Giving permission to embodied knowing to inform nursing research methodology: die poetics of voice(s)This paper originated from my experience of trying to find an authentic way to research women's experience of the pre‐menstruum. I describe how personal change informed an evolving methodological approach. This change occurred when I felt tension between two strong voices. Conflict and insecurities originated from the pressure of my academic voice to conform to the dominant culture in what often seemed a disempowering way; a way (...) that denied my body voice by emphasizing theory over experience. The construction of a poetic of voice (s) to illustrate how I eventually found an embodied voice is used to provide space for the reader's own interpretive process. The evolving embodied voice integrates my experience as a woman/nurse/researcher, validating my knowing bodily, practically, experientially and academically that I was able to help the participants to disclose their embodied knowing. This approach has wider implications when considering the value nurse researchers and academics give to embodied wisdom. (shrink)

BackgroundThis paper considers ethical dilemmas arising where a patient asks their General Practitioner for advice and their personal opinion regarding whether or not to have an abortion. Patients often seek their General Practitioner’s advice regarding treatments and procedures, which may occasionally lead to the General Practitioner facing a difficult dilemma of whether to share their personal opinion with their patient. As General Practitioners are more accessible as the first point of contact for patients and often have a closer relationship with (...) them, they may be particularly exposed to such situations. Additionally, the significance of abortion as a sensitive topic and the fact the General Practitioner may have their own personal viewpoint on its morality may make it particularly difficult for them to know how to respond to such a request.Main textThis paper explores the difficulties arising in such a situation and considers whether it could ever be ethically justifiable for General Practitioners to express their opinions on such a matter. We consider the duties of a doctor, and highlight the need for clearer guidance for healthcare professionals on managing tensions in their professional boundaries between their personal moral views and their professional responsibilities. A range of ethical viewpoints are considered to explore how a doctor might ap, in particular the principle of autonomy, virtue ethics, and consequentialism.ConclusionsThis article recognises that a General Practitioner in a situation such as this faces many ethical challenges. We propose that offering their opinion to the patient where specifically requested may be morally justifiable. A virtue ethics approach in particular requires that the General Practitioner applies practical wisdom to make this decision, and where they do disclose their opinion ensure this is done so in such a manner that it does not harm the patient and promotes flourishing. We encourage GPs and other healthcare professionals to consider their own moral perspectives on sensitive issues such as abortion, and reflect on how their moral viewpoints have the potential to influence their practice. In doing so, we hope clinicians can be better should they be faced with a situation such as this. (shrink)

This paper aims to show that the ethical justifications and the processes for requiring consent for interventional research or treatment are different to requiring consent for the disclosure of patient or subject information. I will argue that these process and theoretical differences are sufficient to view “consent” in the two situations as different concepts and suggest that the phrase “permission to disclose” would be more appropriate in the information disclosure situations.

Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of consent because (...) valid consent requires that information to be understood. The contents of the understanding and disclosure requirements are therefore conceptually linked. In this paper, we argue that the standard view is mistaken. The disclosure and understanding requirements have distinct grounds tied to two different ways in which a token of consent can be rendered invalid. Analysis of these grounds allows us to derive the contents of the two requirements. It also implies that it is sometimes permissible to enroll willing participants who have not understood everything that they ought to be told about their clinical trials. (shrink)

In this paper, I examine the ethics of nonviolent protest when a violent response is either foreseen or intended. One central concern is whether protesters, who foresee a violent response but persist, are provoking the violence and whether they are culpable for any eventual harms. A second concern is whether it is permissible to publicize the violent response for political advantage. I begin by distinguishing between two senses of the term provoke: a normative sense where a provocateur knowingly imposes an (...) unjustified risk of a violent response, and a descriptive sense where the respondent feels provoked. I argue that, when the risk of a violent response is justified, the protesters are not provocateurs but akin to nonculpable, entrapping agents who create an opportunity for the regime to respond with disproportionate violence. The regime’s response can disclose its brutality or criminality and this can be fairly publicized for political advantage. When nonviolent protesters create an unjustified risk of violence either because the injustice they oppose is insufficient to justify the risk of a violent response or because the risked harms are disproportionate with the likely political advantages derived from the protest, they are partially culpable provocateurs. However, I argue these partially culpable provocateurs can still permissibly publicize the disproportionate violence of the regime so as to shape public opinion. (shrink)

