Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms. Here's what the experts had to say: Professor Zaner has provided us with a remarkably (...) lucid and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. Dokecki Richard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee (1985), he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore (...) what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

With disparate rates of morbidity and mortality among minoritized communities, COVID-19 illuminated the need for equity-informed practices in public health. Pacia et al posit FQHCs as entities that addressed inequity when others failed. This commentary further situates how FQHCs address the public health crisis of institutional racism and related health inequities every day and presents a FQHC-led Ethics and Equity Framework and Workflow Checklist to guide ethical and equitable engagement with FQHCs.

Despite its uniform appearance, the cerebellar cortex is highly heterogeneous in terms of structure, genetics and physiology. Purkinje cells (PCs), the principal and sole output neurons of the cerebellar cortex, can be categorized into multiple populations that differentially express molecular markers and display distinctive physiological features. Such features include action potential rate, but also their propensity for synaptic and intrinsic plasticity. However, the precise molecular and genetic factors that correlate with the differential physiological properties of PCs remain elusive. In this (...) article, we provide a detailed overview of the cellular mechanisms that regulate PC activity and plasticity. We further perform a pathway analysis to highlight how molecular characteristics of specific PC populations may influence their physiology and plasticity mechanisms. (shrink)

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

It has been argued that organizational structures (the way tasks are defined, allocated, and coordinated) can influence moral agency in organizations. In particular, low values on different structural parameters (functional concentration, specialization, separation, and formalization) are said to foster an organizational context (allowing for relating to the goals and output of the organization, moral deliberation, and social connectedness) that is conducive to moral agency. In this paper, we investigate the relation between the organizational structure and moral agency in the case (...) of a.s.r. (a large Dutch insurance company). While our empirical results fit the thesis that low values on structural parameters positively relate to moral agency, they also refine our understanding of the influence of structural parameters. In particular, our data suggest that the influence of functional concentration not only depends on whether it is low, but also on the type of criterion used for identifying business units; they suggest that the specific organizational context may put a limit to lowering design parameters and points at several non-structural factors that have an influence on the relation between structure and moral agency. In all, the paper contributes to a more detailed understanding of the conditions conducive to moral agency in organizations. (shrink)

There is extensive discussion of the ethical, social, economic and political issues associated with the use of technologies based on DNA techniques. Many of these debates are premised on the assumption that DNA, and the genetic information that may be derived from it, have unique features which raise new social and ethical issues. In this paper it is argued that several of the features associated with DNA which are sometimes regarded as unique are shared with other biological materials. Others owe (...) more to the cultural image of DNA and some of the metaphors used to discuss it in biology and in wider debates than to the biological properties of DNA. The paper discusses the concepts of genetic material and genetic information and the social construction of DNA in relation to forensic DNA databases, paternity testing and genetic testing for disease. The paper concludes by suggesting that there are seven areas where issues related to DNA and genetic information are at least relatively distinct. (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

Even though the measurement of fear of crime in criminological research commenced a few decades ago, specific populations, such as social activists, remain undocumented. This article is an attempt to address this gap. A study was conducted among 153 social activists involved in exposing corruption and irregularities that take place in the government system in India. This article explores the gap between the fear of crime and actual victimization among the specific social activists in India. The results indicate activists expressed (...) moderate fear of any one form of victimization including verbal and emotional, physical, and sexual victimization. It was also found that one-third of them have reported facing some form of abuse. The research implications are discussed. (shrink)

Using print ads and recognizing the role of visual images in argument (Groarke) and the presence of arguments in ads (Slade), this paper argues that the work of argumentation theorists from Aristotle to van Eemeren and Grootendorst can be used to support the thesis that ads are arguments. I cite as evidence definitions, demarcations, delineations, and descriptions of argument put forth by leading scholars in the field of argumentation. This includes Aristotle, Informal Logic, Toulmin (Claim, Data, Warrant, Backing, Qualifier, Rebuttal), (...) Johnson and Blair (argument as “reasons or evidence as grounds or support for an opinion”), Gilbert (Multi-Modal Argumentation), and van Eemeren and Grootendorst (argumentation as a social activity and pragma-dialectics). I show how, although just fitting a particular advertisement to someone’s definition does not mean that all ads are arguments, nevertheless, the fact that we can find in an ad all these elements from this variety of scholars over time, leaves us reasonably secure in stating that an ad is indeed an argument. Since my argument would be the same for practically any ad, I am using only one ad. I do, however, use the kind of ad that is least likely to seem to be an argument: an ad with few words, an ad which is mostly visual. If I can show how even an almost entirely visual ad can be analyzed as an argument using the terms of all these scholars of argumentation, I will maintain that most ads could be analyzed in the same way. (shrink)

