Unconsented intimate exams on men and women are known to occur for training purposes and diagnostic reasons, mostly during gynecological surgeries but also during prostate examinations and abdominal surgeries. UIEs most often occur on anesthetized patients but have also been reported on conscious patients. Over the last 30 years, several parties—both within and external to medicine—have increasingly voiced opposition to these exams. Arguments from medical associations, legal scholars, ethicists, nurses, and some physicians have not compelled meaningful institutional change. Opposition is (...) escalating in the form of legislative bans and whistleblower reports. Aspiring to professional and scientific detachment, institutional consent policies make no distinction between intimate exams and exams on any other body part, but patients do not think of their intimate regions in a detached or neutral way and believe intimate exams call for special protections. UIEs are found to contribute to moral erosion and moral distress of medical students and compromise the sacred trust between the medical community and the general public. This paper refutes the main arguments in favor of the status quo, identifies a series of harms related to continuing the current practice, and proposes an explicit consent policy for intimate exams along with specific changes to medical school curriculum and institutional culture. Because patients are the rights-holders of their bodies, consent practices should reflect and uphold patient values which call for explicit consent for intimate exams. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 7-9, March‐April 2022.

Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does (...) not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient’s racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers’ abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources. (shrink)

We read with interest Lanphier and Anani’s manuscript on trauma-informed ethics consultation. Their model rightly integrates trauma-informed principles within the ethics c...

Legislative strategies for reducing infant abandonment and neonaticide developed in response to a series of sensational cases that occurred in Texas in 1999. The media coverage of these cases implied that the incidence of the crime was increasing, and Texas legislators responded with a law permitting parents to anonymously surrender their newborn at designated locations such as hospitals. This was the first “safe haven” law. Interest peaked nationwide, and by 2008 all states had a similar version of the law. These (...) laws can trigger rapid cessation of parental rights and a fast-tracked adoption to a preapproved family, reflecting the legislators’ assumption that it is better to permit struggling mothers to leave their children with well-intentioned strangers than to abandon the children or end their lives. These laws, however, suffer from several inadequacies. (shrink)

The use of participatory methods has become increasingly popular in agricultural research and development and natural resource management. A range of approaches are being used at the grassroots level in order to involve local citizens and groups in projects. Many of these activities remain peripheral and isolated from conventional development agencies and policies. However, recent efforts are evolving to link participatory approaches into wider planning and policy-making processes and to increase the influence of such methods in resource management initiatives. Main (...) lessons from these innovative participatory experiences in addressing policy issues for sustainable development are summarized. (shrink)

This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn to (...) the status of the genitals as ‘intimate’ anatomy—a status that is not fully erased by being in a medical context. In this editorial, we draw on the work of Talia Mae Bettcher on ‘intimate agency’ to explore why unconsented interventions into the genitalia may constitute a distinctive sort of personal violation compared to unconsented contact with various other parts of the human body. In their feature article, Marit van der Pijl and colleagues1 argue it is unethical for healthcare providers to perform unconsented episiotomies on persons in labour. In particular, they suggest that, outside of certain rare emergencies in which, for example, the person giving birth is incapacitated1 and the procedure cannot be delayed until consent becomes possible without introducing a significant risk of serious harm (call these ‘medically necessary’2 procedures), ‘presumed consent’ is the incorrect standard to apply. Instead, they stress that, especially when a proposed intervention involves a person’s genital, sexual or reproductive organs, the need to obtain their explicit consent in advance of proceeding must be honoured. As the authors note, the broader social significance of our genitalia—widely regarded as ‘private’ anatomy—is not erased by being in a medical context (see also 2–4). Boundaries must still be observed. Ethically, this ‘leaves a very small margin for error because invasion of these body parts …. (shrink)

Fox’s update of her pivotal 2007 study on ethics consultations in U.S. hospitals found that the gap in ethics consultations is widening between large teaching hospitals and small community hospital...

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

This article provides an overview of the key philosophical themes and debates in discussions of pornography. In particular, I consider the major positions on how pornography ought to be defined, when (and if ) it should be regulated, whether it is best understood as speech (or action), whether there is evidence that is it harmful. I argue in favor of what is known as the civil rights approach to pornography, as reflected in the work of Catharine MacKinnon.

