In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation (...) to its patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

In this book, Kevin M. Cherry compares the views of Aristotle and Plato about the practice, study, and above all, the purpose of politics.

In this paper, I offer a view beyond that which would narrowly reduce the role of parents in medical decision making to acting as custodians of the best interests of children and toward an account of family authority and family autonomy. As a fundamental social unit, the good of the family is usually appreciated, at least in part, in terms of its ability successfully to instantiate its core moral and cultural understandings as well as to pass on such commitments to (...) future generations. The putative rights of children to expression, information, freedom of thought, conscience, religion, and to freedom of association with others are, in this essay, assessed from the perspective of those conditions necessary for the family to function as a moral community. In so doing, I respond to the move to liberate children from parental authority and to effect the transformation of the family as implied by the United Nations’ "Convention on the Rights of the Child" and the pediatric bioethics it supports. (shrink)

Political theorists have recently emphasized the popular dimension of Aristotle’s political thought, and many have called attention to Aristotle’s assertion that certain multitudes should share in the city’s deliberations. In this article, I explore the “part of virtue and prudence” Aristotle believes necessary for a multitude to participate in political life. I argue, first, that military service helps citizens develop the “part of virtue” necessary for political participation and, second, that the “part of prudence” Aristotle has in mind is sunesis. (...) I argue, moreover, that military virtue helps citizens acquire sunesis and guides its exercise. Aristotle recognizes the limitations and potential dangers of military virtue and attempts to avoid these, in part by offering a new understanding of military virtue to offset the Spartan. Understanding the “part of virtue and prudence” citizens have helps understand their role in a polity but also points to how those citizens, and their regime, can be improved. (shrink)

In Roper v. Simmons (2005) the United States Supreme Court announced a paradigm shift in jurisprudence. Drawing specifically on mounting scientific evidence that adolescents are qualitatively different from adults in their decision-making capacities, the Supreme Court recognized that adolescents are not adults in all but age. The Court concluded that the overwhelming weight of the psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than adult persons. The Supreme Court further solidified (...) its position regarding adolescents as less than fully mature and responsible decisionmakers in Graham v. Florida (2010) and Miller v. Alabama (2012). In each case, the Court concluded that the scientific evidence does not support the conclusion that children under 18 years of age possess adult capacities for personal agency, rationality, and mature choice. This study explores the implications of the Supreme Court decisions in Roper v. Simmons, Graham v. Florida, and Miller v. Alabama for the “mature minor” standard for medical decision making. It argues that the Supreme Court’s holdings in Roper, Graham, and Miller require no less than a radical reassessment of how healthcare institutions, courts of law, and public policy are obliged to regard minors as medical decisionmakers. The “mature minor” standard for medical decision making must be abandoned. (shrink)

In Kidney for Sale by Owner: Human Organs, Transplantation, and the Market, I argued that the market is the most efficient and effective—and morally justified—means of procuring and allocating human organs for transplantation. This special issue of The Journal of Medicine and Philosophy publishes several articles critical of this position and of my arguments mustered in its support. In this essay, I explore the core criticisms these authors raise against my conclusions. I argue that clinging to comfortable, but unfounded, notions (...) that human body parts are not commodities, that the physician-patient relationship transcends commercial practices, and that medicine rises above market-place morality (where “market-place morality” is presented rhetorically as a criticism) leads to a real failure adequately to appreciate the complex reality of modern medicine. Denying the illicit moral intuitions that commodification of body parts is immoral or that it necessarily violates human dignity would benefit donors and recipients alike, while also reinforcing virtuous transplantation practice and policy. Honestly acknowledging the medical marketplace would shed light on what is often a hazy and shrouded policy setting. At stake is not solely the efficiency of procuring human organs for transplantation but also the recognition of the moral authority of persons over themselves. (shrink)

(No abstract is available for this citation).

