Critics from a variety of camps have argued that bioethics has suffered an indifference to Cases have been described as thin and the selves inhabiting them hollow. This criticism has been driven at least in part by a reworked conception of the self. The rational and autonomous self that once dominated bioethics discourse has been replaced with a more self, a self embedded in stories, relationships, families, communities, cultures, and other particularitythese differences—matter. They matter because they figure importantly into our (...) ethical analyses of cases, affecting, for example, how we interact with and treat patients. And with this shift has come increasing attention to the processes of moral inquiry that enable inquirers to gather all of this moral information and find their way from complex cases to context-sensitive responses. (shrink)

An absolute decline in US life expectancy in low education whites has alarmed policy makers and attracted media attention. Depending on which studies are correct, low education white women have lost between 3 and 5 years of lifespan; men, between 6 months and 3 years. Although absolute declines in life expectancy are relatively rare, some commentators see the public alarm as reflecting a racist concern for white lives over black ones. How ought we ethically to evaluate this lifespan contraction in (...) low education whites? Should we care, or is it racist to care? Does it constitute an injustice or reflect justice being done? I argue that the lifespan contraction in low education whites violates key normative criteria used to make determinations of health justice, and that these judgments do not vitiate concerns about racism. I conclude with reflections on US population health policy and building an inclusive health equity movement. (shrink)

Empirical evidence demonstrates that minority and marginalized populations receive less and lower quality healthcare than more advantaged groups. Ethical analyses of these disparities explain their injustice. That disparities exist and constitute a moral wrong are uncontroversial views. Less clear are the exact causes of healthcare disparities.

Background This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received.Methods We adapted democratic deliberation, an approach to stakeholder engagement, for use with (...) three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation.Results A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement.Conclusion The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described. (shrink)

Persons of low socioeconomic status generallyexperience worse health and shorter lives thantheir better off counterparts. They alsosuffer a greater incidence of adversepsychosocial characteristics, such as lowself-esteem, self-efficacy, and self-masteryand increased cynicism and hostility. Thesepopulation data suggest another category ofharm to persons: diminished moral agency. Chronic socioeconomic deprivation can createenvironments that undermine the development ofself and capacities constitutive to moralagency – i.e., the capacity forself-determination and crafting a life of one''sown. The harm affects not only the choicesa person makes, but the (...) chooser herself. Thismoral harm is particularly salient in modernWestern societies, especially in the UnitedStates, where success and failure is attributedto the individual, with little notice of thelarger social and political realities thatinform an individual''s circumstances and choices. (shrink)

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.

Childhood obesity may have severe long‐term consequences for health—indeed, for the overall course of a person's life. Do these harms amount to a problem of social justice? And if so, what should be done about it? Parents are usually granted considerable leeway to make decisions that affect their children's health. Social and moral theory has often overlooked the family, however, leaving us with an inadequateunderstanding of parental autonomy and of how social policy may influence it.

Childhood obesity may have severe long-term consequences for health—indeed, for the overall course of a person's life. Do these harms amount to a problem of social justice? And if so, what should be done about it? Parents are usually granted considerable leeway to make decisions that affect their children's health. Social and moral theory has often overlooked the family, however, leaving us with an inadequate understanding of parental autonomy and of how social policy may influence it.

Shift work is a fixture of our 24-hour economy, with approximately 18 per cent of workers in the USA engaging in shift work, many overnight. Since shift work has been linked to an increased risk for an array of serious maladies, including cardiometabolic disorders and cancer, and is done disproportionately by the poor and by minorities, shift work is a highly prevalent economic and occupational health disparity. Here we draw primarily on the state of science around shift work and breast (...) cancer to argue that shift work represents a public health threat serious enough to warrant a precautionary stance. We use the precautionary principle to advance our case and view it as a moral compass for shift work research, empowering public health to cast shift work within the domain of health disparities deserving action despite scientific uncertainty. With the precautionary principle, we call for a deliberative decision-making process and formation of a broad shift work research collaboration to protect the health of many millions who work at night. (shrink)

