In the specialized area of pediatric endocrinology, the use of human growth hormone (hGH) both for children who have a growth hormone abnormality and for the treatment of non-hGH-deficient children who are short is a current clinical reality that raises important ethical questions. Generally speaking, the use of hGH for those children who are clearly lacking it is an efficacious intervention based upon established clinical criteria. The use of hGH for children who are short, but have no growth hormone abnormality (...) is ethically and clinically more controversial. The moral conundrum of how to gain knowledge about new medical treatments that may be beneficial to children while, at the same time, ethically enrolling them in clinical trials with placebo arms in order to gain such knowledge will continue to be a contentious issue in the conduct of research and in the delivery of health care. In addition, there are questions about what ought to be studied and whether a physical characteristic such as short stature ought to be viewed as a circumstance of less than optimal health. (shrink)

The attentive pupil who wishes to be attentive, his eyes riveted on the teacher, his ears open wide, so exhausts himself in playing the attentive role that he ends up by no longer hearing anything....

A wide range of conflicting established moral viewpoints makes development of public policy related to infertility difficult. Where there are pluralities of viewpoints and no single established moral approach, uniform solutions are questionable. The Office of Technology Assessment (OTA), is a nonpartisan analytic support agency that serves the United States Congress by providing objective analyses of major public policy issues related to scientific and technological change. Because analysis of ethical issues is an important part of technology assessment, OTA included a (...) thematic analysis of ethical issues in the report, Infertility: Medical and Social Choices . A consideration of whether infertility is a disease was an important conceptual starting point, and religious perspectives were reviewed as possible sources of moral and ethical insight. Keywords: infertility, U.S. Congress, Office of Technology Assessment, infertility, right to reproduce, embryo CiteULike Connotea Del.icio.us What's this? (shrink)

In the context of the motor skill literature on observational learning and hierarchical skill structuring, Byrne & Russon's findings call into question their standpoint that great apes imitate the behaviour of role models at the programme level. The authors impose a hierarchical model on their observations without properly considering alternative explanations. One such possibility, which stems from a constraints perspective that they dismiss, is put forward.

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted—or terminated—in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult (...) decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness. (shrink)

The enormous destructive power of present stocks of nuclear weapons poses the greatest threat to public health in human history. Technical changes in weapons design are leading to an increased emphasis on the ability to fight a nuclear war, eroding the concept of deterrence based on mutually assured destruction and increasing the risk of nuclear war. Medical planning and civil defence preparations for nuclear war have recently been increased in several countries although there is little evidence that they will be (...) of significant value in the aftermath of a nuclear conflict. These developments have raised new ethical dilemmas for those in health professions. If there is any risk of use of weapons of mass destruction, then support for deterrence with these weapons as a policy for national or global security appears to be incompatible with basic principles of medical ethics and international law. The primary medical responsibility under such circumstances is to participate in attempts to prevent nuclear war. (shrink)

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

This paper is a tentative step toward formalizing in symbolic logic some of the central assumptions of Clark L. Hull's theory of behavior. There will be noticeable deviations from Hull's own terminology and form of statement, but this will be largely in the interest of greater logical simplicity. The notation of symbolic logic will not be used, but the behavioral axioms will be so stated as to admit of easy translation into such notation. Such easy translatability seems to be a (...) prerequisite if theorems are to be derivable with genuine deductive rigor. (shrink)

Face transplantation—or, more properly, facial allograft transplantation —generates much public interest and academic debate. In this paper, we suggest that it is up to opponents of FAT to make the case for its impermissibility. We allow that there is a number of apparently strong arguments that might be deployed against FAT. However, all but one of these turn out not to be compelling after examination. The remaining argument is not so easily dismissed—but its central point is fairly workaday and certainly (...) does not tell us anything about FAT in particular. Therefore, qua argument about facial transplant surgery, it fails to hit its target. Overall, we conclude that a compelling case against FAT remains to be made. (shrink)

The increasing effort, both lay and academic, to encourage a transition from an “I-It” to an “I-Thou” relation to nature is located within a typology of ways of “knowing nature.” This typology provides the context for a particular understanding of human conversation which sees the relation as a cyclical process of “immersion” and “realization” from which a model of the dialectic between “I-It” and “I-Thou” relations to nature can be developed. This model can be used to identify practical measures that (...) can be taken as first steps toward a balance between these relations, both in general and in the context of science-oriented nature conservation organizations such as English Nature in Britain. (shrink)

As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities has published core knowledge (...) competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 42-47, September‐October 2021.

This essay demonstrates proof-theoretically the consistency of a type-free theoryC with an unrestricted principle of comprehension and based on a predicate logic in which contraction (A (A B)) (A B), although it cannot holds in general, is provable for a wide range ofA's.C is presented as an axiomatic theoryCH (with a natural-deduction equivalentCS) as a finitary system, without formulas of infinite length. ThenCH is proved simply consistent by passing to a Gentzen-style natural-deduction systemCG that allows countably infinite conjunctions and in (...) which all theorems ofCH are provable.CG is seen to be a consistent by a normalization argument. It also shown that in a senseC is highly non-extensional. (shrink)

CHAPTER I POLITICAL FAITH AND UTOPIAN THOUGHT In the three and a half centuries since Bacon and the miller prayed for peace among the willows, countless men ...

This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with a clear justification of why it is important to take best standards, norms, and physician judgment seriously and a clear (...) justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

From beginning to end, the poem is literally made up of relations…[that] constitute a method of contemplation and criticism, a way of inviting the reader to think in terms of one thing in terms of another. Consider, for example, Odysseus' trip to Chryse in book 1, a passage I never read without surprise: in this tense and heavily charged world, in which everything seems to have been put into potentially violent contention, why are we given this slow and deliberate journey, (...) so heavily formulaic in texture? The answer is that this is a ritual of reconciliation, a kind of healing, which will receive its most ample performance at the great movement in book 24 when Achilles and Priam share their sorrows. A movement begins here that will run throughout the poem.It is by such an art of arrangement, by placing one thing against another, that Homer criticizes the world of book 1 with which he began; not, as we expect of a writer today, by elaborating competitive languages of motives and value but by ordering his materials into patterns of experience that teach the reader something different from anything the material itself seems to say.1 In a way the poem, as a whole thus has the form of argument; not, of course, argument in the ratiocinative sense of a thesis supported by propositions, from which it can be said to proceed by the rules of logic or the laws of probability, but argument as an activity of critical engagement, a definition of resources and a testing of limits, that results in the creation of a new position taken by the writer and offered to the reader. An argument goes on in the text, but its method is closer to that of music than debate.· 1. Cf. Cedric H. Whitman, Homer and the Heroic Tradition chap. 6, for another view of the ways that formula and image combine.James B. White is a professor in the law school, the college, and the committee on the ancient Mediterranean world at the University of Chicago. He is the author of The Legal Imagination, Constitutional Criminal Procedure, and a book on rhetoric and culture, from which the present article is drawn. (shrink)