The perception of meaningful patterns in random arrangements and unrelated events takes place in our everyday lives, coined apophenia, synchronicity, or the experience of meaningful coincidences. However, we do not know yet what predicts this phenomenon. To investigate this, we re-analyzed a combined data set of two daily diary studies with a total of N = 169 participants (mean age 29.95 years; 54 men). We investigated if positive or negative affect (PA, NA) predicts the number of meaningful coincidences on the (...) following day (or vice versa). By means of a cross-lagged multilevel modelling approach (Bayesian estimation) we evaluated with which of two theoretical assumptions the data are more in line. First, if meaningful coincidences are facilitated by a broader and more flexible thinking style, PA should positively predict meaningful coincidences at the following day. However, if the experience of meaningful coincidences signifies a strategy to cope with negative feeling states, NA should predict the experience of meaningful coincidences during the following day. In favour of a more flexible thinking style, we found that PA predicted the number of perceived coincidences the following day. We did not find any effect for NA, and therefore, no evidence arguing for the coping mechanism hypothesis of meaningful coincidences. (shrink)

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable options (...) as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. (shrink)

The issue of wrongful disability arises when parents face the choice whether to produce a child whose life will be unavoidably flawed by a serious disease or disorder (Down syndrome, for example, or Huntington’s disease) yet clearly worth living. The authors of From Chance to Choice claim, with certain restrictions, that the choice to produce such a child is morally wrong. They then argue that an intuitive moral approach––a “person-affecting” approach that pins wrongdoing to the harming of some existing or (...) future person––cannot account for that wrong since the choice to produce such a child cannot, under the logic of the nonidentity problem, harm that child. The authors propose that we supplement the person-affecting approach with an “impersonal” principle that takes the form of their well-known principle N. In this paper, I argue that the authors are mistaken to suppose that a plausibly articulated person-affecting approach cannot account for the wrong of wrongful disability. We can retain an intuitive, comparative, “worse for” account of harm and still identify serious harms imposed by the choice of wrongful disability. In particular, I argue that harm, both to the impaired child and to others, comes not in the form of that procreative choice’s procreative effect but rather in the form of its many distributive effects. I also argue that the rare, residual case in which a person-affecting approach would approve of the choice of wrongful disability does not function as a counterexample to that approach. As a separate matter, I address legal claims for wrongful disability, which are closely akin to claims for wrongful life. The legal claim is brought by the impaired child, not against the parents, but rather against health care providers whose negligent failure to diagnose or inform parents of an increased risk of a genetic or congenital impairment results in the birth of the impaired child. The authors’ treatment of the moral wrong that is done as impersonal in nature suggests that courts are correct to dismiss any such claim. Once we identify harm, however, the person-affecting approach can identify a clear foundation in the law for the wrongful disability claim. (shrink)

IntroductionEddy M. Zemach was born in Jerusalem in 1935. His mother, Helena, was a dentist as well as a poet, and his father, Shimon, was a dentist as well as a political figure. Eddy completed B.A. and M.A. degrees in both Hebrew literature and philosophy at the Hebrew university of Jerusalem. He studied for a doctoral degree in philosophy at Yale University. In 1965 he completed his dissertation on the boundaries of the aesthetic, supervised by Paul Weiss. Another of his (...) teachers at Yale was Wilfrid Sellars, who influenced his philosophical views on mind and language. Aesthetics, philosophy of mind, and philosophy of language formed the center of his philosophical interest, though this interest was extended to other philosophical areas, such as metaphysics and epistemology.Eddy published extensively in both philosophy and Hebrew literature, and also wrote many short stories . He wrote some two hundred papers, and twelve scholarly books .. (shrink)

David M. Zientek; Response to the Consensus Statement of the Working Group on Roman Catholic Approaches to Determining Appropriate Critical Care, Christian bioe.

