In 2006, I was diagnosed with cancer. This began a crash course in real-world medical ethics. Having cancer was awful, but it was instructive, too. The experience gave me a new understanding of what my profession is about. Individuals in the bioethics field often address topics related to cancer, such as medical decision-making, the patient-physician relationship, clinical trials, and access to health care. Yet few engaged in this work have lived with cancer themselves. Experience as a cancer patient or family (...) caregiver extends and deepens one’s thinking about serious illness and bioethics. During my time as a cancer patient, I kept in touch with several colleagues immersed in their own cancer .. (shrink)

“Lambeth Palace is my Washpot. Over Fulham have I cast my breeches.” So declared the novelist and secularist H. G. Wells in a letter to his mistress, Rebecca West, in May 1917. His claim was that, because of him, Britain was “full of theological discussion” and theological books were “selling like hot cakes”. He was lunching with liberal churchmen and dining with bishops. Certainly, the first of the books published during Wells’s short “religious period”, the novel Mr. Britling Sees (...) It Through, had sold very well on both sides of the Atlantic and made Wells financially secure. Geoffrey Studdert Kennedy (“Woodbine Willie”) wrote that, “Everyone ought to read Mr. H. G. Wells’s great novel, Mr. Britling Sees It Through. It is a gallant and illuminating attempt to state the question, and to answer it. His thought has brought him to a very real and living faith in God revealed in Jesus Christ, and has also brought relief to many troubled minds among the officers of the British Army.” Yet, Wells’s God was explicitly a finite God, and his theology was far from orthodox. How can we account for his boast and for the clerical affirmation which he certainly did receive? This article examines and re-evaluates previous accounts of the responses of clergy to Wells’s writing, correcting some narratives. It discusses the way in which many clergy used Mr. Britling as a means by which to engage in a populist way with the question of theodicy, and examines the letters which Wells received from several prominent clerics, locating their responses in the context of their own theological writings. This is shown to be key to understanding the reaction of writers such as Studdert Kennedy to Mr. Britling Sees It Through. Finally, an assessment is made of the veracity of Wells’s boasting to his mistress, concluding that his claims were somewhat exaggerated. “Lambeth Palace is my Washpot, Over Fulham have I cast my breeches.” Mit diesen Worten erklärte der literarisch außergewöhnlich erfolgreiche und entschieden säkular denkende, kirchenkritische Schriftsteller und Science-Fiction-Pionier Herbert George Wells seiner Geliebten, dass seinetwegen Großbritannien “full of theological discussion” sei. Nicht ohne Eitelkeit schrieb er es seinem im September 1916 mit Blick auf den Krieg geschriebenen und stark autobiographisch gefärbten Roman Mr. Britling Sees it Through von knapp 450 Seiten zu, dass theologische Bücher reißenden Absatz fänden. Auch war er stolz darauf, liberale Kleriker zum Lunch zu treffen und von Bischöfen zum abendlichen Dinner eingeladen zu werden. In einer kurzen Phase seines Lebens war – oder inszenierte sich – Wells als ein frommer, gläubiger Mensch. Sein damals veröffentlichter Roman Mr. Britling Sees It Through verkaufte sich sowohl in Nordamerika als auch im Heimatland so gut, dass der Autor nun definitiv finanziell gesichert war. Der anglikanische Priester und Dichter Geoffrey Studdert Kennedy, der im Ersten Weltkrieg Woodbine Willie genannt wurde, weil er verletzten und sterbenden Soldaten in den Phasen der Vorbereitung auf den Tod Woodbine-Zigaretten anbot, empfahl die Lektüre von Wells’ “great novel” Mr. Britling mit den Worten: “It is a gallant and illuminating attempt to state the question, and to answer it. His thought has brought him to a very real and living faith in God revealed in Jesus Christ, and has also brought relief to many troubled minds among the officers of the British Army.” Allerdings war H. G. Wells’ Gott ein durchaus endlicher Gott, und seine Theologie war alles andere als orthodox. Wie lassen sich dennoch seine evidente Prahlerei und die emphatische Zustimmung zu seinem Roman in den britischen Klerikereliten erklären? Im Aufsatz werden zunächst einige ältere Deutungen der Zustimmung führender Kleriker zu Wells’ Roman untersucht und einige der dabei leitenden Deutungsmuster kritisch infrage gestellt. Deutlich wird, dass nicht wenige anglikanische Geistliche Mr. Britling dazu nutzten, um höchst populistisch das umstrittene Theodizeeproblem anzusprechen. Auch werden die Briefe prominenter Geistlicher an Wells analysiert, mit Blick auf ihre eigenen Publikationen. Diese Reaktionen haben stark Studdert Kennedys Haltung zu Mr. Britling Sees It Through beeinflusst. Besonders aufrichtig war Wells mit Blick auf sich selbst allerdings nicht. Die Selbstinszenierung gegenüber seiner Geliebten war einfach nur peinliche Übertreibung. (shrink)

