This essay is composed of five stories written by practicing physicians about their patients. Each clinical story describes a challenging ethical condition–potential abuse of medical power, gravely ill and probably over-treated newborns, iatrogenic narcotic addiction, deceived dying people. Rather than singling out one ethical conflict to resolve or adjudicate, the authors attempt, through literary methods, to grasp the singular experiences of their patients and to act according to the deep structures of their patients' lives. Examining these five stories with simple (...) literary tools–attention to narrative frames, time, plot, and desire–reveals the mechanisms through which acts of writing and reading contribute to clinical clarity and ethical actions. (shrink)

Psychophysical studies of change blindness indicate that, at any instant, human observers are aware of detail in few parts of the visual field. Such results suggest, to some theorists, that human vision reconstructs only a few portions of the visual scene and that, to bridge the resulting representational gaps, it often lets physical objects serve as their own short-term memory. We propose that human vision reconstructs no portion of the visual scene, and that it never lets physical objects serve as (...) their own short-term memory. (shrink)

Three experiments investigated the relationship between subjective experience and attentional lapses during sustained attention. These experiments employed two measures of subjective experience to examine how differences in awareness correspond to variations in both task performance and psycho-physiological measures . This series of experiments examine these phenomena during the Sustained Attention to Response Task . The results suggest we can dissociate between two components of subjective experience during sustained attention: task unrelated thought which corresponds to an absent minded disengagement from the (...) task and a pre-occupation with one's task performance that seems to be best conceptualised as a strategic attempt to deploy attentional resources in response to a perception of environmental demands which exceed ones ability to perform the task. The implications of these findings for our understanding of how awareness is maintained on task relevant material during periods of sustained attention are discussed. (shrink)

Recent public hearings on misconduct charges belie the conjecture that due process will perforce defeat informed scientific reasoning. One notable case that reviewed an obtuse description of experimental methods displays some of the subtleties of differentiating carelessness from intent to deceive. There the decision of a studious nonscientist panel managed to reach sensible conclusions despite conflicting expert testimony. The significance of such a result may be to suggest that to curtail due process would be both objectionable and unproductive.