The article analyses enforcement of freedom of assembly, draws attention to faults of legal regulation of dispute settlement, and revises a possibility of restriction of freedom of assembly. The authors provide evidence that restriction of freedom of assembly by refusing to grant permission to hold a peaceful assembly, is not an effective measure, therefore, it is suggested to educate the public on legal issues in order to enlighten the society about detrimental effect of publicly expressed ideas that provoke national (...) or racial discord, to disclose actual intentions of people who instigate aggression, force and violence so that they do not attract and rally a sufficiently large part of the public. People usually believe that the society enjoys freedom of knowledge and the right to obtain all information, as well as all news that originate and spread across the market, as it creates a pre-requisite for strengthening the best and most useful culture projects resulting in the development of culture and, alongside, the law. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Significant Interests and the Right to KnowReuven Brandt (bio)1. IntroductionDaniel Groll's book Conceiving People (2021) attempts a novel and insightful defence of why individuals ought to choose open over anonymous gamete donation, barring any special circumstances. In broad strokes, the overall argument proceeds by defending three main claims: (1) that failing to disclose to children that they are donor-conceived is morally problematic, (2) that children who are informed (...) that they are donor-conceived (either intentionally by their social parents or otherwise) are likely to have a worthwhile, significant, subjective interest1 in having knowledge about their gamete donor(s), and (3) that parents have a duty to advance their children's worthwhile subjective significant interests. Groll's account departs from other criticisms of anonymous gamete donation in that it does not rest on the view that knowledge about one's genetic progenitors is essential to self-knowledge, identity formation, or other elements of wellbeing for creatures like us. The view thus attempts to avoid the pitfalls plaguing other criticisms of anonymous gamete donation, which tend to rely on controversial (and likely false) claims of genetic essentialism and/or genetic exceptionalism.Groll's thesis rests on the much more modest (and likely correct) claim that seeking information about one's genetic progenitors is one of many permissible, fruitful, and valuable routes to identity formation. According to Groll, it just so happens that a large portion of donor-conceived individuals aware of the absence of biological ties to one or more social parents choose this route to identity formation. And this empirical fact combined with plausible views about parents' obligations to promote their offspring's wellbeing gives prospective pro-creators strong reason to choose open donors over anonymous donors.Although many aspects of the picture Groll paints are attractive, I remain unconvinced that the overall argument succeeds. My criticism of the argument is multipronged. I am skeptical that failing to disclose to a child that they were donor-conceived and/or failing to disclose information to a child that they are [End Page 201] likely to find important violates the parental duty to build intimate relationships with one's offspring. This shifts the force of Groll's argument to the empirical claim that donor-conceived children are likely to have a significant subjective interest in knowing information about their biological relations. As I will show, the empirical evidence for this claim is not as strong as Groll presumes. In the absence of a deontic argument for disclosure, Groll must provide more robust empirical evidence that anonymous gamete donation is likely to result in off-spring with their weighty interests frustrated, or else argue that the risk is not worth taking. These are not fatal flaws but show that more empirical and normative work needs to be done to defend this line of argument.A more serious set of worries arise in response to Groll's claim that the interest that donor-conceived individuals have in genetic information is likely to be significant. Little is said about what constitutes a significant interest, except that interests fall along a linear spectrum and that the significance of an interest is a factor of "the space, so to speak, it takes up in a person's mental economy (do they think about it a lot?) and the extent to which they organize their lives around it" (2021, 63). My worries here are three-fold. First, it is unclear whether the empirical data support the claim that donor-conceived individuals are likely to have an interest in genetic knowledge that is significant in the sense that it occupies a large portion of their mental energy and is a locus around which they organize their lives. Second, there is scant discussion about whether an interest can become morally problematic (and so no longer worthwhile on Groll's account) if it is given too much weight. I will argue that a plausible reading of Groll's account requires that we treat overvalued interests as no longer worthwhile. Consequently, Groll's argument risks presuming the kind of genetic chauvinism—the view that genetic knowledge is essential to wellbeing—that he seeks to reject. Third, if... (shrink)