Translational science is a 21st century mission. Government officials and industry leaders are making huge investments in an attempt to transform more basic science discoveries into therapeutic applications. Scientists and policymakers express great excitement about the medical advances that could come with the current bench-to-bedside campaign.A key step in translational science is the move from animal and other preclinical studies to initial human testing. Researchers ability to predict human effects is limited, and first-in-human tests present significant uncertainty. Participants in this (...) form of research face risks and can experience serious, even lethal, harm. Well-known incidents involving Jolee Mohr and Jesse Gelsinger, as well as subjects in the 2006 study of the investigational agent TGN1412, show the dangers that can arise in early human research.The bench-to-bedside campaign will need many volunteers to participate in early human testing. Investigators and regulators must not allow the policy enthusiasm for translational science to overshadow the commitment to protect human subjects. Participants in exploratory research are diverse and as a group lack characteristics usually associated with vulnerable populations, such as impaired decisional ability or economic or educational disadvantage. (shrink)

The term “therapeutic misconception” was coined in 1982 by Paul Appelbaum, Loren Roth, and Charles Lidz. Appelbaum and his colleagues interviewed participants in several psychiatric studies, including a drug trial with a placebo control arm. Appelbaum's group found that many people were unaware of the differences between participating in a study and receiving treatment in the clinical setting. Rather than understanding these differences, study participants tended to believe that therapy and research were governed by the same primary goal: to advance (...) the individual patient's best interests. Appelbaum's group labeled this mistaken belief the therapeutic misconception. (shrink)

Most patients suffering from progressive dementia have thoughts, emotions, perspectives, and perceptions of a world of experience. Decisions about life‐sustaining treatment should incorporate a principled approach to evaluating what life is like for these patients.

Proofs are central, and unique, to mathematics. They establish the truth of theorems and provide us with the most secure knowledge we can possess. It is thus perhaps unsurprising that philosophers once thought that the only value proofs have lies in establishing the truth of theorems. However, such a view is inconsistent with mathematical practice. If a proof’s only value is to show a theorem is true, then mathematicians would have no reason to reprove the same theorem in different ways, (...) yet this is a practice they frequently engage in. This suggests that proofs can have a wide variety of values. My purpose in this chapter is to provide a survey of some of them. I will discuss how proofs can have practical value, for example, by helping mathematicians to make new discoveries or learn new mathematical tools, and how they can have abstract value, for example, by being beautiful or explanatory. I will also explore the relationships between different proof values. (shrink)

We consider the current debate between bioconservatives and their chief opponents — whom we dub bioliberals — about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and (...) action, there are circumstances in which they are not reliable. Intuitions — including intuitions about enhancement — are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be. (shrink)

Organisations increasingly use digital nudges to influence their workforces’ behaviour without coercion or incentives. This can expose employees to arbitrary domination by infringing on their autonomy through manipulation and indoctrination. Nudges might furthermore give rise to the phenomenon of “organised immaturity.” Adopting a balanced approach between overly optimistic and dystopian standpoints, I propose a framework for determining the moral permissibility of digital nudging in the workplace. In this regard, I argue that not only should organisations provide pre-discursive justification of nudges (...) but they should also ensure that employees can challenge their implementation whenever necessary through legitimation procedures. Building on Rainer Forst’s concept of the right to justification, this article offers a way to combine contract- and deliberation-based theories for addressing questions in business ethics. I further introduce the concept of meta-autonomy as a capacity that employees can acquire to counter threats of arbitrary domination and to mitigate organised immaturity. (shrink)

van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation (...) to VE; and third, the significant risk of perpetuating under-recognised harms associated with unwanted or unconsented VE. I argue that opt-out consent cannot be ethically justified for VE. Its use would result in further weakening of consent practices, circumvention of individuals’ autonomy, and greater harm for women and birthing people. At the outset, it is important to recognise that the authors do not claim that their approach should be applied to VE, merely that their discussion may have relevance to consent for other interventions beyond episiotomy ‘where consent is also frequently lacking, and which are under-researched’, including VE.1 Nonetheless, it is easy to assume that episiotomy and VE are sufficiently similar that their analysis might be transferred wholesale. I disagree. There are similarities: both interventions are performed on ‘the most intimate and socially sensitive body parts’1; …. (shrink)

Continuing professional education in ethics for psychologists is becoming more common, as psychology licensing boards in 14 states now require continuing education in ethics as a condition of licensure renewal. This article suggests ways to improve the quality of ethics continuing education by diversifying the content and teaching methods.