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This (...) paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who (...) were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence. Des interviews structurés ont eu lieu avec 149 infirmiers/ères dans sept pays en Amérique, Asie, Australie et Europe concernant l'alimentation des malades gravement dément qui refusent de manger. La raison la plus générale pour des infirmiers/ères d'être prêt à changer leures décisions de donner à manger ou non sont: un ordre du médecin, la demande du mari de la malade ou de la réunion du personnel. Il y avait un lien entre la volonté de nourir et le rang des principes éthiques. Les infirmiers/ères les plus enclins de nourir la malade le plus souvent donnaient un rang supérieur au principe éthique de la sainteté de vie, pendant que ceux et celles qui choisissaient de ne pas nourrir la malade donnaient un rang supérieur au principe éthique de l'autonomie. Tous insistaient sur l'importance du principe éthique de la bienfaisance. Konstruktive Interviews wurden mit 149 ausgebildeten Krankenschwestern und Pfleger in sieben Ländern in Amerika, Asien, Australien und Europa gehalten über die Ernährung von schwer von Dementia praecox leidenden Patienten, die das Essen verweigern. Die gewöhnlichsten Gründe des Pflegepersonals für die Bereitwilligkeit, ihre Entscheidung, zu ernähren oder nicht, zu ändern, waren Anordnungen vom medizinischen Chef, Anfragen vom Ehemann der Patientin und/oder einer Personalsitzung. Es bestand ein Zusammenhang zwischen der Bereitwilligkeit zur Ernährung und dem Rang der ethischen Prinzipien. Die Pflegenden, die sich am meisten neigten, die Patientin zu ernähren, gaben dem ethischen Prinzip der Heiligkeit des Lebens einen hohen Rang, während die, die meistens vorzogen, die Patientin nicht zu ernähren, gaben dem ethischen Prinzip der Autonomie einen hohen Rang. Alle Pflegenden legten grossen Wert auf das ethische Prinzip der Wohltätigkeit. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.2 (2003) 277-278 [Access article in PDF] John Hedley Brooke, Margaret J. Osler, and Jitse M. van der Meer, editors. Science in Theistic Contexts: Cognitive Dimensions. Chicago: University of Chicago Press Journals Division, 2001. Pp. xiii + 376. Cloth, $39.00. Paper, $25.00. Some twenty years ago, when I submitted a dissertation proposal to explore connections between theologies of creation and views of scientific (...) knowledge in the seventeenth century, my doctoral committee was not initially enthusiastic—my idea might make a good dissertation in religion, but was it really history of science? I doubt I would have a similar experience today. Not only has the "warfare" thesis of science and religion been laid permanently to rest, historians have begun seriously to question whether it makes sense even to treat "religion" and "science" in an essentialist manner as separate ways of thinking that do not ordinarily interact. Many detailed case studies demonstrating a variety of fascinating, often important connections between science and religion have appeared from leading scholars in the past two decades. This trend continues in the latest volume of Osiris, which contains sixteen essays documenting various ways in which religious beliefs have influenced the actual content and presentation of science.The volume opens with two companion essays laying out the terrain. First, Brooke engages the new methodological and conceptual problems that confront historians following the demise of the "warfare" thesis. Then Stephen Wykstra offers criteria for sorting out the various roles for metaphysical and religious beliefs (which he distinguishes) in shaping scientific knowledge. The case studies begin with E. Jamil Ragep's essay on medieval Islamic astronomy, arguing that religion sometimes had a constructive role—a rather novel claim for Islamic science, he points out. Noah J. Efron and Menachem Fisch show how early modern Jewish exegetical practices influenced David b. Solomon Gans's interpretations of astronomical texts, and quite possibly his interpretation of nature also. A Christian astronomer is next, as Peter Barker and Bernard R. Goldstein detail how Johannes Kepler's theology contributed directly to the discovery of scientific laws. Maurice A. Finnocchiaro then reviews various accounts of the Galileo affair, finding far more conflict in the subsequent historiography of the events than in the trial itself.Moving from astronomy to natural philosophy, Margaret G. Cook's essay on Robert Boyle examines the web of connections between theology, the mechanical philosophy, and [End Page 277] "the Aristotelian philosophy that he sought to replace." She demonstrates that Boyle used the classical art/nature distinction "to interpret the biblical account of the Creation and to argue that chemical techniques offered experimental confirmation that the world, created by art, worked by the same mechanical principles as artificial objects, not by the inherent agency of Aristotelian nature" (136). Margaret J. Osler also writes about Boyle. Contrary to the traditional view that final causes were expunged from science by the mechanical philosophy—a view that originated in the "positivism and scientific optimism" of the postwar period (168)—she proves that final causality remained central to the thought of Boyle and Pierre Gassendi. The essay by Stephen D. Snobelen presents substantial evidence that the famous General Scholium, appended to the second edition of Isaac Newton's Principia, was a carefully worded declaration of Newton's heterodox theology. "A Trinitarian," Snobelen concludes, "could not have written the General Scholium" (186). He also shows the degree to which Newton's theology shaped his overall natural philosophy, decisively debunking the late Richard S. Westfall's view that such influences could not be found.The final seven essays are mainly devoted to nineteenth-century science. Michael J. Crowe documents several ways in which Christian beliefs about divine goodness and the Incarnation affected astronomy. Martin Fichman shows how Alfred Russel Wallace's theism—not merely a vague spiritualism, as traditional accounts claim—"shaped the cognitive content of his mature evolutionary synthesis, which included a theoretical reconceptualization of the scope of natural selection" (227). In a revisionist account of Charles Darwin's philosophy of "nature," Phillip R. Sloan challenges the received view that... (shrink)

The proliferation of personal data collection practices fundamentally reshapes how society is ordered and commercialized, and demands reconsideration of the possibilities for a just and equitable s...

