It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown (...) how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties. (shrink)

Most recent thinking about thevulnerability of research subjects uses a``subpopulation'' focus. So conceived, theproblem is to work out special standards forprisoners, pregnant women, the mentally ill,children, and similar groups. In contrast, an``analytical'' approach would identifycharacteristics that are criteria forvulnerability. Using these criteria, one couldsupport a judgment that certain individuals arevulnerable and identify needed accommodationsif they are to serve as research subjects.Seven such characteristics can be evident inchildren: they commonly lack the capacity tomake mature decisions; they are subject to theauthority of (...) others; they (and their parents)may be deferential in ways that can maskunderlying dissent; their rights and interestsmay be socially undervalued; they may haveacute medical conditions requiring immediatedecisions not consistent with informed consent;they may have serious medical conditions thatcannot be effectively treated; and they (andtheir parents) may lack important sociallydistributed goods. Each of thesevulnerabilities can call for special care inthe design and implementation of researchprotocols. (shrink)

A medical device manufacturer pays a surgeon to demonstrate a novel medical instrument in a live broadcast to an audience of specialists in another city. The surgical patient is unaware of the broadcast and unaware of the doctor's relationship with the manufacturer. It turns out that the patient required a different surgical approach to her condition—one that would not have allowed a demonstration of the instrument—and she later dies. The paper is an exploration of whether the manufacturer shares, along with (...) the doctor, responsibility for the death of the patient. Three arguments for corporate responsibility are considered; two are criticized and the third is offered as sound. (shrink)

The prelims comprise: Background: The Concept of Information Management Clearing the Ground: What Professional Obligations are Not The Concept of a Professional Obligation The Duty to Diminish Risks to Third Parties A Defense of Unqualified Confidentiality Final Thoughts Notes.

There is a broadly held view that neonatologists are ethically obligated to act to override parental nontreatment decisions for imperiled premature newborns when there is a reasonable chance of a good outcome. It is argued here that three types of uncertainty undercut any such general obligation: (1) the vagueness of the boundary at which an infant’s deficits become so intolerable that death could be reasonably preferred; (2) the uncertainty about whether aggressive treatment will result in the survival of a reasonably (...) healthy child or, alternatively, the survival of a child with intolerable deficits; and (3) the inability to determine an acceptable ratio between the likelihoods of those two outcomes. It is argued that the broadly held view accords insufficient weight to the fact that newborn intensive care increases the likelihood of harm to the child by effecting survival with intolerable deficits. Though treatment may offer a reasonable chance of a good outcome, it is argued that there are situations in which neonatologists should nonetheless defer to parental nontreatment decisions. (shrink)

The New Orleans catastrophe and the subsequent allegation of homicides at Memorial Medical Center have complicated our thinking about end-of-life care. Can the conditions in a collapsed health care system ever excuse euthanasia? Following a review of current legal and ethical standards for the causation of death in the clinical setting, and an assessment of the most common argument for euthanasia — the argument from intractable suffering — a different argument is set out for the excusability of euthanasia, one based (...) on forced abandonment. While more familiar in battlefield medicine, this line of reasoning may have applied in post-Katrina New Orleans. When health care professionals are compelled to leave a hazardous clinical setting, and where it is impossible to evacuate patients who are not expected to survive, clinicians must choose between abandoning these patients to die unattended and unmedicated, or euthanizing them before leaving themselves. Because each of these options stands as an egregious violation of an important health care norm, and because there is no third option, neither violation can be rightly condemned. (shrink)

Since it can sometimes seem necessary to undertake research that might affect a developing fetus, it would be useful to have a satisfactory ethical framework governing such efforts. Frank Chervenak...

Twenty distinguished philosophers and social theorists have contributed original papers to this stimulating investigation into the nature of the economically just society. Collectively, and in a remarkably coherent fashion, these papers set out the problems of contemporary social theory within the context of the distributive justice vs. property rights debate initiated by the works of John Rawls and Robert Nozick.

