Volume 25, Issue 2, February 2025, Page 85-87.

Chapman et al. (2025) frame the issue of ethical regulation of data-centric research, including AI and large language models, in an important and challenging manner. While we agree that the risks t...

This paper argues that practical wisdom represents a useful framework for understanding the synthesis of the scientific, technical, and moral dimensions of medical practice and may, therefore, guide the meaningful integration of concepts of competence and character into the education and support of both the technical and moral agency of medical professionals. The authors show the importance of practical wisdom in three distinct domains: (1) in effective deliberation in clinical judgments; (2) in helping clinicians flourish by making wise (...) decisions in light of the moral and emotional challenges they face in their practice; and (3) in helping physicians navigate between the rights of patients, the physician’s own moral good, and the objective good intrinsic to medicine. To promote the physician’s own moral good and the objective good intrinsic to medicine, the authors propose a philosophical position, the agential view, that preserves an essentialist view of medicine but emphasizes the necessity to develop a personal moral philosophy of clinical practice. (shrink)

Challenges in Medical Care Edited by Andrew Grubb School of Law and Centre of Medical Law and Ethics, King’s College, London, UK The sixth volume in the series of King’s College Studies takes a reflective view of medical law and ethics, the health care system and challenges raised by modern technology. A distinguished team of authors returns to problems and controversies that have long challenged medical law and ethics, and shows how new issues (...) are constantly arising as a result of developments in medical care. Topics such as the legal status of the frozen human embryo, medical accountability and the future of the National Health Service are discussed. The need for responsibility, accountability and respect for individual human rights forms a strong linking theme throughout the book. This thought-provoking collection constitutes a useful and informative reference source which will be of value to a wide range of professionals and students including doctors, nurses, lawyers, philosophers and medical sociologists. (shrink)

: Ulysses contracts have faced paternalism objections since they first were proposed. Since the contracts are designed to override a present request from a legally competent patient in favor of a past request made by that patient, enforcement of these contracts was argued to be unjustifiable strong paternalism. Recent legal developments and new theories of practical reasoning suggest that the discussion of Ulysses contracts should be revived. This paper argues that with a proper understanding of the future-directed planning embodied in (...) Ulysses contracts, the charge of strong paternalism can be answered, and the enforcement of some Ulysses contracts may be justified under the rubric of weak paternalism. (shrink)

How research studies should use social media to recruit research participants is a timely question. Importantly, the question is how, not if, studies should use...

The question at hand is whether or not a liberal arts education can be politically neutral, but the very fact that this question is phrased in the curious manner that it is, which is to say that we place emphasis on "can" as opposed to "is" or "how we might better ensure," speaks to the nature of a problem that much more deeply rooted than the mere question of scholarly polarization. Borrowing from Christopher Schlect of New Saint Andrews College, (...) we might say that the "liberal arts teach us how to learn—how to freely gain knowledge and understanding," and that the manner in which they do this is by teaching students not only methodologies for solving problems that are presented to them, but also how to identify problems of their own accord (79). That would mean, by definition, that a political neutral liberal arts curriculum would necessitate not only an active awareness of one's ethical orientation, but also an active tempering of the biases that accompany that orientation out of respect for the spirit of liberalism and in recognition of one's own fallible nature. Unfortunately, since, as I intend to illustrate, our moral and therefore political senses are similar to aesthetic taste as described by Kant in his third critique, they carry with them the paradoxicality of pure subjectivity tethered to the expectation of universality, making the possibility of political neutrality in the liberal arts a grim proposition, to put it at its absolute mildest. In order to determine whether this problem is in any way manageable, it is necessary to analyze of the nature of moral and political taste in a general sense, the rhetoric that educator use toward members of opposing moral frameworks, how that rhetoric is buttressed by institutional teloi, and finally, how different systems of normative ethics might contribute to neutrality in the liberal arts. (shrink)

Community and patient stakeholder partners serve in many roles. One particularly important role of community and patient organizations and representatives is to serve as gatekeepers; in this role, they monitor, and in some cases even determine, what research does and does not get conducted with their communities. Such gatekeeping can prevent “helicopter” research and community research fatigue. Gatekeeping can also aid in identifying and mitigating harms that might occur not only to individual participants but to third parties (who do not (...) provide consent for participation) or to the community as a whole. Although individual informed consent and independent review both aim to protect against research risks, in research with identifiable communities these protections may be insufficient to protect from other types of harms. Given the gaps in protection, the gatekeeping role of community research partners is an important supplement to informed consent and independent IRB review, but it also raises its own set of ethical challenges. Here, we discuss the limitations of informed consent and independent review in research with identifiable communities, the benefits of gatekeeping for protecting third parties and groups, types of gatekeepers, and issues in the selection of gatekeepers. (shrink)

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a (...) definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)

Volume 24, Issue 8, August 2024, Page 109-111.

