It is a privilege to have such extensive engagement with one's work as in the responses of Linda Alcoff, Eva Kittay, Keya Maitra, and Nilanjan Das. I am sincerely thankful for the intellectual generosity and thoughtfulness of their critiques. Before responding to their specific concerns, however, I lay out the general argument of Caring to Know in broad strokes to serve as the common backdrop to their comments.The central idea of Caring to Know is that notions of 'knowing (...) well' are intertwined with ideas of 'living well,' and so epistemology is linked with ethics and politics, and epistemic normativity is reconfigured to involve goodness and justice. Of course, reference to moral concepts when delineating epistemic... (shrink)

The manuscript explores the plausibility of care-based epistemology in a comparative key. Investigating the epistemic virtue of care-giving, the work weaves together insights from care ethics, virtue epistemology and a particular reading of the Mah=abh=arata which, left to themselves, do not appear compatible with one another. Drawing on these traditions, the work goes on to provide a feminist vision of search for truth that is consistent with both ethical relations and interventions for justice.

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact upon (...) the inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

'Caring to Know' argues that “caring is not the ‘other’ of reason and that our lived experiences of caring and being cared for can be useful resources for truth-seeking” (1). This claim is fleshed out over six chapters using a creative blend of analytical feminist theory, virtue theory of knowledge, and cross-cultural philosophy. The brief conclusion braids together different strands of the argument. The review examines the potential of Dalmiya's 'humble relational knowers' for cross-cultural philosophy.

The people's right to know and press rights to gather and publish information remain dominant justifications for controversial media activities. Yet, the power of the media to set the agenda for public discourse in our country warrants a careful analysis of these rights, their corresponding responsibilities, and their moral limits. This article examines the right to know and press freedom from the perspective of their shared purpose, facilitation of informed decision making. This article also demonstrates moral justification of (...) limits on right to know and press freedom based on traditional ethics theories and media impact on public discourse. (shrink)

The major part of this paper is devoted to the task of showing that Husserl's account of knowledge and truth in terms of a synthesis of fulfilment falls prey neither to a form of “metaphysics of presence” nor to a “myth of interiority” or mentalism. Husserl's presentation of the desire to know, his awareness of irreducible forms of absence at the heart of the intuitive presence of the object of knowledge and his formulation of general rules concerning the possible (...) accomplishment of a synthesis of fulfilment are therefore carefully examined. Special attention is also given to the fact that the determination of knowledge and truth provided by the Sixth Logical Investigation rests on an account of an original interweaving between the thing, consciousness, and language. Unlike in Husserl's earlier and later works, no attempt is thereby made to subordinate any of these three elements involved in all knowledge to one of the others. (shrink)

Accidental human immunodeficiency virus (HIV) infection of patients in health care settings raises the question about whether patients have a right to expect disclosure of HIV/AIDS diagnoses by their health workers. Although such a right – and the correlative duty to disclose – might appear justified by reason of standards of informed consent, I argue that such standards should only apply to questions of risks of and barriers to HIV infection involved in a particular medical treatment, not to disclosure (...) of personal diagnoses. Because the degree of risk of HIV infection is low and disclosure would also have damaging consequences for health workers, and because patient protection is available in other ways, it is argued that no such generalized right should be recognized. Keywords: duty to disclose, HIV infection, HIV/AIDS diagnosis, informed consent, right to know CiteULike Connotea Del.icio.us What's this? (shrink)

The present paper explores patients’ experience of lived space at the hospital and at home. To expand the understanding of the existential meaning of lived space the study revisited two empirical studies and a study of a meta-synthesis on health and caring. Phenomenological philosophy was chosen as a theoretical framework for an excursive analysis. The paper demonstrates that existential dimensions of lived space at the hospital and at home differ significantly. For the patients, the hospital space means alien territory as (...) opposed to the familiar territory of home. To some extent the experienced differences are due to the physical environment; however, as our analysis shows, other and more significant meanings are also involved. For patients, lived space at the hospital primarily concerns the influence of complex institutional power structures and specific cultural and social conventions, e.g. the role of the good patient and the ambiance of hospitals. Home, on the other hand, offers familiar lived space in which patients feel protected and safe. Further, the paper relates patients’ experience of lived space to a phenomenological view of lived space in order to illustrate the radical influence of illness on patients’ lifeworld and experience of lived space. The combination of illness and general discomfort may influence patients’ experience of home negatively; the former experience of home as a sanctuary changes into feelings of being left on one’s own and burdened by too much responsibility. Consequently, in the light of the increasing focus on patients’ self-monitoring at home, it is important for healthcare professionals to recognize the influence of spatial aspects on patients’ well-being both at the hospital and at home. (shrink)