A sustained analysis of the moral permissibility of withholding or of the obligation to disclose information to an adopted child is lacking in the literature on parental duties, disclosures, and adoption. These two sets of questions raise issues that appear to fall within the parameters of the concepts of stewardship and gratitude. I propose that adoptive parents are the stewards of the information they receive concerning their child and I show how stewardship and gratitude can aid adoptive parents as (...) they negotiate the terrain of disclosure. (shrink)

If I decide to disclose information about myself, this act may undermine other people’s ability to conceal information about them. Such dependencies are called privacy dependencies in the literature. Some say that privacy dependencies generate moral duties to avoid sharing information about oneself. If true, we argue, then it is sometimes justified for others to impose harm on the person sharing information to prevent them from doing so. In this paper, we first show how such conclusions arise. Next, we (...) show that the existence of such a dependency between the moral significance you are inclined to attribute to privacy dependencies and judgments about permissible self-defense puts pressure on at least some ways of spelling out the idea that privacy dependencies ought to constrain our data-sharing conduct. (shrink)

Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used (...) for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

As costs decline and technology inevitably improves, current trends suggest that artificial intelligence (AI) and a variety of "carebots" will increasingly be adopted in medical care. Medical ethicists have long expressed concerns that such technologies remove the human element from medicine, resulting in dehumanization and depersonalized care. However, we argue that where shame presents a barrier to medical care, it is sometimes ethically permissible and even desirable to deploy AI/carebots because (i) dehumanization in medicine is not always morally wrong, and (...) (ii) dehumanization can sometimes better promote and protect important medical values. Shame is often a consequence of the human-to-human element of medical care and can prevent patients from seeking treatment and from disclosing important information to their healthcare provider. Conditions and treatments that are shame-inducing offer opportunities for introducing AI/carebots in a manner that removes the human element of medicine but does so ethically. We outline numerous examples of shame-inducing interactions and how they are overcome by implementing existing and expected developments of AI/carebot technology that remove the human element from care. (shrink)

The adversary professions--law, business, and government, among others--typically claim a moral permission to violate persons in ways that, if not for the professional role, would be morally wrong. Lawyers advance bad ends and deceive, business managers exploit and despoil, public officials enforce unjust laws, and doctors keep confidences that, if disclosed, would prevent harm. Ethics for Adversaries is a philosophical inquiry into arguments that are offered to defend seemingly wrongful actions performed by those who occupy what Montaigne called "necessary (...) offices."Applbaum begins by examining the career of Charles-Henri Sanson, who is appointed executioner of Paris by Louis XVI and serves the punitive needs of the ancien régime for decades. Come the French Revolution, the King's Executioner becomes the king's executioner, and he ministers with professional detachment to each defeated political faction throughout the Terror and its aftermath. By exploring one extraordinary role and the arguments that can be offered in its defense, Applbaum raises unsettling doubts about arguments in defense of less sanguinary professions and their practices.To justify harmful acts, adversaries appeal to arguments about the rules of the game, fair play, consent, the social construction of actions and actors, good outcomes in equilibrium, and the legitimate authority of institutions. Applbaum concludes that these arguments are weaker than supposed and do not morally justify much of the violation that professionals and public officials inflict. Institutions and the roles they create ordinarily cannot mint moral permissions to do what otherwise would be morally prohibited. (shrink)

