If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team’s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious (...) wrongdoing by physicians. (shrink)

This landmark study examines the role played by the rediscovery of the writings of the ancient atomists, Epicurus and Lucretius, in the articulation of the major philosophical systems of the seventeenth century, and, more broadly, their influence on the evolution of natural science and moral and political philosophy. The target of sustained and trenchant philosophical criticism by Cicero, and of opprobrium by the Christian Fathers of the early Church, for its unflinching commitment to the absence of divine supervision and the (...) finitude of life, the Epicurean philosophy surfaced again in the period of the Scientific Revolution, when it displaced scholastic Aristotelianism. Both modern social contract theory and utilitarianism in ethics were grounded in its tenets. Catherine Wilson shows how the distinctive Epicurean image of the natural and social worlds took hold in philosophy, and how it is an acknowledged, and often unacknowledged presence in the writings of Descartes, Gassendi, Hobbes, Boyle, Locke, Leibniz, Berkeley. With chapters devoted to Epicurean physics and cosmology, the corpuscularian or "mechanical" philosophy, the question of the mortality of the soul, the grounds of political authority, the contested nature of the experimental philosophy, sensuality, curiosity, and the role of pleasure and utility in ethics, the author makes a persuasive case for the significance of materialism in seventeenth-century philosophy without underestimating the depth and significance of the opposition to it, and for its continued importance in the contemporary world. Lucretius's great poem, On the Nature of Things, supplies the frame of reference for this deeply-researched inquiry into the origins of modern philosophy. (shrink)

I argue that there has been inadequate attention to and questioning of the dominance and normativity of whiteness in the cultural construction of bioethics in the United States. Therefore we risk reproducing white privilege and white supremacy in its theory, method, and practices. To make my argument, I define whiteness and trace its broader social and legal history in the United States. I then begin to mark whiteness in U.S. bioethics, recasting Renee Fox's sociological marking of its American-ness as an (...) important initial marking of its whiteness/WASP ethos. Furthermore, I consider the attempts of social scientists to highlight sociocultural diversity as a corrective in U.S. bioethics. I argue that because they fail to problematize white dominance and normativity and the white-other dualism when they describe the standpoints of African-American, Asian-American, and Native-American others, their work merely inoculates difference and creates or maintains minoritized spaces. Accordingly, the dominant white center of mainstream U.S. bioethics must be problematized and displaced for diversity research to make a difference. In conclusion, I give several examples of how we might advance the recommended endeavor of exploring our own ethnicity, class, and other social positioning and norms operating in U.S. bioethics, briefly highlighting "white talk" as one challenge. (shrink)

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. (...) In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

Teaching is not testimony. Although both convey information, they have different uptake requirements. Testimony aims to impart information and typically succeeds if the recipient believes that informationon account of having been told by a reliable informant. Teaching aims to equip learners to go beyond the information given—to leverage that information to broaden, deepen, and critique their current understanding of a topic. Teaching fails if the recipients believe the information only because it is what they have been told.

Photography has become a pervasive component of contemporary communication. Recent technological advances in creating and manipulating images have provided renewed impetus to decades-long debates on use of photographs in science. With increase in the potential for inappropriate image manipulation, fears about misrepresentation have heightened concern among journal editors and scholars about the 'accuracy' of published images. We discuss how science has responded to growing concerns surrounding falsification and inaccuracy of photography. We document progress in implementing a variety of complementary approaches (...) to addressing the problem. These include digital forensics, photo member checking and the implementation of codes of ethics to enhance the veracity of published photographs in science research. We conclude by acknowledging the irreducible conflict likely to remain between use of the photograph as a creative work of art and employment of this medium as a source of information in the progress of science. (shrink)

Issues of balancing data accessibility with ethical considerations and governance of a genomics research biobank, Generation Scotland, are explored within the evolving policy landscape of the past ten years. During this time data sharing and open data access have become increasingly important topics in biomedical research. Decisions around data access are influenced by local arrangements for governance and practices such as linkage to health records, and the global through policies for biobanking and the sharing of data with large-scale biomedical research (...) data resources and consortia. We use a literature review of policy relevant documents which apply to the conduct of biobanks in two areas: support for open access and the protection of data subjects and researchers managing a bioresource. We present examples of decision making within a biobank based upon observations of the Generation Scotland Access Committee. We reflect upon how the drive towards open access raises ethical dilemmas for established biorepositories containing data and samples from human subjects. Despite much discussion in science policy literature about standardisation, the contextual aspects of biobanking are often overlooked. Using our engagement with GS we demonstrate the importance of local arrangements in the creation of a responsive ethical approach to biorepository governance. We argue that governance decisions regarding access to the biobank are intertwined with considerations about maintenance and viability at the local level. We show that in addition to the focus upon ever more universal and standardised practices, the local expertise gained in the management of such repositories must be supported. A commitment to open access in genomics research has found almost universal backing in science and health policy circles, but repositories of data and samples from human subjects may have to operate under managed access, to protect privacy, align with participant consent and ensure that the resource can be managed in a sustainable way. Data access committees need to be reflexive and flexible, to cope with changing technology and opportunities and threats from the wider data sharing environment. To understand these interactions also involves nurturing what is particular about the biobank in its local context. (shrink)

