Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa. A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity (...) in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (shrink)

McCarthy, Homan, and Rozier’s presentation of theological anthropology and its contribution to secular bioethics suffers from three primary limitations. First, the article re...

Advance directives are critically important for capable individuals who wish to avoid the burdens of life-prolonging interventions in the advanced stages of dementia. However, this paper will argue that advance directives should have less application to questions about feeding patients during the clinical course of dementia than often has been presumed. The argument will be framed within the debate between Ronald Dworkin and Rebecca Dresser regarding the moral authority of precedent autonomy to determine an individual’s future end-of-life care plan. We (...) will use a brief analysis of the positions taken in two important papers that come out of the Dworkin/Dresser debate and a hypothetical patient, John, who will be followed from diagnosis of dementia to death, to show how advance directives should apply to key points in the progression of his disease, particularly in relation to food and nutrition. (shrink)

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

The case recapitulates many of the core issues in geriatric ethics that the aging American population will increasingly present to ethics consultation services. The classic ethical dilemma: autonom...

Bianchi and colleagues have written an important article that proposes a harm reduction approach to eating disorders that mediates the ethical tension in the l...

Traditional approaches to human subjects protections in the United States focus on the ethical principles from the Belmont Report: respect for persons, beneficence, and justice. Since research regu...

It is our privilege to be invited to write a commentary on the "Interface of Ethics and Psychiatry: A Philosophical Case Consultation on Psychiatric Ethics on the Ground." The article presents an innovative collaboration between a philosopher and a psychiatrist reasoning together through the ethical aspects of three clinical cases. The case consultation also offers a unique opportunity to reflect on the teaching of psychiatric ethics in clinical settings. This commentary explores those areas of the article from the perspective of (...) a teacher and trainee whose mentoring relationship is grounded in their shared interest in philosophy and psychiatric ethics.A quick search on PubMed and Google Scholar confirms my own... (shrink)

The definitive book on ethics for chemical dependency treatment professionals.

When patients are admitted to the hospital, they are generally expected to remain in or within close proximity to their assigned rooms in order to promote their safety and appropriate medical care. Although there are circumstances when patients may safely leave their hospital room or floor, guidance within the medical literature for the management of patient movement within the hospital are lacking. Excessive restrictions on patient movement may be seen as overly paternalistic, while lax requirements may interfere with high quality (...) care, patient safety and efficient hospital practice. As a result, guidance in the form of institutional policy is warranted. Such policy development should take into consideration the potential clinical, legal, and ethical concerns in balancing the competing values of patients’ preferences and respect for autonomy, while ensuring high quality, safe, and efficacious medical care. This paper will provide a framework for hospitals to create institution-specific patient movement policies that are fair, systematic, and transparent. (shrink)

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

Volume 20, Issue 7, July 2020, Page 145-147.

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)

Like lynching and other mass hysterias, xenophobia exemplifies a contagious, collective wave of energy and hedonic quality that can point toward a troubling unpredictability at the core of political and social systems. While earlier studies of mass hysteria and popular discourse assume that cooler heads (aka rational individuals with their logic) could and should regain control over those emotions that are deemed irrational, and that boundaries are assumed healthy only when intact, affect studies pose individuals as nodes of biosocial networks (...) larger than themselves. Thus rather than suggesting that the individual can only prevent societal harm by gaining command and patrolling the borders of an autonomous self, we embrace the notion that affects can exert a positive and transformative force on a social reality that is resistant to top-down policy intervention and any straightforward moral or logical plea. (shrink)

Near the end of the Protagoras there is a famous argument in which Socrates appears to deny the possibility of weakness of will. The passage is part of a longer examination of whether virtue can be taught and of the unity of the virtues. Socrates and Protagoras discuss whether it makes sense to say, as people commonly do, that they sometimes choose to do things they know are not best for them because they are “overcome by pleasure.” Supposedly “the many” (...) hold that the good is pleasure, and that one chooses what is less good because it is most pleasant. Socrates takes Protagoras through a kind of elenctic examination that purports to show that the many’s claim to being overcome by pleasure in akrasia is absurd or ridiculous. They can’t really do what they claim to do, choose the less good for the more good; thus, and the claim that they do is a misdescription of what really happens. People act in these cases due to ignorance of what is truly the most good. In order to prevent people from choosing things that are not best for them, or to save them, Socrates says that what is needed is an art or science of measurement. In this paper I want to focus on the idea of such an art or science of measurement. (shrink)