Priorities in Medical Research was published in 1988 by a select committee of the House of Lords. The report ushered in an era of NHS research and development that lasted from 2001 to 2006. The inquiry's origins lay in concerns about academic medicine in the United Kingdom, yet PMR gave relatively little attention to this subject. Instead the report focused critically on the disconnect between the Department of Health and the NHS in R & D. This, the committee argued, had (...) led to the neglect of research into health services and public health. To sidestep the report's unwelcome proposal for a National Health Research Agency, the department eventually grafted R & D management onto structures created as part of wider NHS reforms. The Medical Research Council successfully pursued a strategy of keeping the committee's attention away from sensitive aspects of its own programme. The final focus of PMR was shaped by an alignment between committee members with an industrial view of research and champions of health services research. The actions of the various actors involved are interpreted using elite models of the state, and the applicability of these models is critically examined. (shrink)

Background: The division of non-paid labor in heterosexual parents in the West is usually still gender-based, with mothers taking on the majority of direct caregiving responsibilities. However, in same-sex couples, gender cannot be the deciding factor. Inspired by Feinberg’s ecological model of co-parenting, this study investigated whether infant temperament, parent factors (biological relatedness to child, psychological adjustment, parenting stress, and work status), and partner relationship quality explained how first-time gay, lesbian, and heterosexual parents divided labor (childcare and family decision-making) when (...) their infants were four months and 12 months old. We also tested whether family type acted as a moderator. Method: Participants were drawn from [MASKED FOR REVIEW]. Only those who provided information about their biological relatedness (yes or no) to their child (N = 263 parents) were included. When infants were four months (T1), parents completed a password-protected online questionnaire exploring their demographic characteristics including work status and standardized online-questionnaires on task division (childcare and family decision-making), infant temperament, parental anxiety, parental depression, parental stress, and partner relationship satisfaction. When infants were 12-months-old (T2), parents provided information about task division and their biological relatedness to their children. Results: Linear mixed models showed that no factor explained the division of family decision making at T1 and T2. For relative time spent on childcare tasks at T1, biological relatedness mattered for lesbian mothers only: biologically related mothers appeared to spend more time on childcare tasks than did non-related mothers. Results showed that, regardless of family type, parents who were not working or were working part-time at T1 performed more childcare tasks at T1. This was still true at T2. The other factors did not significantly contribute to relative time spent on childcare tasks at T2. Conclusion: We had the opportunity to analyze the division of non-paid tasks in families where parenting was necessarily planned and in which gender could not affect that division. Although Feinberg’s model of co-parenting suggests that various factors are related to task division, we found that paid work outside the home was most important during the first year of parenthood in determining caregiving roles. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by (...) policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

Background: The Declaration of Helsinki, the World Medical Association’s statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.Methods: A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.Results: There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, (...) 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.Interpretation: Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA. (shrink)

BackgroundDespite rapid growth of the scientific literature, no consensus guidelines have emerged to define the optimal criteria for editors to grade submitted manuscripts. The purpose of this project was to assess the peer reviewer metrics currently used in the surgical literature to evaluate original manuscript submissions.MethodsManuscript grading forms for 14 of the highest circulation general surgery-related journals were evaluated for content, including the type and number of quantitative and qualitative questions asked of peer reviewers. Reviewer grading forms for the seven (...) surgical journals with the higher impact factors were compared to the seven surgical journals with lower impact factors using Fisher’s exact tests.ResultsImpact factors of the studied journals ranged from 1.73 to 8.57, with a median impact factor of 4.26 in the higher group and 2.81 in the lower group. The content of the grading forms was found to vary considerably. Relatively few journals asked reviewers to grade specific components of a manuscript. Higher impact factor journal manuscript grading forms more frequently addressed statistical analysis, ethical considerations, and conflict of interest. In contrast, lower impact factor journals more commonly requested reviewers to make qualitative assessments of novelty/originality, scientific validity, and scientific importance.ConclusionSubstantial variation exists in the grading criteria used to evaluate original manuscripts submitted to the surgical literature for peer review, with differential emphasis placed on certain criteria correlated to journal impact factors. (shrink)