Since the introduction of mathematical population genetics, its machinery has shaped our fundamental understanding of natural selection. Selection is taken to occur when differential fitnesses produce differential rates of reproductive success, where fitnesses are understood as parameters in a population genetics model. To understand selection is to understand what these parameter values measure and how differences in them lead to frequency changes. I argue that this traditional view is mistaken. The descriptions of natural selection rendered by population genetics models are (...) in general neither predictive nor explanatory and introduce avoidable conceptual confusions. I conclude that a correct understanding of natural selection requires explicitly causal models of reproductive success. *Received May 2006; revised December 2006. †To contact the author, please write to: Department of Philosophy, Kansas State University, 201 Dickens Hall, Manhattan, KS 66506; e‐mail: [email protected] . (shrink)

The most successful theory in all of science--and the basis of one third of our economy--says the strangest things about the world and about us. Can you believe that physical reality is created by our observation of it? Physicists were forced to this conclusion, the quantum enigma, by what they observed in their laboratories. Trying to understand the atom, physicists built quantum mechanics and found, to their embarrassment, that their theory intimately connects consciousness with the physical world. Quantum Enigma explores (...) what that implies and why some founders of the theory became the foremost objectors to it. Schrodinger showed that it "absurdly" allowed a cat to be in a "superposition" simultaneously dead and alive. Einstein derided the theory's "spooky interactions." With Bell's Theorem, we now know Schrodinger's superpositions and Einstein's spooky interactions indeed exist. Authors Bruce Rosenblum and Fred Kuttner explain all of this in non-technical terms with help from some fanciful stories and bits about the theory's developers. They present the quantum mystery honestly, with an emphasis on what is and what is not speculation. Physics' encounter with consciousness is its skeleton in the closet. Because the authors open the closet and examine the skeleton, theirs is a controversial book. Quantum Enigma's description of the experimental quantum facts, and the quantum theory explaining them, is undisputed. Interpreting what it all means, however, is controversial. Every interpretation of quantum physics encounters consciousness. Rosenblum and Kuttner therefore turn to exploring consciousness itself--and encounter quantum physics. Free will and anthropic principles become crucial issues, and the connection of consciousness with the cosmos suggested by some leading quantum cosmologists is mind-blowing. Readers are brought to a boundary where the particular expertise of physicists is no longer a sure guide. They will find, instead, the facts and hints provided by quantum mechanics and the ability to speculate for themselves. (shrink)

Offers a compelling vision of how to achieve and conduct a liberal but democratic society through the ideal of Neutrality--between people and ideas of the good--and using the tool of Neutral dialogue.

We have a thriving biotechnology industry in the United States. There are over 1,450 biotechnology companies developing diagnostic and treatment technologies in medicine, creating more nutritional foods, and innovating new industrial processes. Yet this $28.5 billion sector of the economy is not without controversy. The “bio” in biotechnology comes from living, biological entities - people, plants, animals, and even bacteria. In the realm of biobanking, people are the source of the raw material for the discovery of genes for research, diagnosis, (...) and therapy, raising a host of issues about rights and responsibilities, fiduciary duties and societal obligations. (shrink)

New Jersey's Baby M case has thrust the issue of surrogate motherhood on state legislatures throughout the country. Like artificial insemination in the 1950s and 1960s, this new reproductive technology is evoking legislative responses ranging from horrified prohibition to cautious facilitation.

Two recent cases raise the question: Should the body be considered a form of property? Patients generally do not share in the profits derived from the applications of research on their body parts and products. Nor is their consent for research required so long as the body part is unidentified and is removed in the course of treatment. A market in body parts and products would require consent to all categories of research and ensure that patients are protected from coercion (...) and given the chance to be paid fairly for their contributions. Such a market might force us to rethink our policies prohibiting organ sales. Donors, recipients, and society will benefit from a market in body parts so long as owners—and no one else—retain control over their bodies. (shrink)

Prabhpal Singh has recently defended a relational account of the difference in moral status between fetuses and newborns as a way of explaining why abortion is permissible and infanticide is not. He claims that only a newborn can stand in a parent–child relation, not a fetus, and this relation has a moral dimension that bestows moral value. We challenge Singh’s reasoning, arguing that the case he presents is unconvincing. We suggest that the parent–child relation is better understood as an extension (...) of an existing relationship formed during the gestational period. The change in this relation at birth is not sufficient to justify the radical change in moral status required to rule out infanticide while accepting the permissibility of abortion. Given that the moral status of orphans is also problematic under Singh’s account, we conclude that Singh has not shown that a newborn has greater moral worth than a fetus. (shrink)