The right not to know is a contested matter. This can be because the inversion of the normal framing of entitlement to information about one's own health is thought to be illogical and inconsistent with self-authorship and/or because the very idea of claiming a right not to know information is an inappropriate appeal to the discourse of rights that places impossible responsibilities on others. Notwithstanding, there has been a sustained increase in this kind of appeal in recent years (...) fueled in large part by the rise and rise of the importance of personal autonomy in health care ethics, and by domestic and international health law. The right not to know has been acknowledged in at least two important international legal instruments. For example, the UNESCO Universal Declaration on the Human Genome and Human Rights, Article 5c provides: “The right of every individual to decide whether or not to be informed of the results of genetic examination and the resulting consequences should be respected.”. (shrink)

As a third-year medical student, I have the job of being the first person from the medical team to check in on patients in the morning, follow up on consults that they may need, and communicate with people from other services who are involved with patients’ care. Because third-year medical students have the most time of anyone on the medical team, we are encouraged to get to know our patients. We are encouraged to take time to understand our (...) patients’ conditions on both a medical and personal level, that is, both to read about their complex diseases and to talk about their preferences, goals, families, and lives outside the hospital. As best we can, we then communicate their personal needs and preferences to the medical team of doctors, nurses, social workers and others. What could be wrong with that? (shrink)

This article uses a case study to examine the conflicting rights of the patient to know a clinician;s HIV status and the clinician's right to privacy.

Bioethicists have for quite some time discussed the right to know and the right not to know personal health information, such as genetic information acquired in health care and incidental health-related findings in research. Several international ethical guidelines explicitly defend these rights.My own interest in these matters stems from my participation in ethics-related research tied to a longitudinal screening study on Type I diabetes involving young children. A few of the participating parents did not want to be (...) informed if the study revealed their child had a high risk of developing diabetes. This response was troublesome, not least since the information would concern the child's and not the parents’ health. Our inclination was that there cannot be a right not to know that should be granted without qualifications. Furthermore, other contextual factors, e.g., that parents experienced pressure to participate and felt concern about some of the personal data handled in the study, gave reason to question whether autonomous decisions were made regarding participation. The autonomy of their expressed desire not to know was therefore questionable. (shrink)

Drawing from the fields of psychology and neuroscience and from the worlds of theater, philosophy, history and education, one of the nation's leading writers and commentators helps us become more understanding and considerate toward others, and to find the joy that comes from being seen.

BackgroundAll hospital trusts in Norway have clinical ethics committees. Some of them invite next of kin/patients to be present during the discussion of their case. This study looks closer at how parents of seriously ill children have experienced being involved in CEC discussions.MethodsTen next of kin of six seriously ill children were interviewed. Their cases were discussed in two CECs between April of 2011 and March of 2014. The main ethical dilemma was limitation of life-prolonging treatment. Health care personnel (...) who could elucidate the case were also present in the discussion. The interviewer observed each discussion and then interviewed the next of kin shortly after the meeting, following a structured interview guide.ResultsAll next of kin emphasized that it had been important for them to be present. They stressed the important role of the CEC chair and appreciated that their case was discussed in a systematic way. Some next of kin appreciated that the child’s impending death was discussed openly, and believed that this would facilitate their future grieving. Having had an opportunity to hear all the arguments behind the decision to be made would probably help them to accept the road ahead.All of them felt that they were taken seriously and listened to. They felt that they had added vital information to the discussion. All but one couple did not want any decision-making responsibility, some of them even worried that they might have influenced the discussion too much.ConclusionsNone of the next of kin felt that being present during the CEC discussion had been too heavy a burden. On the contrary, they claimed that their presence in a CEC discussion may add vital information to the discussion and may improve the quality of the decision. It is important that the CEC’s role is explained to them so they are well prepared for what to expect. They need to be followed up after the discussion. (shrink)