This paper develops a notion of manipulative gaslighting, which is designed to capture something not captured by epistemic gaslighting, namely the intent to undermine women by denying their testimony about harms done to them by men. Manipulative gaslighting, I propose, consists in getting someone to doubt her testimony by challenging its credibility using two tactics: “sidestepping” and “displacing”. I explain how manipulative gaslighting is distinct from reasonable disagreement, with which it is sometimes confused. I also argue for three further claims: (...) that manipulative gaslighting is a method of enacting misogyny, that it is often a collective phenomenon, and, as collective, qualifies as a mode of psychological oppression. (shrink)

By exploring diverse and sometimes positive roles for ignorance, A Defense of Ignorance offers a revisionary approach to epistemology that challenges core assumptions about epistemic values. Townley contributes innovative ways of thinking about the practicalities and politics of knowledge and argues for an expanded domain of responsible epistemic conduct. All social scientists, especially those interested in knowledge and in feminist scholarship, stand to benefit from Townley's arguments.

The manuscript diary of Jane Attwater, an earnestly religious woman from a village near Salisbury in England, offers valuable insight into how women's so-called “private” writings were crucial in preserving familial and community history and in contributing to the production of religious culture. Written regularly between the ages of twelve and eighty-one, Attwater's diary is the most extensive diary written by a nonconformist woman in the eighteenth and nineteenth centuries. The text itself is an extraordinary record of her own religious (...) and family life. At the same time, the materiality of the diary reveals a complex interweaving of faith, family, and memory. The diary contains four generations of Attwater women's diary entries, carefully interleaved to produce diary-conversations; there is evidence of ongoing revisions and excisions throughout; and it was studiously and self-consciously curated for future readership. Attwater wrote both as an aid to her own memory, faithfully placing on paper reminders of God's help, and to preserve the memory of her family and religious community, creating what Pierre Nora calls “lieux de mémoire” – sites for anchoring a group's memory. (shrink)

Although nanotechnology is often defined as operations on the 10-9 meters, the lack of charisma in the scale-bound definitions has been fortified by remarkable dreams and alluring promises that spark excitement for nanotechnology. The story of the rhetorical development of nanotechnology reveals how speculative claims are powerful constructions that create legitimacy in this emerging technological domain. From its inception, nanotechnology has been more of a dream than reality, more fiction than fact. In recent years, however, the term nanotechnology has been (...) actively drawn toward the present to begin to deliver on the fantastic expectations. This debate over time and timing is loaded with paradox. This work examines how future claims work to define what counts as nanotechnology and reveals dilemmas that accompany temporal disjunctures. Science and politics converge in debates about the future of technology as expectations serve to create and enforce power and legitimacy in the emerging area. (shrink)

What is introspective know ledge of one’s own intentional states like? This paper aims to make plausible the view that certain cases of self-knowledge, namely the cogito-type ones, are enough like perception to count as cases of quasi-observation. To this end it considers the highly influential arguments developed by Sydney Shoemaker in his recent Royce Lectures. These present the most formidable challenge to the view that certain cases of self-knowledge are quasi-observational and so deserve detailed examination. Shoemaker’s arguments are directed (...) against two models of ordinary perception, the “object perception model” and the “broad perceptual model”. I argue that the core theses that Shoemaker associated with them are either dubious in their own right or applicable to certain cases of self-knowledge. Overall the aim is to show that there is such a variety of patterns in each case that simple analogies or disanalogies are unhelpful. (shrink)

