated in the UDHR are grounded in traditions of moral theory, a philosophical analysis of which is necessary in order to adjudicate the value of specific (...) policies designed to enshrine rights such as a right to health care. We begin with an overview of the drafting of the UDHR and highlight the primary influence of natural law theory in validating the rights contained therein. We then provide an explication of natural law theory by reference to the writings of Thomas Aquinas, as well as elucidate the complementary “capabilities approach” of Martha Nussbaum. We conclude that a right to health care ought to be guaranteed by the state. (shrink)

Public health ethics is a subfield of bioethics that focuses on population health. This study aims to conform the principles of biomedical ethics to Islamic values in the context of public health. It culturally helps to optimize health care delivery. The approach is based on the method of immanent critique. The principle of the common good in Islam has a rational justification to draw public interests and ward off harms. The rule of “no harm”, with (...) an emphasis on the preferability of preventing harm to increase benefits, is consistent with the principle of utility, intending to produce a maximum balance of benefit over harm in the context of public health. Thus, on the one hand, the government is obliged to prevent harm and improve public benefits and, on the other hand, as a steward of health and with reference to the article “limitation of the ownership dominance”, it has the right to protect public health with the least justifiable harm. Islam attention to human dignity, individual justice and good will in the rule of goodness implies that Islam, beyond distributive justice, knows that human flourishing and the cultivation of moral virtues are a requisite for the realization of social justice. The present study discusses about the adjustment of the principles of PHE to the principles of the Islamic jurisprudence and, at the same time, it explains why the optimal PH in Muslim societies requires research in order to define accurate indicators of benefit and harm based on the teachings of revelation and reason. (shrink)

COVID19 pandemic has clarified that public health policies are central for the future of human societies from several perspectives. As a matter of fact, they are based on certain premises that are practical-political (e.g., ensuring the health of citizens), moral (e.g., health is a value), or epistemological (e.g., certain ideas concerning expertise and shared knowledge). Indeed, effective policies require first and foremost not only to be based on reliable data and models (i.e., so-called evidence-based policy) but (...) also to ensure that these policies are democratically accepted, shared (e.g., considering both cognitive and social dimensions), and hopefully formed after a deliberative process involving experts from various fields alongside citizens. (shrink)