This volume brings together a set of critical essays on the thought of Professor Doctor H. Tristram Engelhardt Jr., Co-Founding Editor of the Philosophy and Medicine book series. Amongst the founders of bioethics, Professor Engelhardt, looms large. Many of his books and articles have appeared in multiple languages, including Italian, Romanian, Portuguese, Spanish, and Chinese. The essays in this book focus critically on a wide swath of his work, in the process elucidating, critiquing, and/or commending the rigor and reach of (...) his thought. This volume compasses analyses of many different aspects of Engelhardt's work, including social and political philosophy, biopolitics, the philosophy of medicine, and bioethics. It brings together internationally known scholars to assess key elements of Engelhardt's work. (shrink)

This article raises three challenges to Richard McCormick's proportionalism. First, adequately to judge proportionate reason requires the specification of a particular background moral content and metaphysical context. Absent such specification, evaluation of proportionate reason is inherently and deeply ambiguous. Second, to resolve such ambiguity and yet remain Christian, proportionalism must adopt a forthrightly Christian moral content set within a straightforwardly Christian metaphysics. This move will, however, set Christian bioethics off as sectarian—a conclusion McCormick wishes to avoid. Third, even if proportionalism (...) were to adopt a Christian moral content and metaphysics to avoid such ambiguity, its methodology sets aside a key aspect of the Christian life: repentance. Proportionalism does not account for the core reality that repentance plays in one's personal encounter with and knowledge of God. As I will argue, the challenge in part is that moral action cannot be adequately conceptualized, nor can moral theology be properly understood, outside of the authentic practice of the religious life, and repentance is central to that Christian reality. (shrink)

The United Nations Educational, Scientific, and Cultural Organization's (UNESCO) Universal Declaration on Bioethics and Human Rights announces a significant array of welfare entitlements—to personal health and health care, medicine, nutrition, water, improved living conditions, environmental protection, and so forth—as well as corresponding governmental duties to provide for such public health measures, though the simple expedient of announcing that such entitlements are “basic human rights.” The Universal Declaration provides no argument for the legitimacy of the sweeping governmental authority, taxation, and regulation (...) to create and impose such “rights.” As this paper explores that some action promotes a purported good, such as “health,” does not thereby make the action morally permissible. Just as there are moral limits on legitimate personal actions, there are also moral limits on legitimate governmental actions to promote purported goods, including health. A core question of any governmental regulation, therefore, is whether it is a legitimate application of moral political authority or an unauthorized act of state coercion. Pace UNESCO's wide-ranging assertions, this paper argues that promoting health only falls within the legitimate authority of governments in very narrowly defined circumstances. As the paper critically explores, at stake are foundational moral and political questions concerning the limits of governmental authority to intervene in the consensual interaction of persons. Imposing such duties on others, including citizens of a state through regulatory activity and taxation, must be justified, nonarbitrary, and demonstrably within the limits of moral political authority. UNESCO's assertions do not meet this burden of proof. (shrink)

A truly Christian bioethics challenges the nature, substance, and application of secular morality, dividing Christians from non-Christians, accenting central moral differences, and providing content-full forthrightly Christian guidance for action. Consequently, Christian bioethics must be framed within the metaphysical and theological commitments of Traditional Christianity so as to provide proper orientation toward God. In contrast, secular bioethicists routinely present themselves as providing a universal bioethics acceptable to all reasonable and rational persons. Yet, such secular bioethicists habitually insert their own biases and (...) prejudices into their moral conclusions, ethical consultations, and political aspirations, without any real justification. As this article explores, the ideologically driven anti-Christian commitments, including commitments to human rights and social justice, embodied within contemporary bioethics routinely illustrate the increasing gap between the traditionally Christian and the devoutly secular, further deepening the culture wars. (shrink)

To comprehend pain, disease, death and suffering as being meaningful - beyond the firing of synapses, the collapse of human abilities, and the mere end of life - requires a context in which to evaluate essential connotations, as well as to place and integrate understandings. If pain and suffering are to have enduring significance, they must be situated within a nest of ontological background assumptions, standards of inquiry, and epistemological foundations. Where secular bioethics fails to give deep meaning to suffering, (...) Christian bioethics succeeds. This essay analyzes the divergent meanings of suffering endorsed by the various Christian religions as conceptualized through the different metaphysical, epistemological, and sociological assumptions of each religion. (shrink)

