The American Journal of Bioethics, Volume 11, Issue 12, Page 59-61, December 2011.

The ethics of managing obstetric patients in medical disasters poses ethical challenges that are unique in comparison to other disaster patients, because the medical needs of two patients—the pregnant patient and the fetal patient—must be considered. We provide an ethical framework for doing so. We base the framework on the justice-based prevention of exploitation of populations of patients, both obstetric and non-obstetric, in medical disasters. We use the concept of exploitation to identify a spectrum from ethically acceptable, to ethically challenging, (...) to ethically unacceptable, management of obstetric patients in medical disasters. We also address the ethics of the care of obstetric and neonatal patients when the resources of a hospital are completely overwhelmed in a large-scale medical disaster. (shrink)

Physicians may justifiably limit patients' refusals of medical interventions when the refusal is based on a negative right to noninterference coupled with a request for an unreasonable alternative.

Heuser, Eller and Byrne provide important descriptive ethics data about how physicians counsel women on the clinical management of pregnancies complicated by severe fetal anomalies. The authors present an account of what such counselling ought to be based on, the ethical concept of the fetus as a patient and the professional responsibility model of obstetric ethics. When there is certainty about the diagnosis and either a very high probability of either death as the outcome of the anomaly or survival with (...) severe and irreversible deficit of cognitive developmental capacity as a result of the anomaly diagnosed, the pregnant woman should be offered the alternatives of aggressive and non-aggressive obstetric management and induced abortion before viability. It is also ethically permissible to offer feticide followed by termination of pregnancy after viability in such cases. This ethically justified approach will reduce the variation in the actual practices of specialists in maternal–fetal medicine described by Heuser, Eller and Byrne. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 1-2, July 2012.

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of 'unborn patient' has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of 'unborn child.' There is a long history of the descriptive use of 'unborn child.' Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of 'unborn child' should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of (...) the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual "Clinical Ethics" issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide (...) a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed: identify a focused question; conduct a literature search using key terms relevant to the focused question; assess the adequacy of the argument-based methods of the papers identified; and identify conclusions drawn in each paper and whether they apply to the focused question. We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia. (shrink)

Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of (...) ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740–1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility. (shrink)

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and (...) periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness. (shrink)

Book reviewed in this article: Ethics in Obstetrics and Gynecology. By Laurence B. McCullough and Frank A. Chervenak.

In our ‘The Professional Virtue of Civility and the Responsibilities of Medical Educators and Academic Leaders’,1 we provided an historically based conceptual account of the professional virtue of civility and the role of leaders of academic health centres in creating and sustaining an organisational culture of professionalism that promotes civility among healthcare professionals and between medical educators and learners. We emphasised that any adequate understanding of the virtues, including professional virtues, has cognitive, affective, behavioural and social components. Some of the (...) commentators expand on these components in important ways. Xuhao et al emphasises the importance of role models, especially in the hierarchical context of medical education.2 The hierarchy of faculty in the senior position and junior doctors and other learners below them has characterised medical education for centuries. Xuhao et al rightly call for academic leaders to shape this hierarchy in a morally responsible way, by becoming ‘exemplary role models’.2 Berry, a clinician manager, in critiquing our account, calls for an increased appreciation for the psychological and environmental factors that might explain why uncivil behaviour occurs.3 …. (shrink)

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of the (...) Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and (...) English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)

Die {raquo}Revolution der Denkart{laquo} hat nicht nur den Anlauf genommen, welchem sie ihren Namen verdankt.! Gezahlt werden noch weitere Umstellungen der Theorie bildung als bloG die kopernikanische Kants. Hier interessieren gleich zwei. Die eine liefert den Gegenstand, die entsprechende, RevolutionPhanomenologie.

Does the universe embody beautiful ideas? Artists as well as scientists throughout human history have pondered this "beautiful question." With Nobel laureate Frank Wilczek as your guide, embark on a voyage of related discoveries, from Plato and Pythagoras up to the present. Wilczek's groundbreaking work in quantum physics was inspired by his intuition to look for a deeper order of beauty in nature. In fact, every major advance in his career came from this intuition: to assume that the universe (...) embodies beautiful forms, forms whose hallmarks are symmetry--harmony, balance, proportion--and economy. There are other meanings of "beauty," but this is the deep logic of the universe--and it is no accident that it is also at the heart of what we find aesthetically pleasing and inspiring. As he reveals here, this has been the heart of scientific pursuit from Pythagoras, the ancient Greek who was the first to argue that "all things are number," to Galileo, Newton, Maxwell, Einstein, and into the deep waters of twentieth-century physics. Gorgeously illustrated, A Beautiful Question is a mind-shifting book that braids the age-old quest for beauty and the age-old quest for truth into a thrilling synthesis. Yes: the world is a work of art, and its deepest truths are ones we already feel, as if they were somehow written in our souls.--From publisher description. (shrink)