This paper examines the ethical and legal duties of confidentiality owed by the nurse, with special reference to obligation to the employer. The main focus is on exploring the parameters of that duty and determining circumstances in which it might be ethically and legally justifiable to disclose confidential information. It is submitted that the obli gation to preserve the confidence of the patient or employer is relative rather than abso lute. In exceptional cases, disclosure is permissible in order to (...) prevent harm to others or to promote a greater public good. A number of suggestions for reform are also made, with a view to reinforcing nurses' ethical and legal rights to exercise discretion to dis close confidential information in appropriate cases in order to protect themselves from victimization by employers. Cet article passe à l'examen les devoirs éthiques et légales de la confidence que les infirmiers/ères doivent obligatoirement à leur employeur. Le point de mire est l'exploration des donnés de cette obligation, et la détermination des circonstances dans lesquelles il est légitime, éthiquement et légalement, d'exposer de l'information confidentielle. Il est suggéré que l'obligation de préserver la confiance du malade ou de l'employeur est relative plutôt qu'absolu. Dans des cas exceptionels pourtant, la révélation d'information est permisible pour prévenir le mal des autres ou pour promouvoir un plus grand bien public. Quelques suggestions pour réformes sont proposées en vue du renforcement des droits éthiques et légales des infirmiers/ères d'exercer la discretion en ce qui concerne la révélation d'information dans des cas bien choisis, et de les protéger des représailles de l'employeur. Dieser Artikel prüft die ethischen und legalen Pflichten des Vertrauens, die das Pflegepersonal dem Arbeitsgeber schuldet. Das Zentrum des Arguments ist eine Untersuchung dieser Pflichten, und eine Festsetzung der Umstände, in welchen es ethisch und rechtlich möglich ist, Information bekannt zu machen. Es ist anerkennt, dass die Pflicht des Vertrauens des Patienten oder des Arbeitsgebers zu behalten, eher relativ als absolut ist. In aussergewöhnlichen Fällen jedoch ist die Bekanntgabe von Information erlaubt, um das Böse zu verhindern und das Gute aller zu fördern. Eine Anzahl von Vorschlägen für Reformen sind gemacht, mit der Absicht, die ethischen und legalen Rechte des Pflegepersonals, in gegebenen Fällen Information bekannt zu machen, zu verstärken, und es von ungerechter Behandlung eines Arbeitsgebers zu schützen. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. The (...) following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

Conversation analysis (CA) of children-adult—interaction in various contexts has become an established field of research. However,child therapyhas received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley,2006). Psychotherapy process researchers in adult (...) therapy (Stiles et al.,2015) have found that therapists “invent” a new therapy for each patient (Norcross and Wampold,2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of “unexplainable rage.” The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe “doing contrariness,” as a conversational practice producing epistemic and affiliative disruptions, while “avoiding doing contrariness” and “remedying contrariness” are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding. (shrink)

Through expanded access protocols, the Food and Drug Administration (FDA) allows patients with serious or immediately life-threatening diseases access to experimental drugs outside the clinical trial setting when no satisfactory alternative treatment is available. While the FDA has established a mechanism for providing patients with unapproved drug access, the regulations do not require the pharmaceutical company to provide the drug. The drug company’s permission to use its experimental drug is a necessary prerequisite to using the FDA’s expanded access mechanism. (...) Increasingly, drug companies are coming under scrutiny regarding the programs governing that decision-making power. Historically, disclosing whether a company has an expanded access program, and whether or how it would respond to an expanded access request, has been left to discretion of the drug companies themselves. Few manufacturers publish adequate expanded access protocols. As a result, patients were provided with little insight into how companies evaluate expanded access requests and are naturally skeptical as to the ethical integrity of the process. The recently passed 21st Century Cures Act changes that practice by requiring drug companies to have, and make publically available, their expanded access procedures including criteria for evaluating and responding to patient requests. In this article, we contend that complying with the new transparency provisions will require drug companies to respond to several unresolved expanded access issues. Namely, how to reconcile a patient’s desire to access lifesaving experimental therapies alongside the company and society’s interest in the efficient development of new drugs. Even more challenging, how can companies devise practices for evaluating and processing expanded access requests that also fairly and equitably acknowledge those concerns? In addressing these questions, this article explores the legal, regulatory, business, and societal influences that have shaped expanded access policies and practices. From there, we provide companies a framework that balances appropriately the desires of individuals and gaining the requisite approvals ensure access not just for one person but for society. (shrink)

