In September 2006, a small start-up company in Cambridge, MA called Sermo, Inc., launched a social networking site with an unusual twist: only physicians practicing medicine in the United States would be allowed to participate. Sermo, which means “conversation” in Latin, marketed its website as an online community exclusively for doctors that would allow them to talk openly about a range of topics, from challenging and unusual medical cases to the relative merits of one treatment versus another. “Sermo enables the (...) private and instant exchange of knowledge among MDs,” the company announced in its first press release. Even better, participation was free and the site carried no advertising. (shrink)

A virtual reality translation of Robert Nozick's "Experience Machine" thought experiment from his "Anarchy, State, and Utopia" (1974). These modules are free to download and use in the classroom and for research/x-phi purposes. NPCs are randomized for gender during startup of each run. *Requires an Oculus Rift or HTC Vive and VR capable computer. To open the files, uncompress the downloaded .zip folder and run the executable (.exe) file. -/- V1.2 Fixed missing projector video footage during experience machine sales pitch.

Since the publication of Listening to Prozac there have been many debates about how and why Prozac and other similar drugs are prescribed. The articles that follow take up debates about what conditions such drugs can and should address, questions about authenticity in using drugs for psychic well‐being, and concerns about what means we morally endorse in projects of self‐creation. The contributions from Carl Elliott, Peter Kramer, James Edwards, and David Healy derive from a project supported by the (...) Social Sciences and Humanities Research Council of Canada, “Enhancement Technologies and Human Identity.” Psychiatry, like the Prozac it prescribes, aims to enhance the patient's internal psychic well‐being. Yet what ails many may be not an internal state like depression or anxiety, but alienation. And the experts of the self to whom we turn cannot “cure” our collective form of life in which alienation takes root. (shrink)

In The Rules of Insanity, Carl Elliott draws on philosophy and psychiatry to develop a conceptual framework for judging the moral responsibility of mentally ill offenders. Arguing that there is little useful that can be said about the responsibility of mentally ill offenders in general, Elliott looks at specific mental illnesses in detail; among them schizophrenia, manic-depressive disorders, psychosexual disorders such as exhibitionism and voyeurism, personality disorders, and impulse control disorders such as kleptomania and pyromania. He takes (...) a particularly hard look at the psychopath or sociopath, who many have argued is incapable of understanding morality. Making extensive use of psychiatric case histories, Elliott explores the various ways in which mental illness can affect a person's intentions and thus excuse him or her from moral responsibility. (shrink)

Longtermists have argued that humanity should significantly increase its efforts to prevent catastrophes like nuclear wars, pandemics, and AI disasters. But one prominent longtermist argument overshoots this conclusion: the argument also implies that humanity should reduce the risk of existential catastrophe even at extreme cost to the present generation. This overshoot means that democratic governments cannot use the longtermist argument to guide their catastrophe policy. In this paper, we show that the case for preventing catastrophe does not depend on longtermism. (...) Standard cost-benefit analysis implies that governments should spend much more on reducing catastrophic risk. We argue that a government catastrophe policy guided by cost-benefit analysis should be the goal of longtermists in the political sphere. This policy would be democratically acceptable, and it would reduce existential risk by almost as much as a strong longtermist policy. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Bioethics is now taken seriously. Is there a danger of its being taken in or taken over? Might it be influenced in other ways, less visible and less easily avoided? As private corporations and bioethicists build relationships with each other, bioethicists must ask themselves about the opportunities, the constraints, and the subtle shifts in attitude and focus that such ties might create.

Activism is rare among clinical ethicists because the position of ethics consultant is constructed in a way that makes activism very difficult. Clinical ethicists have little formal power and few job protections; they work in organizations in which dissent is discouraged if not punished; and as institutional insiders, they often become blind to the injustices that outsiders protest against.

Analogical reasoning relies on subprocesses of long-term memory and problem-solving. Stress, with its accompanying hormones dehydroepiandrosterone and cortisol, has been shown to impair memo...

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is (...) not to examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

In a recent issue of The Lancet, the historian Roger Cooter predicted that the field of bioethics will soon die of self-inflicted wounds. “Conspiring against it,” he wrote, “is exposure of the funding of some of its US centres by pharmaceutical companies; exclusion of alternative perspectives from the social sciences; retention of narrow analytical notions of ethics in the face of popular expression and academic respect for the place of emotions; divisions within the discipline ; and collusion with, and appropriation (...) by, clinical medicine.” Cooter's prognosis? “Hardly wet behind the ears, bioethics seems destined for a short lifespan.”. (shrink)

Some people change dramatically over time, and often those changes result partly from what they have chosen to do for a living. Drawing on the work of Richard Sennett and Sandeep Jauhar, I explore how practicing in a market-driven medical system can corrupt the character of doctors.