One of our great contemporary scientists presents ten insights that illuminate what every thinking person needs to know about what the world is and how it works. Nobel Prize winner Frank Wilczek's Fundamentals is built around a simple but profound idea: the models of the world we construct as children are practical and adequate for everyday life, but they do not bring in the surprising and mind-expanding revelations of modern science. To do that, we must look at the world (...) anew, combining clear thinking with an openness to wonder. This "born again" world is in many ways larger, fuller, and much stranger than it appears. Through an exploration of space, time, matter, and ideas--and equipped with facts, questions, and brilliant speculations--Wilczek guides us through the past, present, and future of fundamental science. Readers will emerge with an expanded vision of our universe. Author Bio: Frank Wilczek won the Nobel Prize in Physics in 2004 for work he did as a graduate student. He was among the earliest MacArthur fellows, and has won many awards both for his scientific work and his writing. He is the author of A Beautiful Question, The Lightness of Being, Fantastic Realities, Longing for the Harmonies, and hundreds of articles in leading scientific journals. His "Wilczek's Universe" column appears regularly in the Wall Street Journal. Wilczek is the Herman Feshbach Professor of Physics at the Massachusetts Institute of Technology, founding director of the T. D. Lee Institute and chief scientist at the Wilczek Quantum Center in Shanghai, China, and a distinguished professor at Arizona State University and Stockholm University. (shrink)

An argument for the inclusion of the human perspective within science and how it makes science possible.

**** Reprint of the Indiana U. Press edition of 1966--which is cited in BCL3. Annotation copyright by Book News, Inc., Portland, OR.

Although declarations of the death of God seem to be provocations announcing the end of the era of theology, this announcement is actually central to the Christian revelation in its most classic forms, as well as to its reworkings in contemporary religious thought. Indeed provocative new possibilities for thinking theologically open up precisely in the wake of the death of God. Already Hegel envisaged a revolutionary new realization of divinity emerging in and with the secular world through its establishment of (...) a total order of immanence. However, in postmodern times this comprehensive order aspired to by modern secularism implodes or cracks open towards the wholly Other. A hitherto repressed demand for the absolute difference of the religious, or for “transcendence”, returns with a vengeance. This difference is what could not be stated in terms of the Hegelian System, for reasons that poststructuralist writers particularly have insisted on: all representations of God are indeed dead. Yet this does not mean that they cannot still be powerful, but only that they cannot assign God any stable identity. Nietzsche’s sense of foreboding concerning the death of God is coupled with his intimations of the demise of representation and “grammar” as epistemologically bankrupt, but also with his vision of a positive potential for creating value in the wake of this collapse of all linguistically articulated culture. He points the way towards the emergence of a post-secular religious thinking of what exceeds thought and representation. (shrink)

Der Übergang vom Verhältnisbewußtsein zum Selbstbewußtsein kann unmöglich nur vom Verhältnisbewußtsein aus gedacht werden, weil wir uns eine Welt, in der das Bewubtsein unserer selbst verteilt ist auf die Dimensionen der Handlung vor deren Zentrierung in uns, gar nicht vorstellen können. Jedes Tableau der Handlungsmöglichkeiten, so abstrakt es auch abgefaßt sein mag, ist gebunden an Vorstellungen möglicher Handlungssubjekte, denen wir Handlungsmöglichkeiten zuschreiben. Handlungstheorie ist daher notwendig Reflexion unserer Praxis, in der wir uns selbst als Selbstbewußtsein erfahren, das seinem Verhältnisbewubtsein enthoben (...) ist, ohne dieses dadurch selbst schon aufzuheben zu können. Daß uns Freiheit im Handeln unaufhebbar prekär und problematisch bleiben mub, ist die Grundvoraussetzung dafür, dab wir Handlungstheorien historisch und bereichsbezogen ständig neu entwerfen müssen. Das Verhältnis von Handlungsphilosophie zu Handlungstheorien kann daher so gefaßt werden, daß Handlungsphilosophie die Grundbegrifflichkeit in kritischer Absicht bereitstellt, die den bereichsorientierten, mehr oder weniger deskriptiven Handlungstheorien abgehen muß. Dazu muß die ontologische Differenz von Handlung und Interpretation methodologisch ernst genommen werden. Die radikale Andersheit der hier zu begründenden Konzeption liegt vor allem in der Ansicht, daß Handlungen nicht als isolierbare Ereignis-Entitäten aufgefaßt werden können, die gegenüber der »Welt der Tatsachen des Bewußtseins« eine kausale, d.h. von der Welt des Bewußtseins abgetrennte Rolle übernehmen. (shrink)