Book Symposium on Andrew Feenberg’s Between Reason and Experience: Essays in Technology and Modernity Content Type Journal Article Pages 203-226 DOI 10.1007/s13347-011-0017-8 Authors Inmaculada de Melo-Martín, Division of Medical Ethics, Weill Cornell Medical College, New York, NY 10065, USA David B. Ingram, Loyola University Chicago, 6525 North Sheridan Road, Chicago, IL 60626, USA Sally Wyatt, e-Humanities Group, Royal Netherlands Academy of Arts and Sciences (KNAW) & Maastricht University, Cruquiusweg 31, 1019 AT Amsterdam, The Netherlands Yoko Arisaka, (...) Forschungsinstitut für Philosophie Hannover, Gerberstrasse 26, 30169 Hannover, Germany Andrew Feenberg, School of Communication, Simon Fraser University at Harbour Centre, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada Journal Philosophy & Technology Online ISSN 2210-5441 Print ISSN 2210-5433 Journal Volume Volume 24 Journal Issue Volume 24, Number 2. (shrink)

Michael Ryan (d. 1840) remains one of the most mysterious figures in the history of medical ethics, despite the fact that he was the only British physician during the middle years of the 19th century to write about ethics in a systematic way. Michael Ryan’s Writings on Medical Ethics offers both an annotated reprint of his key ethical writings, and an extensive introductory essay that fills in many previously unknown details of Ryan’s life, analyzes the (...) significance of his ethical works, and places him within the historical trajectory of the field of medical ethics. (shrink)

In clinical mental health research with children, both child and parent are essential members of the research team. The 3 R's of parent/child team membership are respect, rapport, and recognition. Respect and recognition include fair reimbursement for time, expense, and inconvenience, but the most important compensation for many families is the appreciation of the other team members for their sacrifice and cooperation. Reimbursement, although honoring the principles of justice and respect for persons, raises difficult issues about appropriate amount, particularly in (...) research involving children. The 3 R's are supported by the investigator 5 A's: attitude, adaptability, availability, attachment, and appreciation. Although the principles seem clear in the abstract, implementation encounters many practical problems. Perhaps the most difficult of these is determining the appropriate amount of compensation that avoids undue inducement but not at the expense of the 3 R's and 5 A's. (shrink)

Deception, cheating, and loopholes within the IRB approval process have received significant attention in the past several years. Surveys of clinical researchers indicate common deception ranging from omitting information to outright lying, and controversy surrounding the FDA's decision not to ban “IRB shopping” has raised legitimate concerns about the integrity of the IRB process. One author has described a multicenter trial as being withdrawn from consideration at one institution when rejection was imminent, in order to avoid informing other IRBs reviewing (...) the protocol of the study's rejection. This practice and IRB shopping seem at odds with the spirit, if not the “letter,” of the regulations. While at first blush these practices seem to cast aspersions on the integrity of clinical researchers, the moral issues raised go deeper than the ethics of cheating. (shrink)

In this case, the investigator should be allowed to enroll incompetent adults into this study, with certain safeguards. If an incompetent adult has an agent or a legally authorized representative (...

In this case, it is noted that while DNA testing and methylation are being studied as biomarkers for high-grade squamous intraepithelial lesions in the anal canal, their efficacy is no...

Assume that, even with a time machine, Tim does not have the ability to travel to the past and kill Grandfather. Why would that be? And what are the implications for traditional debates about freedom? We argue that there are at least two satisfactory explanations for why Tim cannot kill Grandfather. First, if an agent’s behavior at time _t_ is causally dependent on fact _F_, then the agent cannot perform an action (at _t_) that would require _F_ to have not (...) obtained. Second, if an agent’s behavior at time _t_ is causally dependent on fact _F_, then the agent cannot perform an action (at _t_) that would prevent _F_ from obtaining. These two explanations have distinct upshots for more traditional debates over freedom. The first implies that causal determinism is incompatible with the ability to do otherwise and also raises questions about the traditional arguments for the incompatibility of divine foreknowledge and the ability to do otherwise; the second does neither. However, both explanations imply that the Molinist account of divine providence renders agents unable to do otherwise, at least in certain circumstances. (shrink)

In Understanding Social Action, Promoting Human Rights, editors Ryan Goodman, Derek Jinks, and Andrew K. Woods bring together a stellar group of contributors from across the social sciences to apply a broad yet conceptually unified array of advanced social science research concepts to the study of human rights and human rights law.