Despite the well-documented social, economic, and adaptive advantages for young children, adolescents, and adults, the traditional family in the West is in decline. A growing percentage of men and women choose not to be bound by the traditional moral and social expectations of marriage and family life. Adults are much more likely than in the past to live as sexually active singles, with a concomitant increase in forms of social isolation as well as in the number of children born outside (...) of marriage. These social shifts are also connected to public policies that provide incentives for individuals to exit the family, leaving behind its social, capital, and economic resources. The individualistic character of the social-democratic egalitarian ideology that underlies the current dominant approaches to health care financing in Western Europe and much of North America, for example, is associated with a decline in family stability. Welfare entitlements, including state-based health care, have made it easier to exit the family, undermining the centrality of the family’s core human relationships. This essay argues for the importance of recognizing the cardinal role and reality of the family and for the importance of family-based health care savings accounts for preserving family integrity, while also providing for sustainable long-term health care reform. (shrink)

In this paper, I assess Peter Dabrock's “Drawing distinctions responsibly and concretely: A European Protestant perspective on foundational theological bioethics.” I explore the ways in which Dabrock announces nontraditional Christian assumptions to guide Christian bioethics, engages the secular bioethical agenda on the very terms set by and congenial to the field of secular bioethics, and searches for insights from philosophy and science through which to recast Christian moral judgments. For example, he cites approvingly, as if they were expressive of Christian (...) moral concerns: human rights, democracy, and state-based social redistribution of resources to satisfy welfare entitlements. In this short essay, I argue that Dabrock has unduly limited the role of Traditional Christian theology to guide bioethics and, consequently, has also wrongly characterized the Christian moral life and Christian social/political obligations. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Traditionally, people were recognized as being dead using cardio-respiratory criteria: individuals who had permanently stopped breathing and whose heart had permanently stopped beating were dead. Technological developments in the middle of the twentieth century and the advent of the intensive care unit made it possible to sustain cardio-respiratory and other functions in patients with severe brain injury who previously would have lost such functions permanently shortly after sustaining a brain injury. What could and should physicians caring for such patients do? (...) Significant advances in human organ transplantation also played direct and indirect roles in discussions regarding the care of such patients. Because successful transplantation requires that organs be removed from cadavers shortly after death to avoid organ damage due to loss of oxygen, there has been keen interest in knowing precisely when people are dead so that organs could be removed. Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized by all 50 states in the United States as an acceptable way to determine death. We explore the ongoing debate over definitions of death, particularly over brain death or death determined using neurological criteria, and the relationship between definitions of death and organ transplantation. (shrink)

This book provides an exploration of the ethics of cardiology practice. The chapters are divided by five broad areas of practice: beginning-of-life, end-of-life, transplantation and allocation of expensive or scarce resources, professionalism, and research.

Health care reform poses numerous challenges. A core challenge is to make health care more efficient and effective without causing more harm than benefit. Additionally, those fashioning health-care policy must encourage patients to exercise caution and restraint when expending scarce resources; restrict the ability of politicians to advance their careers by promising alluring but costly entitlements, many of which they will not be able to deliver; face the demographic challenges of an aging population; and avoid regulations that create significant inefficiencies (...) and restrict access to health care. Given such real-world challenges, how should health care be reformed in the United States or elsewhere? This number of The Journal of Medicine and Philosophy examines many of the complex issues that must be considered in reforming a health-care system. (shrink)

Fairly recently, I came upon the following passage in a review of a book by Colin M. Turnbull, called The Mountain People:A child dumped on the ground is seized and eaten by a leopard. The mother is delighted; for not only does she no longer have to carry the child about and feed it, but it follows that there is likely to be a gorged leopard near by, a sleepy animal which can easily be killed and eaten. An old woman (...) who has been abandoned falls down the mountainside because she is blind, so a crowd gathers to laugh at the spectacle of her distress. A man about to die of gunshot wounds makes a last request for tea. As he feebly raises it to his lips, it is snatched from him by his sister, who runs away delighted. A child develops intestinal obstruction; so his father calls in the neighbours to enjoy the joke of his distended belly. (shrink)