Bioethics traditionally focuses on establishing moral limits between different types of acts. However, boundaries are established by communities and individuals who differ in the constraints shaping their moral world. Phase boundaries, the sites of transition between two physical phases such as a liquid and a gas, provide a metaphor for ‘drawing a line’ in bioethics discourse. Phase boundaries occur where the physical constraints allow both phases to coexist in stable equilibrium. This relationship can also be considered in reverse, using the (...) known position of the phase boundary to disclose the physical constraints. By analogy, instead of trying to locate the ‘correct’ moral boundary, the alternative perspective of ‘reverse ethics’ works from a commonly accepted boundary to examine the constraints of the moral world that are being used to establish it. Genetic interventions into the human body provide interesting examples of boundary establishment. In gene therapy, focusing on boundaries has resulted in a model of moral permissibility that ignores some alternative standpoints and increases the potential for conflict between them. Reverse ethics examines such conflicts in terms of the nature of the moral worlds that have come into contact with each other, taking seriously the diversity of factors governing the location of a boundary, in ways that might help shift some entrenched lines of conflict. (shrink)

BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support (...) of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Respect for confidentiality is firmly established in codes of ethics and law. Medical care and the patients' trust depend on the ability of the doctors to maintain confidentiality. Without a guarantee of confidentiality, many patients would want to avoid seeking medical assistance The principle of confidentiality, however, is not absolute and may be overridden by public interests. On some occasions (birth, death, infectious disease) there is a legal obligation on the part of the doctor to disclose but only to (...) the appropriate authorities. Permissible disclosure can be granted by the patients' consent, for example, for the purpose of insurance they may wish to take out. Moreover, there are some ambivalent situations (such as criminal acts, or notification of sexual partner in case of a patient with AIDS) for which Greek law does not include relevant provisions, and the Codes of Medical Ethics do not offer clear guidelines. Therefore, the Greek doctor is called to estimate the situation and assume full responsibility for his decision. Finally, new considerations have arisen in the context of the recent advances in the field of telemedicine and electronic archiving. The paper discusses the current situation and legislation in Greece. (shrink)

State statutes, case law, and professional codes of ethics in the mental health professions typically stress either a duty or the permissibility of disclosing confidential information in order to prevent clients from seriously harming themselves. These sources are intended to address cases where clients are deemed to be suffering from cognitive dysfunction for which paternalistic intervention, including involuntary hospitalization, is considered necessary to prevent self-destructive behavior.The counselor’s moral and legal responsibility is less apparent when mentally competent clients desire suicide as (...) release from irremediable suffering due to severe physical illness, and this desire is defensible within these clients’ value systems. This paper will explore moral and legal dimensions of a counselor’s decision not to intervene in such cases. The concept of permitted suicide will be introduced and defined, and guidelines for its application developed. (shrink)

Citing recent examples including Enron, Arthur Andersen, and WorldCom, _Permission to Steal_ explores what went wrong and advocates a universal reassessment of what is considered “good” in corporate America. A fascinating exploration of the recent corporate scandals which have rocked the global business community. Written with sharp and compelling style, suitable for students, professionals, and general readers. Companion website offers discussion points for the book as well as an up-to-date chronology of ongoing corporate scandals.