This essay argues that a failure to think and talk critically and candidly about White privilege and White poverty is a key threat to the United States of America's precarious democracy. Whiteness frames one of America's most pressing collective challenges—the poor state of the nation's health, which lags behind other wealthy nations and is marred by deep and entrenched class‐ and race‐based inequities. The broadscale remedies experts recommend demand what is in short supply: trust in evidence, experts, government, and one (...) another. The authors’ prescription is threefold, beginning with a call for intersectional health studies and reports that avoid one‐dimensional misrepresentations of widespread health problems as simply Black or White problems. Second, there is the need for a “critical consciousness” about race and class. Lastly, the essay calls for widescale opportunities for Americans to engage in cross‐racial and cross‐class democratic conversations about their struggles and aspirations in search of common ground. (shrink)

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

Social work and bioethics are fields deeply committed to cross-disciplinary collaboration to do their respective work. While scholars and practitioners from both fields share a commitment to social justice and to respecting the dignity, integrity and the worth of all persons, the overlap between the fields, including shared values, has received little attention. The purpose of this article is to describe the ways in which greater collaboration between the two fields can broaden their scope, enrich their scholarship, and better ground (...) their practice. We describe the potential for realizing such benefits in two areas – health care ethics consultation and social inequalities in health – arguing that the fields both complement and challenge one another, making them ideal partners for the interdisciplinary inquiry and problem-solving so often called for today in health and health care. (shrink)

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.

La presente investigación tuvo como objetivo realizar un análisis del procedimiento abreviado contemplado en el Código Orgánico Integral Penal (COIP), partiendo del criterio de que ciertos aspectos de este procedimiento vulneran derechos fundamentales del investigado. Se destaca particularmente el requisito para el procesado de admitir los hechos que se le imputan para acceder a este procedimiento, lo cual, según la opinión mayoritaria de doctrinarios, compromete el principio de no autoincriminación, la presunción de inocencia y el derecho a un juicio con (...) todas sus fases. El objetivo de esta investigación fue analizar el procedimiento abreviado establecido en el Código Orgánico Integral Penal (COIP), con el propósito de identificar posibles vulneraciones de derechos fundamentales del investigado. Se buscó específicamente evaluar cómo el requisito de admitir los hechos imputados para acceder a este procedimiento podría afectar principios como el de no autoincriminación y la presunción de inocencia. A través de un enfoque cualitativo y utilizando diferentes métodos de análisis, se procuró determinar si el procedimiento abreviado, tal como está configurado, garantiza un debido proceso conforme a los estándares de derechos humanos y constitucionales. La metodología aplicada se sustentó en un enfoque cualitativo, utilizando los métodos inductivo, analítico, sintético y exegético. Se llevó a cabo un análisis documental de la bibliografía relacionada con el tema investigado, así como de instrumentos internacionales de Derechos Humanos, la Constitución de la República de Ecuador, el COIP y jurisprudencia vinculada a la materia. Los resultados de la investigación determinaron que el procedimiento abreviado tal como se encuentra regulado en el COIP beneficia al Estado y al sistema de justicia al agilizar ciertos procesos legales. Sin embargo, se evidenció que este procedimiento puede vulnerar derechos esenciales del procesado, como el principio de no autoincriminación y la presunción de inocencia. Por lo tanto, se concluye que el procedimiento abreviado afecta el debido proceso al comprometer garantías fundamentales. La investigación señala que el procedimiento abreviado regulado en el COIP, si bien puede ser beneficioso para la eficiencia del sistema de justicia, también conlleva riesgos significativos de vulnerar derechos fundamentales del procesado. Por lo tanto, se destaca la necesidad de revisar y modificar este procedimiento para garantizar el respeto absoluto al debido proceso y a las garantías individuales del investigado. (shrink)