Philosopher Myisha Cherry teaches us the right ways to deal with wrongdoing in our lives and the world Sages from Cicero to Oprah have told us that forgiveness requires us to let go of negative emotions and that it has a unique power to heal our wounds. In Failures of Forgiveness, Myisha Cherry argues that these beliefs couldn’t be more wrong—and that the ways we think about and use forgiveness, personally and as a society, can often do more (...) harm than good. She presents a new and healthier understanding of forgiveness—one that will give us a better chance to recover from wrongdoing and move toward “radical repair.” Cherry began exploring forgiveness after some relatives of the victims of the mass shooting at Emanuel A.M.E. Church in Charleston, South Carolina, forgave what seemed unforgiveable. She was troubled that many observers appeared to be more inspired by these acts of forgiveness than they were motivated to confront the racial hatred that led to the killings. That is a big mistake, Cherry argues. Forgiveness isn’t magic. We can forgive and still be angry, there can be good reasons not to forgive, and forgiving a wrong without tackling its roots solves nothing. Examining how forgiveness can go wrong in families, between friends, at work, and in the media, politics, and beyond, Cherry addresses forgiveness and race, canceling versus forgiving, self-forgiveness, and more. She takes the burden of forgiveness off those who have been wronged and offers guidance both to those deciding whether and how to forgive and those seeking forgiveness. By showing us how to do forgiveness better, Failures of Forgiveness promises to transform how we deal with wrongdoing in our lives, opening a new path to true healing and reconciliation. (shrink)

Fairly recently, I came upon the following passage in a review of a book by Colin M. Turnbull, called The Mountain People : A child dumped on the ground is seized and eaten by a leopard. The mother is delighted; for not only does she no longer have to carry the child about and feed it, but it follows that there is likely to be a gorged leopard near by, a sleepy animal which can easily be killed and eaten. An (...) old woman who has been abandoned falls down the mountainside because she is blind, so a crowd gathers to laugh at the spectacle of her distress. A man about to die of gunshot wounds makes a last request for tea. As he feebly raises it to his lips, it is snatched from him by his sister, who runs away delighted. A child develops intestinal obstruction; so his father calls in the neighbours to enjoy the joke of his distended belly. (shrink)

There is a need for person-centred approaches and empowerment of staff within the residential care for older people; a movement called ‘culture change’. There is however no single path for achieving culture change. With the aim of increasing understandings about cultural change processes and the promotion of cultural values and norms associated with person-centred practices, this article presents an action research project set on a unit in the Netherlands providing care for older people with dementia. The project is presented as (...) a case study. This study examines what has contributed to the improvement of participation of older people with dementia in daily occupational and leisure activities according to practitioners. Data was collected by participant observation, interviews and focus groups. The results show that simultaneous to the improvement of the older people’s involvement in daily activities a cultural transformation took place and that the care became more person-centred. Spontaneous interactions and responses rather than planned interventions, analysis and reflection contributed to this. Furthermore, it proved to be beneficial that the process of change and the facilitation of that process reflected the same values as those underlying the cultural change. It is concluded that changes arise from dynamic, interactive and non-linear processes which are complex in nature and difficult to predict and to control. Nevertheless, managers and facilitators can facilitate such change by generating movement through the introduction of small focused projects that meet the stakeholders’ needs, by creating conditions for interaction and sense making, and by promoting the new desired cultural values. (shrink)