This study makes a sizeable leap forward in our understanding of the philosophical and jurisprudential thought related to ownership and inheritance in medieval and early modern India. A seminal 1962 monograph by J.D.M. Derrett has long provided the best account of the intellectual history of Indic ideas of ownership and property. Both concepts in turn underpinned debates about inheritance that later became central to the British colonial administration of what came to be known as Hindu law in the nineteenth century. (...) Fleming's book clears away extraneous detours in Derrett's work to focus instead on three clear lineages of legal thought that each draw on distinct philosophical foundations. The result is a story with... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:564 BOOK REVIEWS illuminating re-examination of the category of inwardness in Kierkegaard 's writings. The majority of the essays in the hook are similarly suggestive and will prove rewarding and interesting reading-they echo the aim and gift, share by Wittgenstein and Kierkegaard, of "making their readers thinkers" (xvi). University of Virginia Charlottesville, Virginia M. JAMIE FERREIRA Let the Future Come. By WILFRED DESAN. Washington, D.C.: Georgetown University Press, 1987. (...) Pp. 152. $9.95 (paper). Toward a lust Social Order. By DEREK L. PHILLIPS. Princeton: Princeton University Press, 1986. Pp. 434. $12.50. After several decades of doldrum thinking, social ethics, i.e., personal and political ethics done on the same canvas, is undergoing a welcome renewal. Perhaps spurred by the growing awareness of the massive problems of our tiny planet, thinkers from diverse areas are beginning to offer what the social sciences call "grand theory." Both Desan and Phillips make valuable contributions to this project and represent the best levels of refleotion from the teleological and deontological perspectives respectively. Desan's essay is the final volume of three, hut may be read independently of the earlier studies, discussed by this reviewer in 1973 in The Thomist (Vol. 37, pp. 249-255). If Desan has a core concept for his thinking it is planetary peace and the human individual as gardener and guardian of this admittedly future state of affairs. Phillips, critically inheriting the Anglo-American rights tradition, focuses on the person, not the planet, on the distinctiveness of the part, not on Desan's projeotion of a whole humanum composed of parts (each a member of the human community yet only a member). The metaphysical background here, then, is the whole-of-parts versus parts·of-awhole dialectic. Read together the two works would truly stimulate a graduate ethics seminar, for we see the renewal of ethical,thinking against some classical ontological themes. For Desan, the person is homo custos, self-aware becoming otheraware ; for Phillips, the person is the source and enactor of rights. He offers heavy criticism of the virtue/community school's orientation towards the common good of society, with subsidiary private rights located within that context. This is the weakest part of his massive survey of recent ethics. Phillips simply cannot see the reality of human community, which is exactly what Desan is determined to project as BOOK REVIEWS 565 our only possible future. Desan's combination of Thomism and Hegel stands to the far side of Phillips's Lockean stress on private rights as the base criterion for any future just public order. We will look first at Desan's final effort to summarize a notion of " planetary " existence that will be valid both individually and communally and then turn to Phillips's detailed, Rawls-like approach. Desan's argument against the primacy of the individual over the world community was carefully nuanced in his two earlier volumes; he has no intention of denigrating the person in order to celebrate the planet, and he is no partisan of the " deep ecology " effort to elevate nature above the sub-category human nature. His planet is social and political, a cosmic existent dependent upon specifically human activitynot individual activity at either the personal or national levels but activity at the level of the total earth population. He is not so much detailing yet another agenda for a New World Order as he is striving to raise modern individualized consciousness to a height where the reality of interdependency is rationally undeniable. Desan's appreciative critique of Husserl's individualized consciousness in his first volume, A Noetic Prelude to a United World, displayed the plight of personalized consciousness as against planetary awareness. In this final panel of his triptych, he synthesizes that critique: "Where the individual Observer is the magister, there are as many worlds as there are magistri." This privatized existence is not to be denied but rather seen for what it is: a limit instead of a secure startpoint for either ethical or epistemological theory. His second volume stressed that our very awareness of this limitation gives rise, perhaps in a Hegelian dialectic, to potential for participation in global existence. To resist this cooperative... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:President’s Council on BioethicsEdmund D. Pellegrino (bio) and F. Daniel Davis (bio)Approximately two weeks before what was to have been its final meeting, the White House dissolved the President’s Council on Bioethics by terminating the appointments of its 18 members. The letters of dismissal, dated 10 June 2009, informed the members that their service on the Council would end with the close of business the next day.The Council’s (...) term was set to expire on 30 September 2009. After President Obama’s election in November and during the transition, we were advised to proceed on the assumption that the Council would be permitted to cease on that date. Reasons for the abrupt move to disband the Council are unknown. We have accepted the fact that we Council members served at the pleasure of the President and that he simply exercised his rightful prerogative. No explanation is therefore required.Some observers have speculated that the action was retaliatory. They related to the fact that several members of the Council disagreed with the President’s stem cell policy in a signed statement published in the Hastings Center’s Bioethics Forum. Others have speculated that the move was pre-emptive. At its final meeting, scheduled for 25–26 June, the Council was set to sign-off on two of its final publications. One was a comprehensive report on the ethics of organ transplantation, and the other a white paper entitled Health Care and the Common Good. The aim was immediately to release the latter as a contribution to the intensifying debate about health care reform. Health Care and the Common Good could well have aided rather than impeded the President’s drive to better control health care costs and achieve universal coverage. The Council report attempted to ground both goals in the ethical framework of, as the title indicates, the common good of all Americans.In his letter terminating the members’ appointments, Assistant to the President for Presidential Personnel Don Gips said that the President “recognizes the values of having a commission of experts in bioethical issues to provide objective and non-ideological bioethics advice to his administration.” Gips went on to say that the President is “currently rethinking the purposes and goals of such a bioethics commission, and is carefully considering a revitalized mission and mandate.” And, [End Page 309] responding to media enquiries, White House press officer Reid Cherlin explained that the President’s Council was terminated because it was a “philosophically leaning advisory group” and, according to a New York Times account by Nicholas Wade, “because it favored discussion over developing a shared consensus.” As for the ultimate outcome of the President’s “rethinking,” Cherlin indicated that President Obama will appoint a new commission with the mandate of offering “practical policy options” in bioethics.In the light of our experiences with the Council, we leave it with hopes that certain questions of national importance will be addressed. In light of the nature of federal advisory commissions, what is or are the proper roles of a national bioethics commission? If the aim is to provide advice and counsel to the President or, perhaps to the U. S. Congress, is that advice best rendered as a group consensus or as an in-depth exploration of the inevitably conflicting ethical perspectives on a given issue? How should such a commission be constituted—with what sorts of individuals? And what is the nature of the expertise that they individually and collectively bring to the commission’s functions? If the commission is to promote public debate and discussion, how exactly should it go about that task? And how is the efficacy of a commission to be assessed? Such questions inevitably lead us deep into contested territory, as the experience of this Council has shown: into the intersections of politics, religion, and science and into the relations between practice and theory—between policy and what some seem to deride as “philosophy.” Indeed, policy without an underlying philosophy is an edifice without a foundation; philosophy without policy is a foundation without an edifice.At the last meeting of the Council in March 2009, we launched a discussion of these questions with the... (shrink)