The Great Psychotherapy Debate: Models, Methods, and Findings comprehensively reviews the research on psychotherapy to dispute the commonly held view that the benefits of psychotherapy are derived from the specific ingredients contained in a given treatment (medical model). The author reviews the literature related to the absolute efficacy of psychotherapy, the relative efficacy of various treatments, the specificity of ingredients contained in established therapies, effects due to common factors, such as the working alliance, adherence and allegiance to the therapeutic protocol, (...) and effects that are produced by different therapists. In each case, the evidence convincingly corroborates the contextual model and disconfirms the prevailing medical model. (shrink)

The second edition of The Great Psychotherapy Debate has been updated and revised to include a history of healing practices, medicine, and psychotherapy, an expanded theoretical presentation of the contextual model, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. would (...) produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

Corporate governance and finance are dynamic academic fields that offer myriad opportunities for business ethics analysis. Within the corporate governance triad in recent years, shareholders have increased their power over boards of directors and executives through both regulation and movements to change corporate by-laws. The impact of board characteristics on firm performance has proven elusive, leading to questions concerning board processes and individual director beliefs and behaviors. At the same time, CEOs have lost considerable power, leaving many struggling to regain (...) their control and maintain their compensation levels, while others adopt a stewardship approach to their posts. In the field of finance, the recent financial debacle has led to a reexamination of financial regulation and of the fundamental nature and purpose of the industry. All of these issues provide business ethicists fodder for investigation and analysis. (shrink)

ITC technologies have come to comprehensively represent images and expectations of the future. Hopes of ongoing progress, economic growth, skill upgrading and possibly also democratisation are attached to new ICTs as well as fears of totalitarian control, alienation, job loss and insecurity. Currently, with the terms "Industry 4.0." and ‘Fourth Industrial Revolution”, public institutions, private institutions, and literature refer to the inchoate transformation of production of goods and services resulting from the application of a new wave of technological innovations: interconnected (...) collaborative robots; machine learning; Artificial Intelligence; 3D printers connected to digital development software; simulation of interconnected machines; integration of the information flow along the value chain; multidirectional communication between manufacturing processes and products. According to the main representations of Industry 4.0. by private and public institutions, its effects are expected to be mainly positive, for what regards productivity, economic opportunities and the future of work. The positive potentials now attributed to the new cycle of innovation evoke and expand those attributed to the previous waves of innovation linked to ITC technologies, and, even before, to the transition from Fordism to Post-Fordism. However, these transformations have so far not achieved any of the promises they raised. Improvements for workers in terms of work conditions, work performance and work relationships cannot be determined by any technical innovation in itself, being technological innovation always socially shaped. (shrink)

Abstract:To date, our understanding of ethical decision making and behavior in organizations has been concentrated in the area of moral judgment, largely because of the hundreds of studies done involving cognitive moral development. This paper addresses the problem of our relative lack of understanding in other areas of human morality by applying a recently developed construct—moral approbation—to illuminate the link between moral judgment and moral action. This recent work is extended here by exploring the effect that organizations have on ethical (...) behavior in terms of the moral approbation construct. (shrink)

Personal Versus Political Affairs in Churchill's This is a Chair There are plenty of issues in the world to petition and fight for, yet each individual also has "battles" at home to contend with. Which is of more importance? We often separate the two indefinitely. In studying Caryl Churchill's work This Is a Chair, however, I would suggest the personal and political to be intimately related and possibly each even a causation of the other. To take care of one may (...) be eliminating the problem of the other as well. Might political problems stem from petty, personal qualms? Even more specifically might jeopardizing moral norms affect the greater social order? If so, this would be a revelation and fresh pursuit in solving many of the monumental political issues which are faced today. (shrink)

BackgroundMedical aid in dying was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two (...) Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend. (shrink)

The UN Security Council adopted sanctions as a means of addressing unrest in Haiti, Iraq, the former Yugoslavia, and Somalia. Damrosch examines this shift from unilateral to collective enforcement and assesses the moral legitimacy and conclusive results of this policy.