Many research ethics guidelines now oblige researchers to offer research participants the results of research in which they participated. This practice is intended to uphold respect for persons and ensure that participants are not treated as mere means to an end. Yet some scholars have begun to question a generalised duty to disclose research results, highlighting the potential harms arising from disclosure and questioning the ethical justification for a duty to disclose, especially with respect to individual results. In (...) support of this view, we argue that current rationales for a duty of disclosure do not form an adequate basis for an ethical imperative. We review policy guidance and scholarly commentary regarding the duty to communicate the results of biomedical, epidemiological and genetic research to research participants and show that there is wide variation in opinion regarding what should be disclosed and under what circumstance. Moreover, we argue that there is fundamental confusion about the notion of “research results,” specifically regarding three core concepts: the distinction between aggregate and individual results, amongst different types of research, and across different degrees of result veracity. Even where policy guidance and scholarly commentary have been most forceful in support of an ethical imperative to disclose research results, ambiguity regarding what is to be disclosed confounds ethical action. (shrink)

According to doxastic involuntarism, we cannot believe at will. In this paper, I argue that permissivism, the view that, at times, there is more than one way to respond rationally to a given body of evidence, is consistent with doxastic involuntarism. Rober :837–859, 2019a, Philos Phenom Res 1–17, 2019b) argues that, since permissive situations are possible, cognitively healthy agents can believe at will. However, Roeber fails to distinguish between two different arguments for voluntarism, both of which can be shown to (...) fail by proper attention to different accounts of permissivism. Roeber considers a generic treatment of permissivism, but key premises in both arguments depend on different, more particular notions of permissivism. Attending to the distinction between single-agent and inter-subjective versions of permissivism reveals that the inference from permissivism to voluntarism is unwarranted. (shrink)

Recently, scholars have argued that disclosure of personal information is an effective mechanism for building high-quality relationships. However, personal information can focus attention on differences in demographically diverse teams. In an experiment using 37 undergraduate teams, we examine how sharing personal information by ethnically similar and ethnically distinct newcomers to a team affects team perceptions, performance, and behavior. Our findings indicate that the disclosure of personal information by ethnically distinct newcomers improves team performance. However, the positive impact on team performance (...) comes at a cost to the newcomers, who are perceived as less competent by others and experience heightened social discomfort in team interactions. Ironically, what benefits the ethnically diverse team may undermine its ethnically distinct members. This study highlights how the management of diversity may sometimes require making trade-offs between individual interests and those of the team. (shrink)

There is an interesting contrast between permissions to act and permissions to believe. Plausibly, if it is permissible to believe something from a perspective with incomplete evidence, it cannot become impermissible to believe it from a second perspective with complete evidence. In contrast, it seems that something permissible to do for an agent in a perspective with limited evidence can become impermissible in a second perspective in which all the relevant evidence is available. What is more, an agent with incomplete (...) evidence may be permitted to do something that she knows would be impermissible if she occupied a perspective of complete evidence. In this paper, I argue that this contrast is explained by a disanalogy between the role played by belief in epistemic deliberation and the role played by action in practical deliberation. Epistemic deliberation may be closed by adopting other attitudes than belief, whereas in general, practical deliberation can only be closed by endorsing some course of action. Thus, when there are pressures to close some practical deliberation, agents have to make a decision about what to do even if they lack relevant information. By contrast, lacking relevant evidence, agents may always refrain from forming a belief and close instead their epistemic deliberation by adopting some other attitude. (shrink)

BackgroundClinical genomic professionals are increasingly facing decisions about returning incidental findings (IFs) from genetic research. Although previous studies have shown that research participants are interested in receiving IFs, yet there has been an argument about the extent of researcher obligation to return IFs. We aimed in this study to explore the perspectives of clinical genomics professionals toward returning incidental findings from genomic research.MethodsWe conducted a national survey of a sample (n = 113) of clinical genomic professionals using a convenient sampling. (...) A self-administered questionnaire was used to explore their attitudes toward disclosure of IFs, their perception of the duties to return IFs and identifying the barriers for disclosure of IFs. A descriptive analysis was employed to describe participants' responses.ResultsSixty-five (57.5%) respondents had faced IFs in their practice and 31 (27.4%) were not comfortable in discussing IFs with their research subjects. Less than one-third of the respondents reported the availability of guidelines governing IFs. The majority 84 (80%) and 69 (62.7%) of the study participants indicated they would return the IFs if the risk of disease threat ≥ 50% and 6–49%, respectively and 36 (31.9%) reported they have no obligation to return IFs.ConclusionClinical genomics professionals have positive attitudes and perceptions toward the returning IFs from genomic research, yet some revealed no duty to do so. Detailed guidelines must be established to provide insights into how genomics professionals should be handled IFs. (shrink)