The reception of Rawls in France has been an extremely complex story where forces of innovation have been, in the end, overwhelmed by the resistance of `philosophical nationalism'. This is surprising as, in many ways, France was going through tremendous changes and modernization at the time of the translation of A Theory of Justice in 1987. In that context, Rawls's project seemed to have something useful and suggestive to offer: bridging the gap between freedom and equality in a new version (...) of social democracy, combining social justice and market efficiency, respecting the plurality of values within civil society and creating a consensus on democratic legitimacy. But the intellectual obstacles, represented mostly by the French idiosyncratic brand of republicanism, were to prove too strong to allow for a true `liberalization' of French intellectual and political life. Whereas a number of lawyers, economists and political scientists as well as proportion of the French civil service saw all the benefits of a rigorous engagement with Rawls, philosophers and the intelligentsia on the whole, with the exception of Paul Ricoeur, reacted negatively to Rawls. (shrink)

This article recounts the development of the Professional/problem-based Ethics Program, the original physicians’ professional ethics remediation course. Since 1992, more than 1,200 healthcare professionals of many disciplines have been mandated to attend ProBE by licensing boards and other oversight entities. Using a small-group, interprofessional setting, the ProBE Program assists participants to discover and articulate ethical underpinnings violated by their misconduct; appreciate professional responsibilities that are societal, regulatory, and ethical; and recommit to professional ideals. The authors describe the rationale for developing (...) ProBE, its curriculum, participant demographics, and infractions and reconsider medical professionalism in light of two decades of ProBE. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Mean It’s Not My Fault:Learning about Lipedema, a Fat DisorderCatherine A. Seo“As a surgeon there is nothing more I can do for you. You need to lose 75 pounds before I can even consider repairing the damage done.” Implied and not directly stated, “… Because it’s your fault.” I sat listening, dumbfounded. I was at one of the top teaching hospitals in the country, face to face with (...) a respected Harvard Medical School trained surgeon who came highly recommended.I had seemingly irreversible damage that was leading to permanent immobility. I was experiencing excessive and uncontrollable swelling in my extremities. I was in unrelenting pain that prevented me from sleeping through the night.The surgeon looked down at the floor avoiding my gaze and—after never before mentioning weight as a possible contraindication to surgery during any of our interactions associated with five surgeries, in over two years, including at least 25 consultations, pre-op, post-op, or follow-up visits stated—in essence, “I can’t help you. You are too fat. It’s your fault.” Not until now, this moment, a couple of months after “the-surgery-gone-wrong-that-ended-in-terrible-complications,” I was being told that it was my fault.He then looked down at his pager that had conveniently buzzed within minutes after he delivered this news, and then walked out of the examining room leaving me to fend for myself in dealing with serious and life-changing complications. Susan1*, his Nurse Practitioner, printed out and handed me a standard listing of BMI calculations, marched me into the common hallway to weigh me, pointed out my BMI >30, reinforced the message that he would do nothing to remedy this horrific situation unless I lost 75 pounds, and then sent me on my way.I stood outside the hospital in shock. This just wasn’t happening, and it couldn’t be happening to me. I had grown to trust this surgeon, and I was struggling to comprehend what had just happened. As the shock wore off, I reengaged in several failed attempts to get help from him. He seemed to have convinced himself that the reason the surgery had gone awry was because of my excess weight, and not because, as I later learned, I had been misdiagnosed and the procedure, as it was performed, was far too aggressive. My health condition was deteriorating and it appeared as if weight was being scapegoated for the complications.If a solution was to be found, I was going to have to find it. After many months of research, I discovered that I have lipedema, an unrecognized [End Page E6] and generally misdiagnosed hereditary, genetically-based fat disorder. I had always had lipedema, which in my case seems to have been triggered at least since puberty. There are an estimated 17 million women in the USA alone who have lipedema, unrecognized or misdiagnosed.I, like most other women in America, knew that weight was a personal choice, and fat is a result of eating too much. Or was it? This ingrained and culturally accepted structure of knowledge began to disintegrate. I then asked the question, if this disease of lipedema is a fat disorder—and I had been to many, many doctors in my 63 years—why was it never identified? Why was I left to struggle in a constant battle trying to accomplish the impossible? I then learned about and named “anti-fat bias” and began to unravel the answers.About LipedemaAccording to Karen L. Herbst, Ph.D., M.D., endocrinologist and expert on fat disorders, lipedema (lipoedema in Europe) is an inherited genetic disease, affecting at least 11% of women of all sizes, from the extremely thin to the morbidly obese, resulting in localized fat that is bilateral, symmetrical and usually from the waist to just above the ankles. It can also affect the upper arms. Unlike the “normal” fat of obesity, lipedemic fat cannot be lost through diet and exercise. It is not uncommon for the comorbidity of overweight or obesity to accompany lipedema. Allen and Hines, physicians at the Mayo Clinic, first named Lipedema in 1940.Believed... (shrink)