We have a thriving biotechnology industry in the United States. There are over 1,450 biotechnology companies developing diagnostic and treatment technologies in medicine, creating more nutritional foods, and innovating new industrial processes. Yet this $28.5 billion sector of the economy is not without controversy. The “bio” in biotechnology comes from living, biological entities - people, plants, animals, and even bacteria. In the realm of biobanking, people are the source of the raw material for the discovery of genes for research, diagnosis, (...) and therapy, raising a host of issues about rights and responsibilities, fiduciary duties and societal obligations. (shrink)

In the Italian national elections in 2013, the Movimento Cinque Stelle, founded just four years earlier, gained 25 percent of votes, more than any other party. Analyses and interpretations are divided between those who consider M5S a member of the family of European populism and those who see M5S’s propositions as akin to the values of the left and social movements. The debate on M5S fits into the context of important ongoing trends in European politics: the growth of populist political (...) movements; the emergence of outsider parties able to challenge stable political systems; changing relationships between parties and social movements; changes in the forms of political organizing. This article investigates the political and cultural nature of this party by analyzing its discourse on democracy, its organizational choices and its main issues; comparing these elements with populism and the left; and linking its fundamental characteristics to contemporary economic processes usually termed “digital capitalism.”. (shrink)

In the context of the worsening economic crisis analogies tend to be drawn between the economic and political crisis in Europe of the 1920s and 1930s and the current situation. Now as then, it is argued, there is the risk that a systemic economic crisis and the crisis of representative politics will in turn lead to authoritarian outcomes. Rarer, however, is the idea that the current political and economic crisis may lead to a “progressive” outcome. This article examines both options (...) under the light of the thinking of one of the most important interpreters of political crisis and change in the 1920s and 1930s: Antonio Gramsci. One of the central arguments in Gramsci’s Prison Notebooks is the crisis of parliamentarism and democratic politics. Gramsci did not limit his analysis to the crisis however. His theoretical undertaking also consisted in the attempt to imagine the conditions for moving beyond the democratic crisis in a progressive manner. What emerges is an existing continuity between the Gramscian categories of Cesarism-Bonapartism, economic-corporative State, hegemonic crisis and contemporary politics, particularly with reference to phenomena such as populism, technocracy and neo-liberalism; the utility of the conceptual category of Passive Revolution to comprehend the current forms of exerting power and building social consent; the potential fruitfulness of Gramsci’s schemata on counter-hegemonies, to understand the changes in the party-organization and the possibilities of building counter-hegemonies. (shrink)

Examines art and literature of the Americas through the lens of the questionnaire, a genre as central as the manifesto to the history of the avant-garde. Demonstrates how modernism and the avant-garde were debated at the very moment of their development and consolidation"--Provided by publisher.

Working in and around the ‘chain of command’: power relations among nursing staff in an urban nursing homeBy most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing’s value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban (...) nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing’s quest for professional status in the face of medicine’s hegemony over health‐care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict — and by aides’ resistance to nurses’ domination. (shrink)

This highly original history of ideas considers the impact of Hegel on French philosophy from the 1920s to the present. As Baugh's lucid narrative makes clear, Hegel's influence on French philosophy has been profound, and can be traced through all the major intellectual movements and thinkers in France throughout the 20th Century from Jean Wahl, Sartre, and Bataille to Foucault, Deleuze, and Derrida. Baugh focuses on Hegel's idea of the "unhappy consciousness," and provides a bold new account of Hegel's early (...) reception in French intellectual history. (shrink)

It is a truism that where one starts from and the direction one goes determines where one ends up. This is no less true in philosophy than elsewhere, and certainly no less true in matters dealing with the relationship between God’s foreknowledge and human free actions. In what follows I will argue that the incompatibilist view that Fischer and others stalwartly defend results from the particular starting point they choose, and that if one adopts a different starting point about divine (...) knowledge the logical incompatibility they envision and philosophically anguish over evaporates. (shrink)

In 1890 a man sold the rights to his body after death to the Royal Caroline Institute in Sweden for research purposes. Later, he tried to return the money and cancel the contract. In the subsequent lawsuit, the court held that he must turn his body over to the Institute and also ordered him to pay damages for diminishing the worth of his body by having two teeth removed.Today, it would be an anathema for a person's body to be used (...) against his wishes and for a research subject not to be allowed to withdraw from a study. In fact, the Uniform Anatomical Gift Act allows people to change their minds and withdraw a previous agreement to donate organs and tissue after their death and the federal research regulations allow people to withdraw from studies without penalty or loss of benefits. (shrink)