In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered--or mandated--even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship and (...) call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards. (shrink)

An experiment investigated the relationship between the ability to encode verbal stimuli during an attentional lapse. The task employed a variation on the sustained attention to response task which involved the detection of an infrequent target against a background of words. As a manipulation, participants were either instructed to encode the stimuli or were merely exposed to the stimuli. Retrieval was measured using process dissociation. Irrespective of the instructions given to the participants during the task, participants were more likely to (...) retrieve information on the basis of recollection after an error was made than before, whilst the likelihood of retrieving information on the basis of familiarity remained invariant over the same period. The implications of this result for methods of investigating subjective experience are discussed. (shrink)

It is difficult for a philosopher to contemplate with equanimity the fate which is overtaking, if it has not already overtaken, the word logical. “Logical” is one of a trio of words selected by the Greeks to represent the three main departments of philosophy; and of this trio the other two members, the words “ethical” and “physical,” have at least remained respectable; and to be called “philosophical” is almost a compliment. But to be logical is apparently, at least in England, (...) to enter on very questionable courses: it is to class yourself with every reckless extremist, with the latest and wildest ism in art, politics, and literature, with Russians and Frenchmen and the “Latin mind.” No less a person than H.M. Secretary of State for Foreign Affairs, on no less an occasion than an Assembly of the League of Nations, has lately proclaimed proudly to the gathered nations that lack of logic is the special virtue and privilege of the British Empire. The “lesser breeds with in the law” heard no doubt and trembled, wondering how they could ever compete with a Power to which the laws of thought themselves were mere expediencies. Thus it appears, if Sir Austen Chamberlain is right, that to be logical is to fall into a human weakness or vice, and that this weakness or vice is fortunately commoner outside than inside the British Empire. (shrink)

The purpose of this article is to highlight ways in which institutional policymakers tend to insufficiently conceptualise their role as ethics practitioners. We use the case of blood product recall notification as a means of raising questions about the way in which, as we have observed it, discourse for those who make institutional ethics policies is constrained by routine balancing of simplified principles to the exclusion of reflexive practices—those that turn ethics reasoning back on itself. The latter allows ethics practitioners (...) with comparatively little formal training to take ownership of traditional parameters, which define their discussions and ultimately ought to make them more insightful when doing ethics. Thus, in the midst of calls for more training to increase the competency of ethics committees, we suggest that an additional problem of how these lay ethicists conceive of their roles also needs to be addressed. (shrink)

Wykstra’s paper defends two objections to my reasoning in The Wisdom to Doubt. One says that we in fact do take evidence to be representative of all the relevant evidence that exists when forming the judgment that it makes some proposition probable, the other that our judgments as to the representativeness of evidence are often justified, and can be justified even in matters of religion. Both objections are instructive but ultimately unsuccessful, as I show here.

Religious epistemology is widely regarded as being in a flourishing condition. It is true that some very sharp analytical work on religion has been produced by philosophers in the past few decades. But this work, for various cultural and historical reasons, has been kept within excessively narrow bounds, and the result is that the appearance of flourishing is to a considerable extent illusory. Here I discuss three important ways in which improvements to this situation might be made.

Fertility preservationFertility preservation is increasingly available to pediatric and adolescentAdolescents populations whose future fertility is threatened. These reproductive technologies raise questions about the interestsInterest of younger children in future fertility, parental interestsInterest and influences on adolescentsAdolescents, and the interestsInterest of persons no longer living. Ethical and legal analyses of specific case examples highlight key issues of parental permissionParental permission and minorMinorassentAssent, emerging adolescentAdolescentsautonomyAutonomy, and postmortemRetrieval, gametegamete retrievalGamete retrieval.

Stephen Finlay’s proposed methodology for defending the central theses of his impressive Confusion of Tongues is an underexplored aspect of this work.1 1 His official methodology is analytic : A reduction of normative to non-normative vocabulary. Here, I argue that taking this official line at face-value forces the reader to conclude that the reductions at the heart of that book cannot be correct. In contrast, a philosophical methodology that does not proceed via analyses would better support those reductions, then understood (...) as non-analytic. As we’ll see below, there are independent, empirical reasons to reject a philosophical methodology that proceeds via analyses. I conclude that there is a method for the study of ethical language that better serves Finlay’s primary philosophical aims. The lesson, though, is generalizable: Given the array of normative and meta-normative theories, we want a semantics for normative discourse to be capable of expressing, we should expect that the more plausible such views will not be defended via analyses. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Health care services increasingly face patient populations with high levels of ethnic and cultural diversity. Cultures are associated with distinctive ways of life; concepts of personhood; value systems; and visions of the good that affect illness experience, help seeking, and clinical decision-making. Cultural differences may impede access to health care, accurate diagnosis, and effective treatment. The clinical encounter, therefore, must recognize relevant cultural differences, negotiate common ground in terms of problem definition and potential solutions, accommodate differences that are associated with (...) good clinical outcomes, and manage irresolvable differences. Clinical attention to and respect for cultural difference (a) can provide experiences of recognition that increase trust in and commitment to the institutions of the larger society, (b) can help sustain a cultural community through recognition of its distinct language, knowledge, values, and healing practices, and (c) to the extent that it is institutionalized, can contribute to building a pluralistic civil society. (shrink)

A côté de la méthode quantitative, qui étudie avec tant de succès les données du domaine inorganique par les relations quantitatives formelles, il faut établir la méthode qualitative, qui examinerait les données du domaine organique, psychique et culturel à l'aide des relations qualitatives matérielles ; et cela, en éclaircissant le sens reel de ces données au moyen de leur destination fonctionnelle. Cette destination une fois fixée, il devient possible de déterminer les conditions de son objectivation plus ou moins adéquate.