Having only emerged in the past few decades, Feminist Philosophy is rapidly developing its own thrust in areas of particular importance to feminism-and women more generally-while also reevaluating and reshaping most other fields of philosophy, from ethics to logic and Marxism to environmentalism. It draws not only on feminist philosophers but criticizes, approves, or appropriates the work of the leading philosophers of all times.

One of the most visible symbols of the debate over human rights and national security in the context of the U.S. "War on Terrorism" has been the detainment of Taliban and Al Qaeda fighters at the U.S. naval base in Guantanamo Bay, Cuba, following the U.S. war in Afghanistan. The controversy concerning the fate of the nearly 600 prisoners demonstrates the emergence of new modes of democratic deliberation over how to strike the balance between rights and security. These new modes (...) of deliberation involve nongovernmental organizations and individuals who function as norm entrepreneurs, by mobilizing public opinion through transnational networks of opinion-makers and policymakers. Transnational networks of norm entrepreneurs have emerged where traditional avenues for foreign policymaking in the U.S. have failed to create a space for meaningful consideration of human rights in the rights/security balance. These traditional avenues are envisioned in the Constitution, which gives the President authority regarding foreign affairs, bounded by checks provided to Congress and the courts. While the goal of the constitutional process is to bring these institutional players into a dialogue, Congress and the judiciary have failed to engage the President in a conversation regarding the balance between human rights and national security. In the absence of initiatives by the government, nongovernmental actors have used communication structures within transnational networks to promote what this Article calls a dialogic approach to enforcement of human rights law. (shrink)

Disorders of consciousness (DOC) are a family of related neurological syndromes characterized by deficits of varying degrees of wakefulness (e.g., sleep–wake cycles and arousal) or awareness (e.g., reacting to stimuli, interacting with the environment). Although coma rarely persists for more than a few weeks, some patients remain in a subsequent vegetative state or a minimally conscious state for months or years. Caring for patients with DOC raises ethical questions, but the perspectives of healthcare providers on these questions remain poorly documented. (...) We conducted a qualitative study involving healthcare providers with different backgrounds. Semistructured interviews were used to explore attitudes toward ethical issues. We found that contextual (e.g., time, resource allocation) and relational aspects (e.g., communication process, families) shaped how ethical challenges surfaced and were managed. We call for greater awareness of contextual, institutional and social aspects and focus on these issues in training programs. (shrink)

L’émergence de l’économique doit-elle être comprise comme l’émancipation des conduites privées de la tutelle politique, ou comme la promotion publique de conduites jusque-là simplement privées, ou particulières? Confrontant le récit classiquement libéral de l’auto-affirmation de l’individu à l’analyse de la recomposition des sphères sociales (famille, économie, État) à l’époque moderne, tout en s’appuyant sur la distinction entre économie formelle et économie substantielle, l’article argumente en faveur de l’étude des sphères qui permet non seulement de rendre compte de l’articulation de l’économique (...) et du politique, mais également du statut de l’individu. (shrink)

« La liberté consiste à n'être soumis qu'aux lois»: cette idée, que Turgot attribue aux «écrivains républicains», a sans doute sa place dans la tradition républicaine. Il s'agit cependant d'une idée essentiellement moderne, et pas nécessairement républicaine, développée dans la critique de l'absolutisme: on en retient l'importance qu'il y a à faire la loi, tout en refusant que qui que ce soit puisse se placer au-dessus des lois. Montesquieu fait du gouvernement modéré, qui peut être une monarchie, le gouvernement de (...) la loi, celle-ci garantit à l'action rationnelle la prévisibilité et la constance dont elle a besoin. C'est Rousseau qui fait du gouvernement de la loi un thème républicain, en identifiant autogouvernement et autonomie. Lier la liberté à la loi, c'est insister sur l'existence politique des libertés: depuis Turgot, les libéraux y voient une menace pour les droits. (shrink)