The idea of a right not to know (RNTK) emerged in the late 20th century, largely in response to the early incorporation of genetic testing into clinical care. While a few commentators took a more absolute view about the strength of the RNTK, most of the scholarship was openly sceptical of the concept, or at least was willing to acknowledge that the RNTK was defeasible.1 After two decades of relative quiet, it was surprising, then, that the RNTK reappeared (...) with a seemingly widespread consensus that it deserved to be treated as an absolute right. In response to the American College of Medical Genetics and Genomics recommendation2 to actively search for a limited set of high-value medical variants as a default (ie, without soliciting the patient’s preference to know or not know that information) many bioethics commentators came forward to endorse a strong RNTK.3 While ‘deliberate ignorance’ is a complicated moral and psychological concept,4 I was and remain sceptical of a strong RNTK in all cases, and largely support the novel arguments put forth by Ben Davies. But he makes two moves that deserve additional discussion and analysis. Specifically, I have concerns about conflating the provision of medical information with the separate decision about whether or not to act on …. (shrink)

When, if ever, can healthcare provider's lay claim to knowing what is best for their patients? In this paper, I offer a taxonomy of clinical disagreements. The taxonomy, I argue, reveals that healthcare providers often can lay claim to knowing what is best for their patients, but that oftentimes, they cannot do so *as* healthcare providers.

The debate on the ‘right to know’ has simmered on for over 30 years. New examples where a right to be informed is contrasted to a right to be kept in ignorance occasionally surface and spark disagreement on the extent to which patients and research subjects have a right to be self-determining concerning the health related information they receive. Up until now, however, this debate has been unsatisfactory with regard to the question what type of rights—if any—are in play (...) here and to what extent they can provide a normative basis for informed consent. This paper provides an analysis of informed consent in the context of ‘epistemic interventions’: interventions which involve the communication of information. First, I offer an analysis of the concept of a ‘right not to know’ in the context of consent to epistemic interventions. I argue that the scope of the consent is determined by the extent to which this intervention can be seen as an infringement of the private sphere. After that I show how this analysis affects the scope and standards of informed consent. (shrink)

Recent advances in genomic research have led to the development of new diagnostic tools, including tests which make it possible to predict the future occurrence of monogenetic diseases (e.g. Chorea Huntington) or to determine increased susceptibilities to the future development of more complex diseases (e.g. breast cancer). The use of such tests raises a number of ethical, legal and social issues which are usually discussed in terms of rights. However, in the context of predictive genetic tests a key question arises (...) which lies beyond the concept of rights, namely, What should we want to know about our future? In the following I shall discuss this question against the background of Kant’s Doctrine of Virtue. It will be demonstrated that the system of duties of virtue that Kant elaborates in the second part of his Metaphysics of Morals offers a theoretical framework for addressing the question of a proper scope of future knowledge as provided by genetic tests. This approach can serve as a source of moral guidance complementary to a justice perspective. It does, however, not rest on the – rather problematic – claim to be able to define what the “good life” is. (shrink)

Healthcare cybersecurity is increasingly targeted by malicious hackers. This sector has many vulnerabilities and health data is very sensitive and valuable. Consequently, any damage caused by malicious intrusions is particularly alarming. The consequences of these attacks can be enormous and endanger patient care. Amongst the already-implemented cybersecurity measures and the ones that need to be further improved, this paper aims to demonstrate how penetration tests can greatly benefit healthcare cybersecurity. It is already proven that this approach has enforced cybersecurity (...) in other sectors. However, it is not popular in healthcare since many prejudices still surround the hacking practice and there is a lack of education on hackers’ categories and their ethics. The present analysis aims to comprehend what hacker ethics is and who ethical hackers are. Currently, hacker ethics has the status of personal ethics; however, to employ penetration testers in healthcare, it is recommended to draft an official code of ethics, comprising principles, standards, expectations, and best practices. Additionally, it is important to distinguish between malicious hackers and ethical hackers. Amongst the latter, penetration testers are only a sub-category. Acknowledging the subtle differences between ethical hackers and penetration testers allows to better understand why and how the latter can offer their services to healthcare facilities. (shrink)

The goal of this article is to suggest that in early modern discussions of agency and causal efficacy it is possible to detect an attempt at pushing to its extreme consequences a specific account of agency and causality that was developed in late scholastic thought. More specifically, the article examines Francisco Suárez's (1548–1617) account of freedom and how this relates to his views on efficient causality. Despite Suárez's careful way of differentiating between natural (necessary) and human (free) agents, his view (...) can be exploited to drive home occasionalist positions that deny causal efficacy for natural agents lacking reason. The family resemblance that might be noted between early modern positions could be traced back to the reception of a common late scholastic background and to the tensions and potential nestled there. (shrink)

Approximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child’s medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child’s biological parents should play in making serious medical decisions. Here we (...) highlight some of the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician. (shrink)

Objectives—To discover what dementia sufferers feel is wrong with them; what they have been told and by whom, and what they wish to know about their illness.Background—Ethical guidelines regarding telling truth appear to be equivocal. Declarations of cognitively intact subjects, attitudes of family members and current psychiatric practice all vary, but no previous research has been published concerning what patients with dementia would in fact like to know about their diagnosis and prognosis.Design—Questionnaire study of the patients' opinions.Setting—Old Age (...) Psychiatry Service in Worcester.Participants—30 consecutive patients with dementia.Results—The quality of information received has been poor and many patients have no opportunity to discuss their illness with anybody. Despite that almost half of the participants in this study had adequate insight and a majority declared that they would like to know more about their predicament.Conclusions—Although many patients would like to know the truth, the rights of those who do not want to know should also be respected. Therefore the diagnosis of dementia should not be routinely disclosed but health care professionals should seek to understand their patients' preferences and act appropriately according to their choice. (shrink)

We all have questions about God. But very few of us get the answers we’re looking for–if those answers even exist! Do they? Where (in heaven’s name) do you go to find out? Eric Metaxas understands. That’s why he’s written this refreshingly down-to-earth take on the big questions everyone asks (but not always out loud). Finally a book that takes questions about God seriously enough to get silly (where appropriate). Wonderfully conversational and often very funny, this book joins you in (...) wondering: ·How can a good God create a world that has evil and suffering? ·Is God anti-sex? ·Doesn’t science make God obsolete? ·What’s the real story on miracles? ·If God is everywhere, why go to church? ·Don’t we already have God within us? ·Isn’t God too busy running the universe to care about the details of my day? ·What does the Bible say about things like UFOs, ESP, and the afterlife– and what about Bigfoot? These questions (and many more like them) get straight answers that don’t hide behind dull and confusing theological language. So get the lowdown on the big questions everyone asks–but please try not to laugh (because it’s a very serious topic). (shrink)

What's the point of time travel? Not to change the past; no matter how carefully a time traveler plans, all of her attempts to change the past end in failure. Paul Horwich has argued that the implausibility of such failures gives us reason to doubt that there will be frequent time travel to the local past. I defend a modified version of Horwich's argument and show how we might gain evidence about the chance of there being frequent time travel in (...) the future without having any information that explains why that chance value obtains. (shrink)

This is the first description of the questions that clinicians ask a department of clinical law, relating to the legal rules applicable to the care of their patients.ObjectivesTo describe in detail the demography of clinical legal enquiries made by clinicians of all professions concerning the care of their patients. To collate and categorise the varieties of enquiry, to identify phenotypic patterns. To provide colleges, regulators, commissioners, educators and the NHS with an insight into hitherto undescribed subject matter, better (...) to understand and respond to this aspect of clinical practice.DesignProspective collection of all clinical legal referrals recorded in writing over 12 years by a department of clinical law.SettingAn English Tertiary Hospital NHS Trust.ParticipantsClinical staff of the regulated professions, all seeking to have their clinical legal enquiries answered.Main outcome measuresThe description of the demography of clinical law.Results1251 written records were identified and reviewed. These were divided into nine broad clinical legal subject areas (domains): mental disorders, parents and children, incapacity, consent for treatment, disclosure of private information, other statutory, regulated practice, professional practice, clinical practice. Within these, 149 clinical legal phenotypes were identified to which each case could be assigned.ConclusionsAmong a broad range of enquiries, recognisable clinical legal phenotypes exist and have for the first time been described and categorised. These are clinical situations which clinicians need to be able to recognise and equipped to deal with. Doing so will likely facilitate timely and better treatment. (shrink)

Background: Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision. Objectives: The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel. Methods: In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were (...) collected by deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach. Ethical considerations: Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality. Findings: The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes. Conclusion: Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients’ moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them. (shrink)

