Background Surgery for intersex infants should be delayed until individuals are able to decide for themselves, except where it is a medical necessity. In an ideal world, this single principle would suffice and such surgeries could be totally prohibited. Unfortunately, the world is not perfect, and, in some places, intersex neonates are at risk of being abandoned, mutilated or even killed. As long as intersex persons are at such high risk in some places, any ethical guidelines for intersex surgeries will (...) need to take these extreme risks of harm into account. Main text I therefore argue for five basic principles that ought to inform ethics guidelines for surgical interventions in intersex children, specifically in contexts in which such children are at risk of significant harm. What I set out to come up with is a set of principles that do not completely prohibit surgery, but only allow it where a strong case can be made for its necessity, in the best interests of the child, and where there is some kind of oversight to prevent misuse. The first principle is that interventions as drastic as these surgeries should only be performed when there is strong evidence that they are beneficial and not harmful. The second principle is that in surgeries should normally only be performed in cases of true medical necessity. Principle three is that surgeries should normally be delayed until such time as the intersex person is mature enough to assent to treatment or decide against it. Principle four is that the conventional ethical requirements regarding truth telling apply equally to intersex children as to anyone else. The final principle is that where physicians or parents think that surgery is in the best interests of the child, the burden of proof lies with them. Conclusion It is hoped that these principles might help medical teams and parents make better decisions about intersex surgeries on children, and they would make such surgeries very rare indeed, if they happen at all. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Although many bioethicists have given attention to the special health issues of Africa and to the ethics of research on the continent, only a handful have considered these issues through the lens of African moral thought. The question has been for the most part neglected as to what a distinctively African moral perspective would be for the analysis and teaching of bioethics issues. To address the oversight, the authors of this paper describe embarking on a project aimed at incorporating African (...) moral perspective, values and philosophy into a teaching curriculum. The authors clarify the rationale for the project and discuss the strategies employed in Africanizing the bioethics curriculum. (shrink)

Contributing reviewersThe editors of Philosophy, Ethics, and Humanities in Medicine would like to thank all our reviewers who have contributed to the journal in Volume 10.

Bringing together thinkers from philosophy of religion, religious studies, music, art, and film, while drawing on a wealth of phenomenological resources and methods, a team of renowned scholars provide new vantages on the question of how art is an expression of the human desire for God. In three interrelated parts, chapters employ phenomenological tools to propose new ways for speaking of the desire for God. Scholars first draw upon music, sculpture, film, and painting to develop ways of expressing diverse philosophical (...) and religious aspects characteristic of aesthetic experience. The discussion then opens up to examine the mystical and wounded aspects of embodied interface with God. The final part investigates embodied aesthetic praxis in philosophy of religion and religious studies. (shrink)

I give an account how the principle of ‘respect for autonomy’ dominates the field of bioethics, and how it came to triumph over its competitors, ‘respect for persons’ and ‘respect for free power of choice’. I argue that ‘respect for autonomy’ is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental importance of understanding persons within (...) the nexus of their communal relationships. I defend the claim that ‘respect for persons’ is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for ‘respect for persons’ is problematic because of the important debate around the definition of ‘personhood’ in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging. (shrink)

The Children’s Act and its associated regulations allow for virginity tests to be performed on male and female children over the age of 16. This is subject to a number of legislated conditions, including that informed consent should be obtained. In this article I argue that, whilst it is important that the right to social and cultural practice be protected in South Africa, virginity testing is a practice that cannot be morally justified. Firstly, I defend the claim that the practice (...) is inherently unjust. At least some of those subjected to the tests will inevitably experience the undesirable consequences of a false test result. The practice is also discriminatory as it typically and unjustly targets girl children, since boys are far less commonly tested. I argue further that the practice perpetuates a harmful patriarchal social order. Finally, I contend that any attempts to justify this legislation are fatally flawed, because it is fundamentally irrational, since there is no reliable means of testing for virginity. (shrink)

A recent study using a crossmodal matching task showed that the identity of a talker could be recognized even when the auditory and visual stimuli that were being matched were different sentences spoken by the talker. This finding implies that general temporal features of a person's speech are shared across the auditory and visual modalities.

The main question examined is: How do nurses and other healthcare professionals ensure ethical interprofessional collaboration-in-practice as an everyday practice actuality? Ethical interprofessional collaboration becomes especially relevant and necessary when interprofessional practice decisions are contested. To illustrate, two healthcare scenarios are analyzed through three ethics lenses. Biomedical ethics, relational ethics, and virtue ethics provide different ways of knowing how to be ethical and to act ethically as healthcare professionals. Biomedical ethics focuses on situated, reflective, and nonabsolute principled justification, all things (...) considered; relational ethics on intersubjective, professional, and institutional relations; and virtue ethics on prephilosophical tradition and what it means to be good and to be human embedded in social and political community. Analysis suggests that interprofessional collaboration-in-practice may be more rhetoric than actuality. Key challenges of interprofessional collaboration-in-practice and specific conditions perpetuating dissension and conflict are outlined with specific education and policy recommendations included. (shrink)