ABSTRACT The paper is a discussion of moral responsibility and excuses in regard to psychiatric disorders involving abnormal desires (e.g. impulse control disorders such as kleptomania and pyromania, psychosexual disorders such as exhibitionism, obsessive‐compulsive disorder and others). It points out problems with previous approaches to the question of whether or not to excuse persons with these disorders, and offers a new approach based on the concept of duress. There is a discussion of duress in regard to non‐psychiatric cases based on (...) the core notion of duress involving a choice between undesirables, and the paper concludes with an argument that moral blame for individuals with these sorts of disorders should often be lessened and in some cases removed entirely. (shrink)

This chapter contains sections titled: The Standard Models of Decision‐making Capacity and Surrogate Decision‐making References Further reading.

Libertarians often portray the decision to use enhancement technologies purely as a matter of individual choice, affecting the person who uses them but no one else. Yet individual choices often add up to large social changes that profoundly affect the lives of other people, effectively pushing individual choices in a particular direction. It seems plausible that self-reinforcing loops such as those that have driven the adoption of technologies like cars and air-conditioners might also play a role in the adoption of (...) enhancement technologies, effectively exerting pressure on people to use a technology that they might otherwise resist. (shrink)

Book Reviws in this ArticleThe Human Body and the Law, 2nd edition by D.W. Meyers, Edinburgh University Press, 1990Classic Cases in Medical Ethics by Gregory E. Pence. New York: McGraw‐Hill Publishing Co. 1990Changing Values in Medical and Health Care Decision Making, edited by Uffejuul Jensen and Gavin Mooney. Chichester: John Wiley & Sons, 1990IVF and Justice by Teresa Iglesias, London: The Linacre Centre For Health Care Ethics, 1990The Practical, Moral and Personal Sense of Nursing: A Phenomenon‐ological Philosophy of Practice by (...) Anne H. Bishop and John R. Scudder, Jr. New York: State University of New York Press, 1990A Companion to Ethics, edited by Peter Singer. Oxford and Cambridge, Mass: Basil Blackwell, 1991.Ethics and Law in Health Care and Research edited by Peter Byrne, Chichester, UK: 1990The Human Embryo edited by G.R. Dunstan, Exeter: Exeter University Press, 1990Everyday Ethics: Resolving Dilemmas in Nursing Home Life by Rosalie A. Kane and Arthur L. Caplan. N.Y.: Springer Publishing Company, 1990Psychiatric Ethics, 2nd edition, edited by S. Bloch and P. Chodoff. Oxford, Oxford University Press, 1991Health Care and Gender by Charlotte Muller. New York: Russell Sage Foundation, 1990. (shrink)

Thirty years ago, the only people drug companies thought worth buying were doctors and politicians. But the ground began to shift in the 1980s, when HIV/aids activists showed everyone how powerful patient advocates could be. It didn't hurt that many advocates were so strapped for money that they could be purchased at bargain prices. Today over 80 percent of patient advocacy groups accept money from the pharmaceutical industry, and the testimony of marginalized patients carries such cultural power that drug companies (...) like Sprout Pharmaceuticals are willing to fake grassroots patient movements. Whether you see this change as a victory for patients or a cautionary tale of institutional corruption depends on how deeply committed you are to the idea that free markets represent our best hope for the future of medicine. Count Sharon Batt as one of the skeptics. Her superb new book, Health Advocacy, Inc.: How Pharmaceutical Funding Changed the Breast Cancer Movement, is a deep scholarly account of the way that pharmaceutical funding has warped the patient advocacy movement into a tool for medical capitalism. Taking the Canadian breast cancer movement as a case study, Batt uses extensive interviews, scholarly resources, and her personal history to explore the struggles faced by patient advocates as they decide whether industry funding is necessary to keep their organizations afloat. (shrink)

Several years ago, the University of Minnesota hosted a lecture by Alan Milstein, a Philadelphia attorney specializing in clinical trial litigation. Milstein, who does not mince words, insisted on calling research studies “experiments.” “Don't call it a study,” Milstein said. “Don't call it a clinical trial. Call it what it is. It's an experiment.” Milstein's comments made me wonder: when was the last time I heard an ongoing research study described as a “human experiment”? The phrase is now almost always (...) associated with abuses. Asking a prospective subject to sign up for a medical experiment would probably get roughly the same response as asking him or her to sign up for a police interrogation. It wasn't always this way. In the early days of American bioethics, scholars used the word “experimentation” in the same neutral way that they later began to use “research study” and “clinical trial.”. (shrink)