Mothers serve as an important layer of the health-care system, with special responsi-bilities to care for the health of families and nations. In our social discourse, we tend to treat maternal “choices” as though they were morally and causally Self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers’ caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. I (...) give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

Dr. Elisabeth Kübler-Ross is credited as one of the first clinicians to formalize recommendations for working with patients with advanced medical illnesses. In her seminal book, On Death and Dying,...

In this issue, Paul Menzel and M. Colette Chandler‐Cramer propose a novel advance directive. Besides giving competent people the opportunity to refuse future life‐prolonging medical interventions, they say, advance directives should give people the opportunity to refuse ordinary food and water if they later experience severe dementia.This proposal is both appealing and unsettling. It is appealing because it offers some relief to people seeking to avoid the prolonged decline and extreme incapacity they have witnessed in relatives and friends with advanced (...) dementia. But does it sufficiently protect patients? Menzel and Chandler‐Cramer want to empower competent persons to impose potential discomfort and distress on a later self who cannot understand the reasons for that choice. In this situation, the price of respecting autonomy is paid by a frail incapacitated patient who has no idea why food and water are no longer offered to her. (shrink)

Much of the public debate over laboratory animal use has focused on either the scientist's demand for absolute freedom of inquiry, or the abolitionist's demand for an end to animal use in science. Yet many recent proposals for reform seek instead to balance the interests of laboratory animals in avoiding harm against the interests of research beneficiaries in continued animal use. This essay is an analysis of the intermediate reform positions and their underlying ethical principles. Keywords: animal research, animal experimentation, (...) ethics CiteULike Connotea Del.icio.us What's this? (shrink)

In 1837, Dirichlet proved that there are infinitely many primes in any arithmetic progression in which the terms do not all share a common factor. Modern presentations of the proof are explicitly higher-order, in that they involve quantifying over and summing over Dirichlet characters, which are certain types of functions. The notion of a character is only implicit in Dirichlet’s original proof, and the subsequent history shows a very gradual transition to the modern mode of presentation. In this essay, we (...) describe an approach to the philosophy of mathematics in which it is an important task to understand the roles of our ontological posits and assess the extent to which they enable us to achieve our mathematical goals. We use the history of Dirichlet’s theorem to understand some of the reasons that functions are treated as ordinary objects in contemporary mathematics, as well as some of the reasons one might want to resist such treatment. We also use these considerations to illuminate the formal treatment of functions and objects in Frege’s logical foundation, and we argue that his philosophical and logical decisions were influenced by many of the same factors. (shrink)

Bioethics, Volume 36, Issue 5, Page 500-510, June 2022.

Human Rights Education (HRE) has traditionally been articulated in terms of cultivating better citizens or world citizens. The main preoccupation in this strand of HRE has been that of bridging a gap between universal notions of a human rights subject and the actual locality and particular narratives in which students are enmeshed. This preoccupation has focused on ‘learning about the other’ in order to improve relations between plural ‘others’ and ‘us’ and reflects educational aims of national identity politics in citizenship (...) education. The article explores the learning of human rights through narratives in relations, drawing on Hannah Arendt and Sharon Todd. For this re-thinking of relations in learning human rights, the article argues that HRE needs to address both competing historical narratives on the drafting of the Universal Declaration on Human Rights (UDHR) as well as unique life narratives of learners. (shrink)

Members of the serine/arginine (SR)‐rich protein family of splicing factors play versatile roles in RNA processing steps and are often essential for normal development. Dynamic changes in RNA processing and turnover allow fast cellular adaptions to a changing microenvironment and thereby closely cooperate with transcription factor networks that establish cell identity within tissues. SR proteins play fundamental roles in the processing of pre‐mRNAs by regulating constitutive and alternative splicing. More recently, SR proteins have also been implicated in other aspects of (...) RNA metabolism such as mRNA stability, transport and translation. The‐ emerging noncanonical functions highlight the multifaceted functions of these SR proteins and identify them as important coordinators of gene expression programmes. Accordingly, most SR proteins are essential for normal cell function and their misregulation contributes to human diseases such as cancer. (shrink)

The paper considers nonviolence, not merely as a set of tactics for demonstrations and protests, but as a broad ethical ideal governing attitudes as well as conduct. I argue that the meanings of nonviolence—its relationship to personal and political honor and integrity—may differ with one’s level of privilege and social authorization to employ violence. Furthermore, the moral and attitudinal commitments prominent in some strands of nonviolence theory are in some ways at odds with the needs of survivors of violent abuse—particularly (...) of the kinds typically committed by men against women and children in intimate contexts. There isthus an apparent tension between some of the commitments of nonviolence theory and our obligation to demonstrate solidarity with survivors. Recognizing and resolving this apparent tension is a necessary further step in the development of nonviolence theory. (shrink)