First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

Frank Ramsey was the greatest of the remarkable generation of Cambridge philosophers and logicians which included G. E. Moore, Bertrand Russell, Ludwig Wittgenstein and Maynard Keynes. Before his tragically early death in 1930 at the age of twenty-six, he had done seminal work in mathematics and economics as well as in logic and philosophy. This volume, with a new and extensive introduction by D. H. Mellor, contains all Ramsey's previously published writings on philosophy and the foundations of mathematics. The (...) latter gives the definitive form and defence of the reduction of mathematics to logic undertaken in Russell and Whitehead's Principia Mathematica; the former includes the most profound and original studies of universals, truth, meaning, probability, knowledge, law and causation, all of which are still constantly referred to, and still essential reading for all serious students of these subjects. (shrink)

In this paper, I consider the relationship between Inference to the Best Explanation and Bayesianism, both of which are well-known accounts of the nature of scientific inference. In Sect. 2, I give a brief overview of Bayesianism and IBE. In Sect. 3, I argue that IBE in its most prominently defended forms is difficult to reconcile with Bayesianism because not all of the items that feature on popular lists of “explanatory virtues”—by means of which IBE ranks competing explanations—have confirmational import. (...) Rather, some of the items that feature on these lists are “informational virtues”—properties that do not make a hypothesis \ more probable than some competitor \ given evidence E, but that, roughly-speaking, give that hypothesis greater informative content. In Sect. 4, I consider as a response to my argument a recent version of compatibilism which argues that IBE can provide further normative constraints on the objectively correct probability function. I argue that this response does not succeed, owing to the difficulty of defending with any generality such further normative constraints. Lastly, in Sect. 5, I propose that IBE should be regarded, not as a theory of scientific inference, but rather as a theory of when we ought to “accept” H, where the acceptability of H is fixed by the goals of science and concerns whether H is worthy of commitment as research program. In this way, IBE and Bayesianism, as I will show, can be made compatible, and thus the Bayesian and the proponent of IBE can be friends. (shrink)

In this paper, I offer an analysis of the radical disagreement over the adequacy of string theory. The prominence of string theory despite its notorious lack of empirical support is sometimes explained as a troubling case of science gone awry, driven largely by sociological mechanisms such as groupthink (e.g. Smolin 2006). Others, such as Dawid (2013), explain the controversy by positing a methodological revolution of sorts, according to which string theorists have quietly turned to nonempirical methods of theory assessment given (...) the technological inability to directly test the theory. The appropriate response, according to Dawid, is to acknowledge this development and widen the canons of acceptable scientific methods. As I’ll argue, however, the current situation in fundamental physics does not require either of these responses. Rather, as I’ll suggest, much of the controversy stems from a failure to properly distinguish the “context of justification” from the “context of pursuit”. Both those who accuse string theorists of betraying the scientific method and those who advocate an enlarged conception of scientific methodology objectionably conflate epistemic justification with judgements of pursuit-worthiness. Once we get clear about this distinction and about the different norms governing the two contexts, the current situation in fundamental physics becomes much less puzzling. After defending this diagnosis of the controversy, I’ll show how the argument patterns that have been posited by Dawid as constituting an emergent methodological revolution in science are better off if reworked as arguments belonging to the context of pursuit. (shrink)

We develop a Bayesian framework for thinking about the way evidence about the here and now can bear on hypotheses about the qualitative character of the world as a whole, including hypotheses according to which the total population of the world is infinite. We show how this framework makes sense of the practice cosmologists have recently adopted in their reasoning about such hypotheses.

This article rebuts Ramsey's earlier theory, in 'Universals of Law and of Fact', of how laws of nature differ from other true generalisations. It argues that our laws are rules we use in judging 'if I meet an F I shall regard it as a G'. This temporal asymmetry is derived from that of cause and effect and used to distinguish what's past as what we can know about without knowing our present intentions.