I am an academically trained philosopher who has taught and written about medical ethics for three decades, who has done extra-mural ethics consultation in clinical and other settings for two decades, and who has served as an expert ethics witness in the courts for more than ten years. Trained as a traditional academic, none of these three pursuits have come easily. Like most philosophers, my education did not prepare me for such responsibilities. Indeed, regardless of a bioethicist's initial background - (...) i.e., health care, law, theology or philosophy - it is invariably necessary to build upon foundational knowledges and abilities in gearing up for work as a health care ethics consultant.Edward J. Imwinkelreid has prepared a remarkable overview of the work of the expert ethics witness from the point of view of the law of evidence. My perspective as a philosopher, an ethicist, and an expert witness, stands in contrast with his. (shrink)

I am an academically trained philosopher who has taught and written about medical ethics for three decades, who has done extra-mural ethics consultation in clinical and other settings for two decades, and who has served as an expert ethics witness in the courts for more than ten years. Trained as a traditional academic, none of these three pursuits have come easily. Like most philosophers, my education did not prepare me for such responsibilities. Indeed, regardless of a bioethicist's initial background - (...) i.e., health care, law, theology or philosophy - it is invariably necessary to build upon foundational knowledges and abilities in gearing up for work as a health care ethics consultant.Edward J. Imwinkelreid has prepared a remarkable overview of the work of the expert ethics witness from the point of view of the law of evidence. My perspective as a philosopher, an ethicist, and an expert witness, stands in contrast with his. (shrink)

Applied ethics is sometimes understood on the engineering model: As engineers apply physics to human problems, so philosophers apply ethics to dilemmas of professional practice. It is argued that there is nothing in ethics comparable to physics. Using legal ethics as an example, it is suggested that political philosophy provides a better approach to understanding professional ethics. If, for example, the adversary system is a legitimate social institution, and if attorneys must adhere to certain principles in order for that institution (...) to fulfill its purposes, then attorneys may be said to be subject to those ethical principles. (shrink)

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown (...) how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties. *A longer version of this article will appear as “Medical Confidentiality” in The Blackwell Guide to Bioethics, ed. R. Rhodes et al. Oxford, UK: Blackwell, 2006. (shrink)

The New Orleans catastrophe and the subsequent allegation of homicides at Memorial Medical Center have complicated our thinking about end-of-life care. Can the conditions in a collapsed health care system ever excuse euthanasia? Following a review of current legal and ethical standards for the causation of death in the clinical setting, and an assessment of the most common argument for euthanasia — the argument from intractable suffering — a different argument is set out for the excusability of euthanasia, one based (...) on forced abandonment. While more familiar in battlefield medicine, this line of reasoning may have applied in post-Katrina New Orleans. When health care professionals are compelled to leave a hazardous clinical setting, and where it is impossible to evacuate patients who are not expected to survive, clinicians must choose between abandoning these patients to die unattended and unmedicated, or euthanizing them before leaving themselves. Because each of these options stands as an egregious violation of an important health care norm, and because there is no third option, neither violation can be rightly condemned. (shrink)

It is always appropriate to ask whether an expedient foreign policy is morally justifiable, just as it is always appropriate to ask whether a morally defensible policy is consistent with the national interest. The ongoing dialogue between morality and realpolitik gives much of foreign policy debate its characteristic bite. In this collection of essays, a distinguished group of philosophers, political theorists, and lawyers- including Russell Hardin and Marshall Cohen-explore these contrasting themes. In essays that are at once insightful and accessible, (...) noted political thinkers examine the tension of the conflicting demands of morality and national self-interest in the context of the foundations of international order, the possession and use of nuclear weapons, recourse to war, and the prospects for peace. A final postscript addresses the question of the responsibility of intellectuals in the national foreign policy debate. This book will appeal to scholars and students in any discipline dealing with international affairs as well as to lay readers who wish to explore the implications of taking morality and reason seriously in foreign policy. (shrink)

The Society of American Foresters has, proposed another revision of the Society's Code of Ethics. Changing a profession's code of conduct might cause considerable controversy. Some will support the current wording and oppose change, and others will see great merit in the new wording. Regardless, what we need is a code that articulates the core professional values of all foresters. A first step, then, is distinguishing our personal values from the core values of forestry.