The book is divided into three sections. In the first section, Lynch presents what he calls “truisms about truth.” The first truism is that truth is objective. Accepting a kind of Aristotelian realism, Lynch defines “true beliefs” as “those that portray the world as it is and not as we may hope, fear, or wish it to be”. The second truism is that truth is good. The point here is not that truth is morally good, but that it is generally (...) pursued, and the opposite is generally avoided and even ridiculed. Closely related to this is the third truism: truth is a worthy goal of inquiry. The fourth truism is that truth is worth caring about for its own sake. To help recognize this, he refers the reader to the movie, The Matrix. While some may choose to enter the matrix for a short period of bliss, most would prefer to live an authentic life of truth, in the real world. (shrink)

Individuals can often take steps to preserve or improve their own health. They can eat appropriate quantities of healthy foods, exercise, and refrain from smoking. They can obtain preventive care and adhere to their physicians’ advice about how best to manage their health. But they often fail to take these steps.A widespread failure to adopt healthy behaviors can significantly erode public health while increasing health care costs. Obesity, for example, increases the risk of heart disease, stroke, liver disease, and certain (...) cancers. By one estimate, it is responsible for almost 10 percent of medical spending in the United States, or about $147 billion per year. Smoking increases the risk of heart disease, stroke, lung disease, and cancer; it accounts for nearly 20 percent of deaths each year in the United States and about $96 billion in health care expenditures. (shrink)

Achilles is vindictive; he wants to get even with Agamemnon. Being so disposed, he sounds rather like many current crime victims who angrily complain that the American system of criminal justice will not allow them the satisfactions they rightfully seek. These victims often feel that their particular injuries are ignored while the system addresses itself to some abstract injury to the state or to the rule of law itself – a focus that appears to result in wrongdoers being treated with (...) much greater solicitation and respect than their victims receive. If the actual victims are noticed at all, they will likely be told that there is another branch of law – tort law – that has the job of dealing with private injuries and grievances and that, if they pursue this route at their own expense, they might ultimately get some financial compensation for the wrongs done to them. However, just as Achilles felt that mere compensation was inadequate to the kind of injury done to him by Agamemnon, many of these victims will often claim that the injuries they have suffered do not admit of financial compensation. How, they might ask, can a dollar value be set on the humiliation and degradation they have experienced? They might also note that those who injure them tend, unlike Agamemnon, to be judgment-proof – so lacking in resources as to be unable to make any meaningful contribution to any compensation package that the victim may win. (shrink)

Men often make riskier decisions than women across a wide range of real-life behaviors. Whether this sex difference is accentuated, diminished, or stable under stressful conditions is, however, contested in the scientific literature. A critical blind spot lies amid this contestation: Most studies use standardized, laboratory-based, cognitive measures of decision making rather than complex real-life social simulation tasks to assess risk-related behavior. To address this blind spot, we investigated the effects of acute psychosocial stress on risk decision making in men (...) and women using a standardized cognitive measure and a novel task that simulated a real-life social situation. Participants were exposed to either an acute psychosocial stressor or an equivalent control condition. Stressor-exposed participants were further characterized as high- or low-cortisol responders. Results confirmed that the experimental manipulation was effective. On the IGT, participants characterized as low-cortisol responders made significantly riskier decisions than those characterized as high-cortisol responders. Similarly, in the online chatroom, participants characterized as low-cortisol responders were, relative to those in the Non-Stress group, significantly more likely to make risky decisions. Together, these results suggest that at lower levels of cortisol both men and women tend to make riskier decisions in both economic and social spheres. (shrink)

The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, (...) personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

This book focuses on the degree to which certain moral and legal doctrines are rooted in specific passions that are then institutionalised in the form of criminal law. A philosophical analysis is developed of the following questions: when, if ever, should hatred be overcome by sympathy or compassion? What are forgiveness and mercy and to what degree do they require - both conceptually and morally - the overcoming of certain passions and the motivation by other passions? If forgiveness and mercy (...) indeed are moral virtues, what role, if any, should they play in the law? (shrink)

Based on a series of lectures delivered at the University of Virginia in October 1981. Includes bibliographical references and index.

The idea that immoral conduct ought to be criminalized is already often rejected, But not for precisely the right reasons. Victim-Less crimes ought to be decriminalized not (as h l a hart and j s mill argue) because it is immoral to make crimes of them, But because it is contrary to the nature of the criminal law itself. Acts of private immorality do not violate the rights of the participants; thus they cannot be crimes because there is no crime (...) where there is no deprivation of rights. (staff). (shrink)

Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in (...) CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

We have all been victims of wrongdoing. Forgiving that wrongdoing is one of the staples of current pop psychology dogma; it is seen as a universal prescription for moral and mental health in the self-help and recovery section of bookstores. At the same time, personal vindictiveness as a rule is seen as irrational and immoral. In many ways, our thinking on these issues is deeply inconsistent; we value forgiveness yet at the same time now use victim-impact statements to argue for (...) harsher penalties for criminals. Do we have a right to hate others for what they have done to us? Providing a nuanced approach to a proper understanding of the place of our strongest emotions in moral, political, and personal life, and using lucid, easily understood prose, this volume is a classic example of philosophical thinking applied to a thorny, everyday problem. (shrink)