Approaches to supporting autonomy in medicine need to be able to support complex and sensitive decision-making, incorporating reflection on the patient's values and goals. This should involve deliberation in partnership between physician and patient, allowing the patient to take responsibility for her decision. Nowhere is this truer than in decisions around pregnancy and Caesarean section where maternal autonomy can seem to directly conflict with foetal interests. Medical and societal expectations and norms such as the expectations of a ‘mother’, constraints of (...) making decisions in an emergency, and the role of technology in viewing the foetus as a separate patient and surgery as a guarantor of results can all act to limit a woman's autonomy. In considering decisions about Caesarean section, maternal interests in bodily integrity can be dismissed as being less important than the foetus's own interests and the mother's duties to it, despite the inherent risks and impacts of such a major surgical procedure... (shrink)

Book reviewed in this article: To Do No Harm: DES and the Dilemmas of Modern Medicine. By Roberta J. Apfel and Susan M. Fisher.

According to radical moral particularists such as Jonathan Dancy, there are no substantive moral principles. And yet, few particularists wish to deny that something very like moral principles do indeed play a significant role in our everyday moral practice. Loathe at dismissing this as mere error on the part of everyday moral agents, particularists have proposed a number of alternative accounts of the practice. The aim of all of these accounts is to make sense of our appeal to general moral (...) truths in both reaching and justifying our particular moral judgments without thereby violating the particularists' stricture against substantive moral principles. In this paper, I argue that the most prominent non-substantive accounts of moral generalities appealed to by radical particularists – the heuristic account and default reasons accounts – fail in this aim. (shrink)

Despite some important progress over the past decade, academic philosophy remains a male-dominated discipline. This raises questions about how established philosophers can best support and advise female students and junior academics in philosophy. We need to avoid encouraging them to adopt a fatalistic attitude to their success, while also avoiding encouraging them to believe that their success lies in their own hands and that therefore it must be their own fault if they don't succeed. I argue that we can do (...) this by reflecting on what success in a misogynistic culture looks like, and by guiding young female philosophers to distinguish between the changes that it is possible for them, as individuals, to make, and those that require action by many individuals. (shrink)

We can safely infer that a proposition is possible if p is the case. But, I argue, this inference from the actual to the possible is merely explicative in nature, though we employ it at times as if it were ampliative. To make this inference ampliative, we need to include an inference to the best explanation. Specifically, we can draw a substantive conclusion as to whether p is possible from the fact that p is the case, if via our best (...) explanation we can explain how p could occur again in the complete and coherent set of propositions that describes the actual world. (shrink)

New and experienced psychotherapists alike can find themselves overwhelmed by an ethical quandary where there doesn't seem to be an easy solution. This book presents positive ethics as a means to overcome such ethical challenges. The positive approach focuses on not just avoiding negative consequences, but reaching the best possible outcomes for both the psychotherapist and the client. The authors outline a clear decision-making process that is based on three practical strategies: the ethics acculturation model to help therapists incorporate personal (...) ethics into their professional roles, the quality enhancement model for dealing with high-risk patients who are potentially harmful, and ethical choice-making strategies to make the most ethical decision in a situation where two ethical principles conflict. Throughout the decision-making process, psychotherapists are encouraged to follow four basic guidelines: Focus on overarching ethical principles Consider intuitive, emotional, and other nonrational factors Accept that some problems have elusive solutions Solicit input from colleagues and consultation groups Numerous vignettes illustrate how to apply positive ethics to many different ethical challenges that psychotherapists will likely encounter in practice. (shrink)

The term “off-label drug use” refers to drugs that have not yet acquired “approved” status or drugs that have acquired “approved” status but are used with a different dosage, route, or administration method other than that for which the drug has been approved. In New Zealand, the Medicines Act 1981 specifically allows for off-label drug use. However, this authority is limited by the Health and Disability Commissioner Regulations 1996 and the common law, which require that off-label drug use is of (...) an acceptable standard, that the patient should be fully informed, and that the patient should give informed consent. Off-label drug use is an important issue because the current law provides medical practitioners very wide discretionary power, without providing clarification for what is required of the practitioner in exercising his or her discretion in prescribing off-label. This paper discusses possible solutions to this issue, for example, establishing protocol for off-label use, an electronic database of off-label use, and the amendment of legal provisions. (shrink)