As reproductive genetic technologies advance, families have more options to choose what sort of child they want to have. Using preimplantation genetic diagnosis (PGD), for example, allows parents to evaluate several existing embryos before selecting which to implant via in vitro fertilization (IVF). One of the traits PGD can identify is genetic deafness, and hearing embryos are now preferentially selected around the globe using this method. Importantly, some Deaf families desire a deaf child, and PGD–IVF is also an option for (...) them. Selection for genetic deafness, however, encounters widespread disapproval in the hearing community, including mainstream philosophy and bioethics. In this paper I apply Elizabeth Barnes’ value-neutral model of disability as mere-difference to the case of selecting for deafness. I draw on evidence from Deaf Studies and Disability Studies to build an understanding of deafness, the Deaf community, and the circumstances relevant to reproductive choices that may obtain for some Deaf families. Selection for deafness, with deafness understood as mere-difference and valued for its cultural identity, need not necessitate impermissible moral harms. I thus advocate that it is sometimes morally permissible to select for deafness in one’s child. (shrink)

There can be some direct clinical value to receiving valid incidental findings of XXY for most individuals with Klinefelter’s syndrome. The severity of Klinefelter’s and the magnitude of benefit fr...

In this paper, I begin by defending permissivism: the claim that, sometimes, there is more than one way to rationally respond to a given body of evidence. Then I argue that, if we accept permissivism, certain worries that arise as a result of learning that our beliefs were caused by the communities we grew up in, the schools we went to, or other irrelevant influences dissipate. The basic strategy is as follows: First, I try to pinpoint what makes irrelevant influences (...) worrying and I come up with two candidate principles. I then argue that one principle should be rejected because it is inconsistent with permissivism. The principle we should accept implies that it is sometimes rational to maintain our beliefs, even upon learning that they were caused by irrelevant influences. (shrink)

BackgroundIn this study, medical errors are defined as unintentional patient harm caused by a doctor’s mistake. This topic, due to limited research, is poorly understood in Malaysia. The objective of this study was to determine the proportion of doctors intending to disclose medical errors, and their attitudes/perception pertaining to medical errors.MethodsThis cross-sectional study was conducted at a tertiary public hospital from July- December 2015 among 276 randomly selected doctors. Data was collected using a standardized and validated self-administered questionnaire intending (...) to measure disclosure and attitudes/perceptions. The scale had four vignettes in total two medical and two surgical. Each vignette consisted of five questions and each question measured the disclosure. Disclosure was categorised as “No Disclosure”, “Partial Disclosure” or “Full Disclosure”. Data was keyed in and analysed using STATA v 13.0.ResultsOnly 10.1% intended to disclose medical errors. Most respondents felt that they possessed an attitude/perception of adequately disclosing errors to patients. There was a statistically significant difference when comparing the intention of disclosure with perceived disclosures. Most respondents were in common agreement that disclosing an error would make them less likely to get sued, that minor errors should be reported and that they experienced relief from disclosing errors.ConclusionMost doctors in this study would not disclose medical errors although they perceived that the errors were serious and felt responsible for it. Poor disclosure could be due the fear of litigations and improper mechanisms/procedures available for disclosure. (shrink)

Participants in some clinical trials are at risk of being harmed and sometimes are seriously harmed as a result of not being provided with available, relevant risk information. We argue that this situation is unacceptable and that there is a moral duty to disclose all adverse clinical trial results to participants in clinical trials. This duty is grounded in the human right not to be placed at risk of harm without informed consent. We consider objections to disclosure grounded in (...) considerations of commercial interest, and we argue that these concerns are insufficient to override the moral duty to disclose adverse clinical trial results. However, we also develop a proposal that enables commercial interests to be protected, while promoting the duty to disclose adverse clinical trial results. (shrink)