A debate over the possibilities for foundations of knowledge has been a key feature of theoretical discussions in the discipline of International Relations. A number of recent contributions suggest that this debate is still active. This article offers a contribution to this debate by suggesting that the study of complexity may provide a contingent foundation for the study of international relations. We examine the grounds on which such a claim might be made, and examine the implications for taking complexity as (...) a foundational claim. (shrink)

This paper focuses on Confucian formulations of personhood and the implications they may have for bioethics and medical practice. We discuss how an appreciation of the Confucian concept of personhood can provide insights into the practice of informed consent and, in particular, the role of family members and physicians in medical decision-making in societies influenced by Confucian culture. We suggest that Western notions of informed consent appear ethically misguided when viewed from a Confucian perspective.

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022–2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating (...) which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus‐based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid‐19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication. (shrink)

This paper is going to explore the adverse effects of exposure to combat death on medics’ holistic well-being, which, if ignored could decrease individual readiness and negatively impact the mission. We rely on the experience of United States Air Force Special Operation Surgical Teams (AF SOST) whose exposure to mass casualty scenarios in austere environments could serve as approximations of conditions of future battlefields. Over the past two decades, the ability to deliver advanced medical care on and off the battlefield (...) along with a rapid casualty evacuation platform has allowed for unprecedented survival rates exceeding 90%. While laudable, these medical achievements have also set up a casualty management paradigm in which medical decision-making singularly focuses on life-saving care. Confronting peer-peer adversaries in large scale combat operations (LSCO) on a multi-domain battlefield will make casualty management frighteningly more complex by introducing major infrastructural, personnel, and resource constraints. When considering the high number of casualties expected in LSCO alongside enormous limitations in medical resource and resupply capability, the current casualty management paradigm will not be sustainable. The resource constrained environment in LSCO will shift medical decision-making away from a singular focus on life-saving care to triage, which hinges on the ability to determine futile medical interventions—a skill that has been lost in the past two generation of combat medics. As such, a broad ethical challenge that arises in preparation for LSCO is the need to set new expectations concerning dying and death. However, medical decision-making focused on death and dying has not been explicitly addressed in military medical training, research, or policy. Relying on a body of literature known as terror management theory (TMT) and ethnographic data from our study with AF SOST medics, we are going to argue that it is important to expose medics to death in mass casualty and triage training. (shrink)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 1-2, Page 164-188, June 2022.

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population. There are no data in this work.

Existing whistle-blowing models rely on “cold” economic calculations and cost-benefit analyses to explain the judgments and actions of potential whistle-blowers. I argue that “hot” cognitions – value conflict and emotions – should be added to these models. I propose a model of the whistle-blowing decision process that highlights the reciprocal influence of “hot” and “cold” cognitions and advocate research that explores how value conflict and emotions inform reporting decisions. I draw on the cognitive appraisal approach to emotions and on the (...) social-functional value pluralism model to generate propositions. (shrink)

The increasing concern about ethics and integrity in research communities has brought attention to how students and junior academics can be trained on this regard. Moreover, it is known that ethical behaviour and integrity not only involve individual but also group norms and considerations. Thus, through action research and participant observation, this research investigates the learning processes through which 64 students collaboratively develop research ethics and integrity competencies. The aim was to understand how bachelor, master and PhD students approach ethical (...) dilemma cases through a collaborative process. The data consisted of recorded group work on ethics cases, student group reports, and post-training questionnaires. Later, the analyses considered groups as the unit of analysis. These data were analysed through content analysis utilizing the SOLO taxonomy to identify levels of understanding and assess evolvement of ethical sensitivity during a case-based training session. The results show that all groups reached the level of understanding where the groups demonstrated that concepts had been understood appropriately, but occasionally struggled to make connections between them. Students perceived working collaboratively as beneficial. The results help teachers of research ethics and integrity to make pedagogically justified choices in their teaching. Drawing on the results of this study, we propose a tool for the formative assessment of student learning of research ethics and integrity. (shrink)