Prenatal diagnosis challenges the issue of parental autonomy. Two ethical aspects of the parental decision making process with reference to PND have been taken into consideration: the duty to know and the right not to know. Whilst the first approach has been widely discussed in literature, the latter seems to be overlooked. In order to find good moral reasons supporting the right not to know, firstly the duty to know approach was critically analysed. Subsequently, the emphasis (...) was put on the unconditional parental love and the issue of child’s best interests as the features supporting parental right not to know. The clarification of what is good parenthood was presented as the best normative approach supporting the parental right not to know in case of PND. Apart from parental autonomy, raising the question of the right not to know is important in the debate about the place and role of people with disabilities in society. (shrink)

In recent years, the research participant’s family’s need, if not right, to know their disease risk has comprised a great deal of the genetic testing discourse. This most often arises in the context of clinical genetic tests for hereditary cancers, especially colorectal and breast cancer, and other genetic disorders where the presence of a genetic mutation greatly increases the likelihood of the disease’s manifestation. However, this discussion has not led to comprehensive or cohesive guidance for health care professionals (...) or patients. Indeed, various governmental and professional bodies run the gamut of possibilities, from no disclosure to family without the consent of the patient, to recognition that genetic risk information is important enough to the family to allow exception to traditional notions of confidentiality. (shrink)

Over the coming decades, Artificial Intelligence will profoundly impact the way we live, work, wage war, play, seek a mate, educate our young, and care for our elderly. It is likely to greatly increase our aggregate wealth, but it will also upend our labor markets, reshuffle our social order, and strain our private and public institutions. Eventually it may alter how we see our place in the universe, as machines pursue goals independent of their creators and outperform us in (...) domains previously believed to be the sole dominion of humans. Whether we regard them as conscious or unwitting, revere them as a new form of life or dismiss them as mere clever appliances, is beside the point. They are likely to play an increasingly critical and intimate role in many aspects of our lives. The emergence of systems capable of independent reasoning and action raises serious questions about just whose interests they are permitted to serve, and what limits our society should place on their creation and use. Deep ethical questions that have bedeviled philosophers for ages will suddenly arrive on the steps of our courthouses. Can a machine be held accountable for its actions? Should intelligent systems enjoy independent rights and responsibilities, or are they simple property? Who should be held responsible when a self-driving car kills a pedestrian? Can your personal robot hold your place in line, or be compelled to testify against you? If it turns out to be possible to upload your mind into a machine, is that still you? The answers may surprise you. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Know You Have to Stay … I Wish I Could, I Wish I CouldMegan K. SkaffIn the world of healthcare, I advocate for the scores of youth who have had Adverse Childhood Experiences (ACEs). I work to understand where the child has been so we can learn the extent of the trauma that the child has been through. While working for a facility as the Street Outreach (...) Case Manager, my priority was based mainly on one girl, let us call her Tawny. I knew Tawny was going to be a very difficult client to work with the moment I realized she did not trust anyone in her own life, let alone the facility I worked in. She would not talk to a single staff member. However, being her case manager, it was my job to get her to trust me so I could crack her case and really get down to the problems she was facing. I promised myself the day I met Tawny that I would never cast one judgment upon this girl, and I made good on that promise until this very day.I find it true that we are all raised in different situations. Tawny endured such horrific childhood experiences that she voluntarily entered herself into our organization. My specialty was the homeless and runaway case manager. Hence, the reason she ended up on my caseload. After running many different tests, I learned that her ACEs score was a ten out of ten. To her, everything she had endured that warranted this score was baseline normal; she did not see her experiences as traumatic, she just saw them as a piece of her life. For me as her case manager, looking at this ten was devastating. I wanted to know everything I could that went into this high score. I needed Tawny to learn to trust me so I could understand what was going on in her home life and better understand her and her trust issues.Just a side note, the staff around me strongly hated Tawny. The worst part about this was that she knew it because they vocalized it. The staff [End Page 5] was so horrible that they would not even pretend to her face that they liked her. The one job they had as staff—to make her feel welcomed and loved in an environment full of broken kids—they could not do. There was no question as to why I struggled to build a relationship with my most vulnerable yet strongest client. Tawny would not let anyone see her as vulnerable. She did not want to be vulnerable because to her vulnerability meant weakness.I was determined to build a solid foundation of trust with Tawny. It was difficult, but I did it. At best, this process took weeks, maybe close to over a month. After many days of her asking other staff, "why is this b**** still in here," and her finally, slowly inching closer to me to say, "Sup," and me answering, "Just waiting for you to talk to me." This answer would make her smile, even though she tried hard not to. As much as she did not want it to be true, I was the only person she wanted to hang out with on the floor. She did not want anything to do with the kids or the staff. She knew the kids on the floor were toxic for her, and she wanted a better life for herself. She knew the staff were toxic for her as well.She started to ask daily where I was, so I started making sure I was on the floor every day. I gave her my work cell and wrote it in the call book along with a message that she had permission to call at any time, no matter day or night. Staff hated that. I did not care. Let me tell you, she tested it to its limits. If she called me at 3:00 AM, I would answer. She would say she was calling to say goodnight; when really, she just needed to know someone would be there. She needed to know she could trust me... (shrink)

