The past two decades have been a time of heightened interest in the moral aspects of the practice of medicine. This interest has been reflected in medical education by the establishment of medical humanities programs in both preclinical and clinical education in many medical schools. It has also been reflected in the literature with a dramatic increase in journal articles on medical ethics as well as the development of medical ethics in textbooks. A number of journals have developed that are (...) specifically devoted to medical ethics, including The Journal of Medical Ethics, The Journal of Medicine and Philosophy, The Journal of Medical Humanities, Theoretical Medicine, Cambridge Quarterly of Healthcare Ethics, just to name a few. The literature includes both theoretical foundations and conceptual analyses of particular issues as well as practical advice and general suggestions for how to implement programs in medical humanities. (shrink)

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, (...) interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated the father for hypertension, and brought an unborn child into this world is now almost nonexistent. Since the time of the Rockwell portrait, a highly technical medical industry has evolved. Now two-thirds of physicians are board certified in subspecialties, and patients visit an average of 3–4 different physicians per year. Today's physicians see themselves less as “benevolent and wise counselors overseeing the patient's welfare (...) and more as objective scientists applying the latest technical methods to bring about the desired end.” The intimate patient-physician relationship that was once the norm in our society is rapidly disappearing. (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while (...) nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of (...) consultant and patient advocate. (shrink)

In recent years, the theoretical work of Gilligan in women's psychological development has led to the development of the concept of moral orientation or moral voice in contrast to the concept of moral reasoning or moral judgment developed by Kohlberg. These concepts have been of particular interest in gender studies, especially as applied to adolescence. These concepts of moral orientation and moral reasoning are being increasingly employed in healthcare ethics studies in a wide variety of settings. The recent work has (...) included studies of physicians, nurses, dentists, veterinarians, social workers, teachers of medical ethics, and hospital ethics committees. However, the study of moral development in healthcare providers has been hampered because collecting the necessary data from healthcare workers has been labor intensive and extremely time consuming. More efficient methods are needed. (shrink)

This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females (...) and other demographic data on age and educational background were consistent with other studies of the field of medical humanities.Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field. (shrink)

Following a brief consideration of two contrasting purposes for teaching the medical humanities, a description is given of a film discussion elective course. In contrast to the usual teaching of medical ethics which is primarily a cognitive activity emphasizing the development of a code of principles such as justice, autonomy, and beneficence, the film discussion elective was primarily an affective activity emphasizing the development of an ethical ideal of caring, relatedness, and sensitivity to others. The pass/fail elective, offered for one (...) credit each quarter for two quarters, met once a week for one hour for twenty-four weeks. Each week a film was shown followed by a group discussion. A wide variety of social issues were covered. The objective of the course was to increase the ethical sensitivity of the medical students through promotion of introspection and reflection on social issues. A brief discussion is given of the importance and appropriateness of using film to promote the affective focus of medicine on the relief of suffering. Examples are given of how the course achieved its objective. A detailed description of the resource materials is provided. (shrink)

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists (...) function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway. (shrink)

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in (...) detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs. (shrink)

A study of physicians and medical students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in medicine and their epistemological presuppositions in relationship to the subjective-objective controversy in value theory. The study revealed that most physicians and medical students tend to be objectivists in value theory, i.e., believe that value judgements are knowledge claims capable of being true or false and are expressions of moral requirements and normative imperatives emanating from an external value (...) structure or moral order in the world, but that most physicians and medical students are inconsistent in the philosophical foundations of their medical ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. The study also revealed that most physicians and medical students think more emphasis should be placed upon medical ethics in medical education. (shrink)

A study of nurses and nursing students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in nursing and their relationship to the subjective-objective controversy in value theory. The study revealed that most nurses and nursing students tend to be subjectivists in value theory, i.e., believe that value judgments are purely personal, private expressions of one's own opinion or inner-feelings and not believe that value judgments are knowledge claims capable of being true or false (...) and therefore not expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most nurses and nursing students are inconsistent in the philosophical foundations of their ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value (...) judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

On May 11th a round table discussion was held on the subject "The Interactions of Science and Art under the Conditions of the Revolution in Science and Technology ," organized by the editorial boards of the journals Voprosy filosofii and Voprosy literatury.