This interdisciplinary and ecumenical collection of essays honors the transformative work of Margaret A. Farley, Gilbert L. Stark Professor of Christian Ethics at Yale Divinity School, using it as a starting point for reflection on the contribution of feminist method to theology and ethics. Through a variety of perspectives, contributors show that by resisting classical oppositions between “interpersonal” and “social” ethics and by insisting that social, economic, and political realities be taken seriously in considerations of justice, feminist concerns challenge the (...) very categories of Christian ethics. With essays ranging from sexual ethics to human rights, medical ethics to freedom, _A Just and True Love_ offers a broad perspective on the last twenty-five years of feminist innovation in Christian ethics and a glimpse of its global future, particularly in continents such as Africa. “This book brings together a number of the most prominent thinkers in Christian theology and ethics today in a justly deserved tribute to the work and influence of Margaret Farley. The essays explicitly acknowledge and engage Farley in various degrees; one comes away appreciating both the integrity of her work and its versatility.” —_Darlene Fozard Weaver, Villanova University _ “Inevitably while listening to or reading Margaret Farley, we find her refrain, ‘I want to ask all over again.’ Reexamining, reframing, and rethinking is Farley’s method of engaging anew human experience and relationality. The authors of these essays capture that method as they reconsider feminism and sexuality, love and freedom, justice and truth, contraception and women’s rights. Like her own work, they reset the ethical agenda to recapture a more loving truth. A very successful collection for a most admired colleague. Ryan and Linnane are to be congratulated!” —_James F. Keenan, S.J., Boston College_ “In_ A Just and True Love,_ a host of distinguished scholars consider fundamental themes of feminist theological ethics and their significance for global justice, the meaning of Christian love, creative casuistry, and truthful life in the Church. I can imagine no higher praise than to affirm that these authors have succeeded marvelously in doing exactly what they set out to do: to produce a volume worthy of the theological work and wisdom of Margaret Farley.” —_William Werpehowski, Villanova University_. (shrink)

While many scholars agree that the ‘‘separation thesis’’ (Freeman in Bus Ethics Quart 4(4):409–421, 1994)—that business issues and ethical issues can be neatly compartmentalized—is harmful to business ethics scholarship and practice, they also conclude that eliminating it is either inadvisable because of the usefulness of the positive/ normative distinction, or actually impossible. Based on an exploration of the fact/value dichotomy and the pragmatist and virtue theoretic responses to it, we develop an approach to eliminating the separation thesis that integrates ‘‘business’’ (...) with ‘‘ethics’’ while still permitting a positive/ normative distinction, which we call ‘‘ethics from observation.’’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On PartnershipRyan Schwarz, Duncan Smith-Rohrberg Maru, Dan Schwarz, Bibhav Acharya, Bijay Acharya, Ruma Rajbhandari, Jason Andrews, Gregory Karelas, Ranju Sharma, and Mark ArnoldyRecently, Bayalpata Hospital, in the rural district of Achham, Nepal almost collapsed under the weight of its own staff's discontent. The hospital had been largely abandoned until 2009 when our organization, Nyaya Health, renovated and opened it in partnership with the Nepali government. Since then, the hospital (...) has seen great progress and has experienced widespread community support. Nonetheless, earlier this year, a broad-based staff revolt occurred, led primarily by our senior clinical staff members, raising concerns that Nyaya's management policies were ineffective, and wages and benefits were too low. The unrest included everything from a strike, limiting services to our patients, to aggression against non-strikers and slander and racist comments in public media against the Nyaya Health Board of Directors. Ultimately, the conflict was resolved, though not without the departure of our three most senior clinicians. The incident deeply damaged staff morale [End Page 101] and impeded basic services to our patients, and from our perspective as a leadership and management team, it was deeply troubling and spiritually challenging. We have learned much in the wake of the strike, but here we focus more narrowly on the concept of partnerships in our work by examining the recent strike and the two key issues that lead to it: wages and benefits, and management policies at Bayalpata Hospital.In grappling with the recent staff crisis, some of our leadership team expressed concerns that we would never be able to develop a true partnership in Achham if our senior-level employees led strikes against the organization. The leaders of the strike were our most well-educated and high-ranking staff. They were also individuals who had come to work for us specifically citing the moral imperative of our work, and their pride in helping to serve the poorest of the poor. One leadership team member asked, "What is 'partnership' then? We came into this work with the premise that we would work together, with our partnership built around the right to health—but who are our partners if they lead strikes damaging the very services our collective mission aims to offer?"Another leadership team member commented, "The first time I visited Achham I was invited for tea at Meena's* house (one of Nyaya's midwives). We arrived at her house and Meena greeted us warmly. She showed us in to a small room: there was no furniture, but there was an immaculately swept mat which we joined her on. We drank tea, seated on her rug, and listened to her tell us how she had come to live in the house, how she had come to work for Nyaya, and her pride in now being able to provide both for her own children, as well as, the children of her relatives. As the only employed family member, she now had the challenge of providing for all of them. When we question our partnership, I'm taken back to Meena's warm, but extremely poor, home. She has worked for Nyaya for almost four years. She has helped our organization provide free care to over 75,000 people. Is this not a type of 'partnership'?"Allow us to offer some background on the issue of wages—Meena has been with our team since 2008, and has been paid about $2,500 per year—a generous wage compared to other employers in the region. Meena was one of the striking staff members. Among other concerns about the way the hospital was being run, she and other staff asked indignantly why we couldn't provide them with higher wages, better benefits, and more resources, both for her and the hospital. Notably, Meena's salary (and the rest of our staff's) was well above her equivalent in other, more urban hospitals (to compensate for the extremely remote area in which we work), and in a district where most families are farmers, our staff's salaries occupy the highest income bracket in the region. Nonetheless, as is common throughout the world in both rich and poor areas... (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 53-54, July 2012.