Human Progress is often understood to be a rather natural and obvious truth of human existence. That this is not necessarily so, is indicative of the pervasive social, psychological, and educational inculcation that sustains its ubiquitous acceptance. Moreover, the uncritical and ill‐informed understanding of Progress as an unquestioned expression of human beneficence has serious consequences for those concerned with the health and welfare of people. It is argued in this paper that, much of what we might consider deleterious in the (...) socio‐political milieu that now confronts us is, to a significant extent, a matter of progressive ideological epistemology and its ensuing manner of human institutionalization. Part one contends that the current socio‐political structure of the current postmodern affairs is in reality that of a pervasive postmodern economic ideology. Part two provides a brief overview of the historical and philosophical development of Progress as an idea, including some of the profound effects wrought by it on human affairs in the contemporary world. Finally, Part three presents a discussion of the influential effects of the philosophy of Progress on the epistemology of human health and welfare intervention, specifically that of nursing and its claim to a holistic ethic of Caring. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managing the Transition from Patient-Centered Care to ProtocolDavid SlakterI learned that I would need a kidney transplant in the summer of 2015. This was not a complete surprise to me, as I had been subjected to a number of tests and invasive procedures to investigate nephritis since I was a child. I had heard similar stories of clinicians performing repeated tests on my father for similar reasons without (...) any conclusions. Following my recommendation for transplant and consultation with genomics specialists, the cause of my kidney failure was determined to be Alport syndrome. What made Alport syndrome so difficult to diagnose in my case was that the associated mutation is a rare, autosomal-dominant one that has only recently been associated with the condition.After reviewing the data on survival rates for transitioning to dialysis versus a transplant, my family and I then considered the success rates for living versus cadaver donors, and the success rates at various transplant centers. The current data favor the long-term outcomes of transplant over dialysis and living over cadaver donors. Since we had decided to focus on searching for a live donor, my nephrologist recommended contacting Renewal, an organization that specializes in connecting those in need of a kidney transplant with live donors and providing support for donors to make the donation process less burdensome.On Renewal’s recommendation, my family and friends reached out across their social networks to search for potential donors. Many of those tested for compatibility were eliminated on basic matching criteria, others due to previously undiagnosed medical problems. Finally, the wife of a childhood friend came forward as an eligible donor and was also an incredibly close match on the antigens tested for kidney transplants.Having a living donor who was also a friend made the transplant experience somewhat less intimidating than it might have been. It meant the transformation of an existing relationship with someone already close to me, with fewer open questions about what may have motivated them to be so generous than if the donor had been someone I did not know. It also meant our families could be together in the waiting room, and that we shared in each other’s recoveries.Life post-transplant has been a significant improvement from what it was like immediately beforehand. Before my transplant, I regularly weighed food and consulted nutrition charts to gauge how much potassium I was consuming. To prevent too much potassium from building up in my bloodstream, I had to take sodium polystyrene [End Page 111] regularly. As one might guess from the name, it tastes much like burnt Styrofoam, and I could only ingest it with copious amounts of fruit-flavored syrup (strawberry covered up the awful flavor the best). There are other potassium binders on the market now, so fewer people with kidney failure will likely need to engage in such gustatory experimentation.I was also able to engage in more activities than what was possible even years before my transplant. I had long experienced difficulty with aerobic exercises, but assumed the reason was merely being out of shape. Though I have always walked regularly, even the one-mile walk from my office to my apartment had become a chore by the end. Within a few months after my transplant, I was riding a bicycle all over NYC, from Harlem to Brooklyn and back regularly, and hiking trails in nearby state parks. I began sessions with a personal trainer and attained a level of fitness I had not reached since I played soccer as a child.The transition from personalized care to one more driven by protocol has been a surprising and challenging aspect of the transplant process. While my previous experience with medical treatment has been individual meetings with physicians, my post-transplant care is managed by a team of nephrologists and other specialists in transplant care. My initial transplant nephrologist was automatically assigned to me. Because the standard of care for transplant patients is often driven by protocol, my assigned nephrologist recommended a biopsy on my transplanted kidney due to results in my recent lab tests. When pressed on the necessity of a biopsy in my case versus... (shrink)

Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's theory of tacit knowing (...) is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels. (shrink)

Providing patients with information is fundamental to respecting autonomy. However, there may be circumstances when information may be withheld to prevent serious harm to the patient, a concept referred to as therapeutic privilege. This paper provides an analysis of the ethical, legal and professional considerations which impact on a decision to withhold information that, in normal circumstances, would be given to the patient. It considers the status of the therapeutic privilege in English case law and concludes that, while reference is (...) made to circumstances when information (primarily in relation to risk disclosure) may be withheld, further clarification is required on the status of therapeutic privilege. I suggest there has been shift in English law relating to the standard of information disclosure towards one set by the test of the reasonable, prudent patient. It is this shift that necessitates the existence of a therapeutic privilege which enables doctors to withhold information that would usually be given to the patient in order to prevent serious harm. I then explore the professional guidance in relation to information disclosure and how this relates to the legal position. There are strong ethical arguments in favour of disclosure of information to patients. In light of these, further clarification is required to identify and define the grounds on which this exception exists, the information that could lawfully be withheld and how this exception extends to rest of the health care team, particularly nurses. As such, explicit ethical and legal scrutiny of therapeutic privilege is needed in order to consider how this concept might be articulated, constrained and regulated. (shrink)

Inside this complete guide you will find: A guide to facilitate conversation with your family; How to create peace when war has been declared on your body; How to alleviate pain and suffering; How to choose your own end; How to use the dying process as a mechanism for personal and family growth. Filled with inspirational and helpful stories, Mortal Dilemmas... is a book that not only will prepare you for the inevitable, but will also give you a sense of (...) satisfaction and control."--P. [4] of cover. (shrink)

Children with HIV are dependent on taking continuous medication and care, and family preparation is required when disclosing HIV. This study aimed to unveil families’ experiences with HIV disclosure to children under 13 years old. Eight family members who have disclosed HIV to seropositive children were interviewed in‐depth and individually. The fieldwork took place at a public paediatric outpatient hospital in Rio de Janeiro. The results showed that the family members’ discourse highlighted two ways of knowing their own condition (...) and disclosing the condition of the children with HIV. First, they needed to address the communication of bad news and discover their own HIV status through their children's disease. Second, the disclosure was a process constituted by four stages: preparing for disclosure, identifying the time, deciding how and where to tell, and instilling silence after disclosure. They also recognized that nurses had a role in the process as part of an interprofessional team. Nurses can develop advocacy care and empower family members in the preparation of safe HIV disclosure. By systematizing and institutionalizing the care advocacy process, nurses may enable caretakers and children to participate in their therapeutic management, improving adherence to the treatment and self‐care with autonomy. (shrink)

In the article I consider whether philosophical anthropology offers knowledge about man. I begin with a definition of knowledge, then I present philosophical anthropology against the background of other kinds of anthropology. Having explained what is proper to it, I show that its goal cannot be the attainment of knowledge. Knowledge has requirements that an unreduced philosophical anthropology cannot fulfill; reduction deprives it of what is proper to it. However, the fact that it does not produce knowledge is not a (...) defect. The goal of my article is to create a common arena for considering various different approaches to man; this requires that the various parties admit that man cannot be reduced to what can be known about him. In order to know something, it is necessary to use carefully selected methods; it is not the case that merely saying something about man implies the possession of knowledge about him. (shrink)

Kate Robins-Browne and her colleagues have written a conceptually daring, empirically grounded article that is rich in scholarship and just conceivably might have a salutary effect on the theory and practice of advance care planning. It is, alas, just as easy to believe that its appreciation will be restricted to like-minded theorists. Writing from a posture of great admiration for this article’s agenda and achievements, I will consider why non-relationallybased understanding of deciding for others are so enduring, and what (...) might be done about that. (shrink)