After noting why the issue of the use of animals in medical education and research needs to be addressed, this article briefly reviews the historical positions on the role of animals in society and describes in more detail the current positions in the wide spectrum of positions regarding the role of animals in society. The spectrum ranges from the extremes of the animal exploitation position to the animal liberation position with several more moderate positions in between these two extremes. Then (...) the philosophical issue of the moral agency of animals is discussed in terms of an explication of the concept of rights and the concept of personhood. Further research is suggested concerning institutional policies regarding medical students who refuse to do physiology dog labs or other assignments which involve the suffering and/or death of animals. (shrink)

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether (...) there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults. (shrink)

Whether ethics is too important to be left to the experts or so important that it must be is an age-old question. The emergence of clinical ethicists raises it again, as a question about professionalism. What role clinical ethicists should play in healthcare decision making – teacher, mediator, or consultant – is a question that has generated considerable debate but no consensus.

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to (...) determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically. (shrink)

The enormous growth in medical humanities programs during the past decade has resulted in an extensive literature concerning the content of the discipline and the issues that have been addressed. Comparatively little attention, however, has been devoted to the structure of the discipline of medical humanities concerning the process or the theoretical aspects of the pedagogy of teaching the discipline. This report explicitly addresses the pedagogical aspects of the discipline by comparing and contrasting two different basic approaches to the discipline (...) referred to as the classical humanities approach and the humanistic psychology approach which roughly approximate the cognitive and affective approaches respectively. These two approaches are compared and contrasted in terms of their goals, objectives, methods of implementation, philosophical assumptions and evaluational techniques. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and ‘caring about’ is (...) made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

This paper examines relationships between accountants’ personal values and their moral reasoning. In particular, we hypothesize that there is an inverse relationship between accountants’ “Conformity” values and principled moral reasoning. This investigation is important because the literature suggests that conformity with rule-based standards may be one reason for professional accountants’ relatively lower scores on measures of moral reasoning (Abdolmohammadi et al. J Bus Ethics 16 (1997) 1717). We administered the Rokeach Values Survey (RVS) (Rokeach: 1973, The Nature of Human Values (...) (The Free Press, New York)) and the Defining Issues Test (DIT) (Rest: 1979, Development in Judgment Moral Issues (University of Minnesota Press, Minneapolis, MN)) to164 graduating accounting students enrolled in capstone courses at two universities in the Northeastern United States. As potential entrants into the accounting profession, these subjects bring their values and moral reasoning to bear on attitudes and behaviors in the workplace. We find a highly significant inverse relationship between “Conformity” values and principled moral reasoning (i.e., those who prefer Conformity values have lower levels of moral reasoning). However, we also find that accounting students as a group do not prefer Conformity values above other values such as Self-actualization and Idealism, and we find positive relationships between Self-actualization and Idealism values and moral reasoning. Implications for values and ethics research are discussed. (shrink)

Empirical evidence suggests that a majority of people believe that time robustly passes, and that many also report that it seems to them, in experience, as though time robustly passes. Non-dynamists deny that time robustly passes, and many contemporary non-dynamists—deflationists—even deny that it seems to us as though time robustly passes. Non-dynamists, then, face the dual challenge of explaining why people have such beliefs and make such reports about their experiences. Several philosophers have suggested the stable-self explanation, according to (...) which what partly explains one or both of the explananda is that people believe themselves to have a stable persisting self which is imagined either as moving through time, or as being stationary, with time moving around it. This paper empirically investigates this explanation. We found, however, no evidential support for the stable-self explanation, leaving the non-dynamist but also, we will argue, the dynamist, with an extant explanatory challenge. (shrink)

This wide-ranging book reconstructs this debate and places within their contemporary contexts the rival claims concerning the nature of the cosmos and the ...