An excellent introduction to communication theory, this book is a comprehensive study of its subject; fields such as linguistics, logic, mathematics, and psychology are considered in terms of their relevance for communication theory. No material that appeared in the first edition has been deleted from this second edition, but some comments have been added, some figures updated, and the bibliography extended to include the new publications in the field. Cherry begins with an examination of the concept of "communication"; he (...) also discusses social structures, considering the pattern of communication within a social group. After this introductory chapter, Cherry presents an historical review of the evolution of communication theory; he discusses codes, signs, brains, and machines, mentioning the work of such scientists as Shannon, Zipf, and Wiener. Topics such as phonetics, phonemics, object language and metalanguage, Zipf's Law, and semantics are also considered, as well as the role of the telecommunication engineer, who describes and analyzes the physical signals themselves without reference to their meanings. In the concluding chapter, psychological considerations concerning the reception of information are presented: recognition, for example, of universals, of geometric figures, of speech sounds, of distorted speech, the relevance of past experience, and the intake of information by the senses. Although technical material is presented, the book is very readable; jargon is kept at a minimum. The result is an exceedingly interesting and stimulating book.—E. M. (shrink)

This critical note responds to Guiaşu and Tindale’s “Logical fallacies and invasion biology,” from our perspective as ecologists and philosophers of science engaged in debates about invasion biology and invasive species. We agree that “the level of charges and dismissals” surrounding these debates might be “unhealthy” and that “it will be very difficult for dialogues to move forward unless genuine attempts are made to understand the positions being held and to clarify the terms involved.” Although they raise several important scientific, (...) conceptual, and ethical issues at the foundations of invasion biology, we believe Guiaşu and Tindale’s attempts to clarify the debate were unsuccessful. Like some other critics of the field, they tend to misrepresent invasion biology by cherry-picking and constructing “straw people,” inaccurately portraying invasion biology, and thus failing to elevate the dialogue. In this critique, we clarify areas in the invasion biology literature misrepresented by Guiaşu and Tindale. We attempt to provide a more balanced view of areas of reasonable debate within invasion biology, including disputes about empirical evidence, diverse risk attitudes, and other diverse ethical commitments. (shrink)

© Copyright 2015, Mary Ann Liebert, Inc..Signal transducer and activator of transcription factor 3 is hyperactivated in head and neck squamous cell carcinomas. Cumulative evidence indicates that IL-6 production by HNSCC cells and/or stromal cells in the tumor microenvironment activates STAT3 and contributes to tumor progression and drug resistance. A library of 94,491 compounds from the Molecular Library Screening Center Network was screened for the ability to inhibit interleukin-6 -induced pSTAT3 activation. For contractual reasons, the primary high-content screening campaign was (...) conducted over several months in 3 distinct phases; 1,068 primary HCS actives remained after cytotoxic or fluorescent outliers were eliminated. One thousand one hundred eighty-seven compounds were cherry-picked for confirmation; actives identified in the primary HCS and compounds selected by a structural similarity search of the remaining MLSCN library using hits identified in phases I and II of the screen. Actives were confirmed in pSTAT3 IC50 assays, and an IFNγ-induced pSTAT1 activation assay was used to prioritize selective inhibitors of STAT3 activation that would not inhibit STAT1 tumor suppressor functions. Two hundred three concentration-dependent inhibitors of IL-6-induced pSTAT3 activation were identified and 89 of these also produced IC50s against IFN-γ-induced pSTAT1 activation. Forty-nine compounds met our hit criteria: they reproducibly inhibited IL-6-induced pSTAT3 activation by ≥70% at 20 μM; their pSTAT3 activation IC50s were ≤25 μM; they were ≥2-fold selective for pSTAT3 inhibition over pSTAT1 inhibition; a cross target query of PubChem indicated that they were not biologically promiscuous; and they were ≥90% pure. Twenty-six chemically tractable hits that passed filters for nuisance compounds and had acceptable drug-like and ADME-Tox properties by computational evaluation were purchased for characterization. The hit structures were distributed among 5 clusters and 8 singletons. Twenty-four compounds inhibited IL-6-induced pSTAT3 activation with IC50s ≤20 μM and 13 were ≥3-fold selective versus inhibition of pSTAT1 activation. Eighteen hits inhibited the growth of HNSCC cell lines with average IC50s ≤ 20 μM. Four chemical series were progressed into lead optimization: the guanidinoquinazolines, the triazolothiadiazines, the amino alcohols, and an oxazole-piperazine singleton. (shrink)