This paper argues that it will be important for new genomic technologies to recognize the limits of traditional approaches to informed consent, so that other-regarding implications of genomic information can be properly contextualized and individual rights respected. Respect for individual autonomy will increasingly require dynamic consideration of the interrelated dimensions of individual and broader community interests, so that the interests of one do not undermine fundamental interests of the other. In this, protection of individual rights will be a complex interplay (...) between individual and community concerns. (shrink)

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

In his paper, ‘Patients, doctors and risk attitudes,’ Nicholas Makins1 argues that healthcare professionals should defer to a patient’s higher-order risk attitudes (ie, the risk attitudes they desire to have or endorse within themselves upon reflection) when making medical decisions. We argue against Makins’ deference to higher-order risk attitudes on the basis that (1) there are significant practical concerns regarding our ability to easily and consistently access and verify the higher-order risk attitudes of patients, (2) there is a lack (...) of a theoretical limit on higher-order risk attitudes (eg, second, third, fourth order), and (3) the consideration of higher-order risk attitudes is actually more paternalistic than Makins suggests because it narrows what counts as an autonomous preference to the limited occasions in which an individual actually reflects on his or her own risk attitude. On the issue of practicality, we can reasonably expect that healthcare professionals would find difficulty eliciting the higher-order risk attitudes of their patients. Take for example the patient who has never expressed his higher-order desire to be more risk adverse and who is not willing nor comfortable expressing this desire. What is the healthcare professional expected to do in this situation? This is even more of a concern for the incapacitated patient, to which Makins seems to imply that …. (shrink)

"I have been using the book in a freshman seminar in which we are exploring college. Most of the texts we are using are academic satire novels, but we are using Delbanco's book to help us talk about the place of college in American culture.

Here I consider some of the ethical and philosophical issues at the intersection of medical assistance in dying (MAiD) and deceased organ donation (DOD). Three possible objections about inherent aspects of the practice of DOD after MAiD are considered, and rejected. The bulk of the chapter examines recent calls to keep decisions about DOD and MAiD separate, and to clarifying the nature of the ethical concerns underlying effort to protect patients from undue pressure and coercion. Several insights are revealed (...) as a result of this analysis, including that there is good reason to think that sometimes it may be morally justifiable to allow an eligible patient to pursue MAiD because they wish to donate their organs after death. Noting that more research is needed, I close with several recommendations for policy and practice. (shrink)

In an era of climate change, deforestation, melting ice caps, poisoned environments, and species loss, many people are turning to the power of the arts and humanities for sustainable solutions to global ecological problems. Introduction to the Environmental Humanities offers a practical and accessible guide to this dynamic and interdisciplinary field. This book provides an overview of the Environmental Humanities' evolution from the activist movements of the early and mid-twentieth century to more recent debates over climate change, sustainability, energy policy, (...) and habitat degradation in the Anthropocene era. The text introduces readers to seminal writings, artworks, campaigns, and movements while demystifying important terms such as the Anthropocene, environmental justice, nature, ecosystem, ecology, posthuman, and non-human. Emerging theoretical areas such as critical animal and plant studies, gender and queer studies, Indigenous studies, and energy studies are also presented. Organized by discipline, the book explores the role that the arts and humanities play in the future of the planet. Including case studies, discussion questions, annotated bibliographies, and links to online resources, this book offers a comprehensive and engaging overview of the Environmental Humanities for introductory readers. For more advanced readers, it serves as a foundation for future study, projects, or professional development. (shrink)

Ryan Recalls is not a typical autobiography for while it contains personal memoirs and preoccupations, it also contains book reviews, book launches, published and unpublished papers as well as various newspaper articles put together by the author" --Page 2 of cover.