CONSCIOUSNESS AND THE BRAIN SELF-REGULATION PARADOX The relationship of consciousness to biology has intrigued mankind thoroughout recorded history. However, little progress has been made not only in understanding these issues but also in raising fundamental questions central to the problem. As Davidson and Davidson note in their introduction, William James suggested, almost a century ago in his Principles of Psychology, that the brain was the organ of mind and be havior. James went so far as to suggest that the (...) remainder of the Principles was but a "footnote" to this central thesis. This volume brings together diverse biobehavioral scientists who are addressing the various aspects of the mindlbrainlbodylbehavior issue. Although some of the authors have previously published together in other volumes, by and large the particular combination of authors and topics selected by the editors makes this volume unique and timely. Unlike the Consciousness and Self-Regulation series (Schwartz & Shapiro, 1976, 1978), also published by Plenum, this volume is devoted entirely to a psychobiological approach to consciousness. Although readers will differ in their interest in specific chapters, the well-rounded investigator who is concerned with the psychobiology of consciousness will want to become intimately acquainted with all the views presented in this volume. As noted by the individual contributors, the topic of this volume stimulates fundamental questions which, on the surface, may appear trivial, yet, on further reflection, turn out to have deep significance. (shrink)

Most individuals realise that we have a moral obligation to avoid the evils of war. But this realization raises a host of difficult questions when we, as responsible individuals, witness harrowing injustices such as ""ethnic cleansing"" in Bosnia or starvation in Somalia. With millions of lives at stake, is war ever justified? And, if so, for what purpose? In this book, Richard J. Regan confronts these controversial questions by first considering the basic principles of just-war theory and then applying those (...) principles to historical and ongoing conflicts. Part One presents two opposing viewpoints: first, that war is not subject to moral norms and, second, that war is never morally permissible. The author rejects both perspectives, and moves to define the principles of just-war theory. He evaluates the roles of the president, Congress and, most importantly, the UN Security Council in determining when long-term US military involvement is justified. The moral limits of war conduct and the moral problem of using, or threatening to use, nuclear weapons are also discussed. On the just cause to wage war, Regan argues that defense of nations and nationals - whether in self-defense or in defense of others - remains the ""only"" classical cause that in the modern world would justify resorting to war. With respect to military intervention in secessionist and revolutionary wars, he contends that such intervention might be justified, but that prudence dictates extreme caution. In considering acceptable war conduct, Regan elaborates the specific principle of discrimination and proportionality; he maintains that civilians uninvolved in the enemy's war should not be directly targeted and that the costs of military action must be proportionate to the anticipated benefits of destroying military targets. The second part of the book presents case studies of eight historical wars - World War I, the Vietnam War, the Falklands War, the revolution and civil war in Nicaragua, the civil war in El Salvador, the Gulf War, the intervention in Somalia, and the Bosnian War - and poses several provocative questions about each. It invites readers and students to apply just-war principles to complex war-related situations and to understand the factual contingencies involved in moral judgements about war decisions. The book should be of particular interest to students of the moral issues of international relations and to readers interested more generally in philosophy, theology and political science. (shrink)

This book develops and defends a version of utilitarianism, including expected-utility theory, as a normative model of decision making. The defense, based on the idea of utility as achievement of goals, considers the endorsement of a norm as a decision and asks what reasons we have to endorse norms for decision making. The reasons derive from our pre-existing goals, so any norm we endorse must not fly in the face of these goals, although it must not be selfishly biased, either. (...) This approach is further clarified by drawing distinctions between decisions for the self, for a single other person, for several others, and for the self and others. The book discusses the implications of this argument for the psychological study of decision making, the act--omission distinction, moral education, decision analysis, risk analysis, and other questions of public policy. The final chapter sketches a prescriptive approach to group decision making. (shrink)

It is widely believed by philosophers that we human beings are capable of stepping back from inclinations to act in a certain way and consider whether we should do so. If we judge that there are enough reasons in favour of following our initial inclination, we are definitely motivated, and, if all goes well, we act. This view of human agency naturally leads to the idea that our actions are self-determined, or controlled by ourselves. Some go one step further (...) to the point of saying that we should extend the fundamental aspects of this view of human agency to the epistemic realm. This we call ‘the control-view”. Here we will make a strong case against the control-view. While we have a substantial control over our practical lives, it is very unlikely that this extends to our epistemic lives. Our discussion will proceed in three stages. We will present two asymmetries between our practical and epistemic lives which are followed by a general argument against the control-view. (shrink)

in N. Eilan, A. Marcel and J. Bermudez, The Body and the Self, 29-42.