There appears to be a tension between two commitments in liberalism. The first is that citizens, as rational agents possessing dignity, are owed a justification for principles of justice. The second is that members of society who do not meet the requirements of rational agency are owed justice. These notions conflict because the first commitment is often expressed through the device of the social contract, which seems to confine the scope of justice to rational agents. So, contractarianism seems to ignore (...) the justice claims of the severely cognitively impaired. To solve this problem, Martha Nussbaum proposes the capabilities approach. The justifiability condition, on this approach, is met by the idea of overlapping consensus. This essay argues that overlapping consensus cannot meet liberalism’s justifiability condition, nor is it more inclusive of the cognitively impaired. Therefore, we have reason to retain the contract device and look for another way to ensure that liberalism respects the justice claims of all. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Recent research finds that people respond more generously to individual victims described in detail than to equivalent statistical victims described in general terms. We propose that this “identified victim effect” is one manifestation of a more general phenomenon: a positive influence of tangible information on generosity. In three experiments, we find evidence for an “identified intervention effect”; providing tangible details about a charity’s interventions significantly increases donations to that charity. Although previous work described sympathy as the primary mediator between tangible (...) information and giving, current mediational analyses show that the influence of tangible details can operate through donors’ perception that their contribution will have impact. Taken together with past work, the results suggest that tangible information of many types promotes generosity and can do so either via sympathy or via perceived impact. The ability of tangible information to increase impact points to new ways for charities to encourage generosity. (shrink)

The relationship between corporate executives and shareholders has riveted the attention of business ethicists since the inception of the field. Most ethicists agree that corporate executives owe their investors the duties of loyalty, candor, and care. These fiduciary duties undergird the promises made to shareholders at the time of incorporation, placing on executives moral obligations to engage in fair dealing and to avoid conflicts of interest.We concur that executives owe all of their existing shareholders both promise-keeping and fiduciary duties and (...) argue that some corporateexecutives violate these responsibilities by attempting to withhold information from or limit information to some shareholders while courting others. We analyze the ethical implications of six techniques and tools that executives use to attract certain types of shareholders while deterring others. We conclude with recommended structural and behavioral changes to these current managerial and investor practices. (shrink)

Hypothetical contracts have been said to be not worth the paper they are not written on. This paper defends hypothetical consent theories of justice, such as Rawls's, against the view that they lack justificatory power. I argue that while hypothetical consent cannot generate political obligation, it can generate political legitimacy.

In this chapter, I argue that one can articulate a historically attuned and analytically rich model for understanding jazz in its various inflections. That is, on the one hand, such a model permits us to affirm jazz as a historically conditioned, dynamic hybridity. On the other hand, to acknowledge jazz’s open and multiple character in no way negates our ability to identify discernible features of various styles and aesthetic traditions. Additionally, my model affirms the sociopolitical, legal (Jim Crow and copyright (...) laws), and economic structures that shaped jazz. Consequently, my articulation of bebop as an inflection of Afromodernism highlights the sociopolitical, and highly racialized context in which this music was created. Without a recognition of the sociopolitical import of bebop, one’s understanding of the music is impoverished, as one fails to grasp the strategic uses to which the music and discourses about the music were put. (shrink)

The literature of Adrienne Rich, Toni Morrison, Ana Castillo, and Chimamanda Adichie teaches a risky, self-giving way of reading that brings home the dangers and the possibilities of suffering as an ethical good. Working the thought of feminist theologians and philosophers into an analysis of these women's writings, Cynthia R. Wallace crafts a literary ethics attentive to the paradoxes of critique and re-vision, universality and particularity, reading in suffering a redemptive or redeemable reality.

We often think of trust as an interpersonal relation, and of the distinction between trust and reliance as a distinction between kinds of interpersonal relations. Indeed this is often the case. I may trust one colleague but not find her reliable; rely on another but find him untrustworthy; both trust and rely on my best friend; neither trust nor rely on my dean. One of us has discussed the nature of such relations and distinctions at length. But trust is not (...) only an interpersonal matter. Human society comprises not only individuals but also institutions, and indeed individuals who occupy crucial institutional roles. We often individually or collectively trust, distrust, rely on, or fail or refuse to rely on such institutions or institutional players qua players. In this essay we explore the structure, scope and value of such institutional trust and distrust, which we call “public trust.” Public trust, we will argue, plays a central role in constituting the public sphere and in structuring societies in which it is worth living. (shrink)