Review of Will Bunch, After the Ivory Tower Falls: How College Broke the American Dream and Blew Up Our Politics--And How to Fix It.

Prominent among the principles put forward by Professor Bernard Williams in ‘The Idea of Equality’ were that for every difference in the way men are treated a relevant reason should be given and the proper ground of the distribution of medical care is ill health. Prominent among his conclusions was that we are confronted with an irrational state of affairs where wealth functions as a necessary condition for receiving medical care. In ‘The Idea of Equality Reconsidered’ Philosophy 85–90), (...) I argued that, on his principles alone, this conclusion though correct was one-sided. (shrink)

Foundations of medical ethics and law -- Professionalism and medical ethics -- The doctor, the patient, and society -- Ethics and law at the beginning and end of life -- Healthcare commissioning and resource allocation -- Introduction to sociology and disease -- Experience of health and illness -- Organization of health care provision in the UK -- Inequalities in health and health care provision -- Epidemiology and public health -- Clinical governance.

Medical collaboration with authoritarian regimes historically has served to facilitate the use of torture as a tool of repression and to justify atrocities with the language of public health. Because scholarship on medicalized killing and biomedicalist rhetoric and ideology is heavily focused on Nazi Germany, this article seeks to expand the discourse to include other periods in which medicalized torture occurred, specifically in Argentina from 1976 to 1983, when the country was ruled by the Proceso de Reorganización Nacional military (...) regime. The extent to which medical personnel embedded themselves within the Proceso regime’s killing apparatus has escaped full recognition by both scholars and human rights activists. This article reconstructs the narrative of the Proceso’s human rights abuses to argue that health professionals knowingly and often enthusiastically facilitated, oversaw, and participated in every phase of the “disappearance,” torture, and mass murder process. (shrink)

Abstract“Suffering” is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which “suffering” is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals to suffering (...) are often getting at something ethically important. But this is where the work of ethics begins, not where it ends. (shrink)

Self-harm within immigration detention centres has been a widely documented phenomenon, occurring at far higher rates than the wider community. Evidence suggests that factors such as the conditions of detention and uncertainty about refugee status are among the most prominent precipitators of self-harm. While important in explaining self-harm, this is not the entire story. In this paper, we argue for a more overtly political interpretation of detainee self-harm as resistance and assess the ethical implications of this view, drawing on interviews (...) with detainees from Australia’s offshore system. Self-harm by detainees is not only a medical ‘condition’ arising in response to oppression but a form of political action to lessen or contest it. We first establish how self-harm could be conceptualised as resistance. We then discuss its political purpose, noting it serves at least three functions: intrinsic, instrumental and disruptive or coercive. Viewing detainee self-harm as political resistance is a supplement to (rather than a substitute for) a medical approach. However, conceptualising self-harm this way has several advantages, namely, moving away from the idea that such behaviour is ‘maladaptive’, recognising detainees as political agents, combatting government claims of ‘manipulation’ and ‘blackmail’ and clarifying the duties of healthcare workers who work in detention. (shrink)

In this article I explore the contribution of ethical analysis and theological reflection to understanding and responding to moral injury of healthcare workers in light of the COVID pandemic. I begin by critically appraising the relevance of moral injury for healthcare contexts, and suggest that the term ‘medical moral injury’ should be used to differentiate it from ‘military moral injury’. I briefly relate medical moral injury to other relevant phenomena, such as moral dilemmas, moral distress, and moral residue, (...) arguing that moral injury in healthcare contexts might take chronic as well as acute forms. I suggest that agent regret might play an important role in understanding medical moral injury. The associated distinction between harms and wrongs, and so regret and remorse, help us identify different kinds of moral injury, and the distinct role that apology plays in each instance. Theological reflection on penitence, forgiveness, and lament also contributes to understanding and responding to potentially morally injurious events. I conclude that while psychological intervention plays an important role in medical moral injury, moral and theological perspectives provide both crucial lenses through which to understand these potentially injurious moral landscapes, and resources to assist healthcare workers in navigating them more safely. (shrink)

Volume 25, Issue 3, March 2025, Page 138-140.