The current study collected orally-delivered autobiographical narratives from a sample of 44 undergraduate students. Participants were asked to produce both deceptive and non-deceptive versions of their narrative to two specific autobiographical question prompts while standing in front of a video camera. Narratives were then analyzed with Coh-Metrix software on 33 indices of linguistic cohesion. Following a Bonferroni correction for the large number of linguistic variables , results indicated that the deceptive narratives contained more explicit action verbs, less linguistic complexity, and (...) less referential coherence . The results support a theory that, in deceptive narratives, there is greater narrative distance between the self that narrates and the self that is narrated about. This suggests that narrative selves are constituted not as autonomous selves, but are subject to processes that are likely operating on a subconscious level. (shrink)

Terminologically, the “topos of mu” and the “predicative self” originated in the Kyoto School and are traceable to the work of its founder NISHIDA Kitarō. The full phrase was coined by NAKAMURA Yūjirō. Conceptually, the topos of mu or place of nothingness is Nishida’s development of the Buddhist notion of anatta or no self and radiating out from that locus of emptiness is a self constituted by its predicates or the things to which it is connected by (...) an existential copula. Deeply ingrained in Western languages, metaphysics, and religion is the subjective self, in both the linguistic and psychological senses of “subjective.” That Buddhism, as reworked by the Kyota School, or Daoism, or any other non-Western tradition of thought, will catch on in the West was a puerile fantasy of some members of the first generation of environmental philosophers. There is a good chance, however, that the Western worldview may evolve toward a similar conception of the self—as ecological, relational, or systems thinking becomes ever more ingrained. We in the West may come to understand that we are constituted by our social and environmental relationships, in which we are deeply embedded and on which we are utterly dependent, such that world care is the essence of self-help. (shrink)

Previous research has suggested that bodily signals from internal organs are associated with diverse cortical and subcortical processes involved in sensory-motor functions, beyond homeostatic reflexes. For instance, a recent study demonstrated that the preparation and execution of voluntary actions, as well as its underlying neural activity, are coupled with the breathing cycle. In the current study, we investigated whether such breathing-action coupling is limited to voluntary motor action or whether it is also present for mental actions not involving any overt (...) bodily movement. To answer this question, we recorded electroencephalography (EEG), electromyography (EMG), and respiratory signals while participants were conducting a voluntary action paradigm including self-initiated motor execution (ME), motor imagery (MI), and visual imagery (VI) tasks. We observed that the voluntary initiation of ME, MI, and VI are similarly coupled with the respiration phase. In addition, EEG analysis revealed the existence of readiness potential (RP) waveforms in all three tasks (i.e., ME, MI, VI), as well as a coupling between the RP amplitude and the respiratory phase. Our findings show that the voluntary initiation of both imagined and overt action is coupled with respiration, and further suggest that the breathing system is involved in preparatory processes of voluntary action by contributing to the temporal decision of when to initiate the action plan, regardless of whether this culminates in overt movements. -/- . (shrink)

Philosophical discussion tends to converge on the view that narratives are at the center of the emotion of grief. In this article, I expand on this kind of view. On the one hand, I argue that key strands of phenomenological and neuroscientific studies suggest that grief consists in a complex emotional process of disconfirmation-and-updating of the narrative self-model. By heuristically drawing on an analogy between binocular rivalry and grief, I show that certain salient aspects of the phenomenology of grief, (...) such as self-alienation and ambiguity, are straightforwardly reflected by this account. On the other hand, I argue that this hierarchical approach has the resources to: (i) show that both narratable and unnarratable experiences of personal loss are both instances of grief; and (ii) differentiate between narratable and unnarratable experiences of grief, without compromising the view that self-constituting narratives are at the center of the phenomenon. (shrink)

Williams, Elster and Pears hold that an effort to induce in oneself a belief in the truth of some proposition that one believes to be false can succeed only if one manages, somewhere along the way, to forget that one is engaged in such an effort. Although this view has strong intuitive appeal, it is false, and in this paper it is shown to be false by example.