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

We examine the asking and answering of `silly questions' in British police interviews with suspects, the courses of action SQs initiate, and the institutional contingencies they are designed to manage. We show how SQs are asked at an important juncture toward the ends of interviews, following police officers' formulations of suspects' testimony. These formulations are confirmed or even collaboratively produced by suspects. We then examine the design of SQs and show how they play a central role in the articulation of (...) suspects' reported `state of mind', and particularly attributing to them criminal intentions constitutive of the offence with which they may be charged. In cases where SQs do not produce unambiguous answers about `state of mind' or intentionality, police officers move toward direct questioning about suspects' intent, thus making explicit the project of SQs in such interviews. Following SQ—Answer sequences, police officers reformulate suspects' testimony, with subtle but crucial differences with regard to suspects' knowledge state and criminal intent. Suspects overwhelmingly align with police officers' formulations of their testimony, and such agreements have the interactional shape of affiliation. Yet SQs may work in ways that are institutionally adversarial with regard to criminal charges, relevant evidence and self-incriminating testimony. (shrink)

This paper examines three arguments that are meant to show that all intentional false assertions are intrinsically evil. The first argument holds that lying is intrinsically evil, all false assertions are lies. The second argument is that all intentional deception is intrinsically evil, and all false assertions are attempteddeceptions. Finally, I explore the argument that false assertions are intrinsically evil because they are a violation of self-unity and unity with the community. Each ofthese arguments, I hold, fails to demonstrate the (...) conclusion which, nevertheless, may be true for other reasons not examined in this paper. (shrink)

Standing is a peculiar norm, allowing for deflecting that is rejecting offhand and without deliberation interventions such as directives. Directives are speech acts that aim to give directive-reasons, which are reason to do as the directive directs because of the directive. Standing norms, therefore, provide for deflecting directives regardless of validity or the normative weight of the rejected directive. The logic of the normativity of standing is, therefore, not the logic of invalidating directives or of competing with directive-reasons but of (...) ‘exclusionary permission’. That is, standing norms provide for permission to exclude from practical deliberation directive-reasons if given without the requisite standing, regardless of their normative weight. As such, standing is a type of second-order norm. Numerous everyday practices involve the deflection of directives, such as pervasive practices of deflecting hypocritical and officious directives. Of various possible models, the one that best captures the normative structure of these practices of deflection is the standing model. Accordingly, the normativity of standing is pervasive in our everyday practices. Establishing that standing, although a neglected philosophical idea, is a significant and independent normative concept. (shrink)

This paper discusses Nicholas Agar's argument in Humanity's End, that it can be morally permissible for human beings to prevent the coming into existence of morally enhanced people because this can harm the interests of the unenhanced humans. It contends that Agar's argument fails because it overlooks the distinction between morally permissible and morally impermissible harm. It is only if the harm to them would be of the morally impermissible kind that humans are provided with a reason to prevent the (...) coming into existence of enhanced people. But if their enhancement includes moral enhancement, it is unlikely that the enhanced people will cause morally impermissible harm. (shrink)

Seizing the opportunity to apply what they had learned, the students declared a cheating competition. Outspoken participants (future lawyers, politicians, and captains of industry) bragged about their ruses. But to their chagrin, an ethics student prevailed.

Canonical utility theory may have adopted its selfishness postulate because it lacked theoretical rationales for two major kinds of incentive: empathic utility and self-signaling. Empathy – using vicarious experiences to occasion your emotions – gives these experiences market value as a means of avoiding the staleness of self-generated emotion. Self-signaling is inevitable in anyone trying to overcome a perceived character flaw. Hyperbolic discounting of future reward supplies incentive mechanisms for both empathic utility and self-signaling. Neither can be effectively suppressed for (...) an experimental game. (shrink)