Problems concerning future populations help us better understand what it is for one possible future, or world, to be morally better than another. The repugnant conclusion challenges traditional forms of consequentialism, including utilitarianism. A key issue is whether, per the traditional view, we make things morally better by creating additional people whose lives are worth living and by creating nonidentical better-off people in place of less well-off but distinct people. Or can we, instead, make things morally better only by making (...) things better for some particular person or another? Is the structure of morality aggregative in nature or instead person-affecting in nature? While the latter, non-traditional view may tempt us, it also seems to give rise to the nonidentity problem and various inconsistency objections. Can those problems be resolved? Questions raised by Parfit and others decades ago remain unsettled today but as critical as ever. (shrink)

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond (...) its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials. (shrink)

Jan Narveson has articulated a deeply held, widely shared intuition regarding what moral law has to say about bringing additional people into existence: while we are “in favour of making people happy,” we are “neutral about making happy people.” Various formulations of the Narvesonian intuition (closely related to the _person-affecting intuition_ or _restriction_) have been widely criticized. This present paper outlines an off-the-beaten-path alternate construction of the intuition—the _existence condition_—and argues that that particular construction has the resources to avoid some (...) of those criticisms. But still other considerably more widely recognized alternate constructions have been offered as well. Thus John Broome outlines what he calls the _neutrality intuition_. While Broome finds the underlying intuition “strongly attractive,” he nonetheless argues that the neutrality intuition itself leads us quickly into inconsistency. Wlodek Rabinowicz disagrees. On his view, Broome’s inconsistency argument shows, not that the neutrality intuition is false, but rather that it doesn’t follow, from the fact that the outcome, or possible future or _world_, that includes the additional person is neither better nor worse than the (otherwise similar) world that excludes that person, that the one world is exactly as good as the other. The better view, according to Rabinowicz, is that, on occasion, and specifically when the coming into existence of additional people is at stake, the one world is _incommensurate_ with the other. What is called the _principle of trichotomy_ is, in other words, false. Difficulties arise, however, when we try to reject that seemingly compelling conceptual principle. This present paper concludes with the argument that the availability of the existence condition—which, together with certain other uncontroversial moral principles and a handful of conceptual principles, forms the _existential approach_—shows that we can maintain the most intuitive parts of neutrality intuition while avoiding both Broome’s inconsistency worry and Rabinowicz’s commitment to incommensurability. Incommensurability may be correct on other grounds—but not, this present paper argues, on the grounds provided by Broome’s inconsistency argument. (shrink)

The article presents the conceptualization of philosophical education, in the context of which the evolution of the development of society from informational to smart society takes place. The purpose of the article is to reveal the conceptualization of philosophical education in the context of the idea of a smart society and to show that philosophical education does not stand still but develops along with the development of science and technology, which requires the development of a conceptual and categorical apparatus. Research (...) objectives: to show the development of philosophical knowledge, in the context of which new innovative ideas are ripening; to reveal that the concept of a smart society is based on the expectation or belief in the ability of modern smart technologies to positively influence social processes and lead to a new qualitative state of all social life, which is called a smart society; to prove that much in solving all these problems depends on the state of education, including philosophical and ideological, not only developing our cognitive abilities, but also forming a responsible and demanding attitude to goal setting, the choice of basic life values. Analysis of recent research and publications, which presents a solution to this problem. We rely on the works of I.Ardashkin, V.Voronkova, M.Kastels, O.Kivlyuk, K.Korsak, A.Lazarevich, R.Oleksenko, O.Punchenko, which in one way or another reflected the problem of the formation of a smart society. The research methodology is the dialectical, historical, systemic, informational methods, which allowed to penetrate deeply into the evolution of philosophical knowledge that is not in mass, but develops with the development of science, technique and technology. The result of research - based smart society the development of information and computer technologies that lead to breakthrough technologies and innovative development It is noted that the proposed reorganization of the system of social-humanitarian education in the universities of the Republic of Belarus intended to raise to the level of philosophical training of domestic specialists. (shrink)

Suppose we have a group of Bayesian agents, and suppose that theywould like for their group as a whole to be a Bayesian agent as well. Moreover, suppose that thoseagents want the probabilities and utilities attached to this group agent to be aggregated from theindividual probabilities and utilities in reasonable ways. Two ways of aggregating their individual data areavailable to them, viz., ex ante aggregation and ex post aggregation. The former aggregatesexpected utilities directly, whereas the latter aggregates probabilities and utilities (...) separately.A number of recent formal results show that both approaches have problematic implications. This studydiscusses the philosophical issues arising from those results. In this process, I hope to convincethe reader that these results about Bayesian aggregation are highly significant to decision theorists, butalso of immense interest to theorists working in areas such as ethics and political philosophy. (shrink)

Suppose we have a group of Bayesian agents, and suppose that theywould like for their group as a whole to be a Bayesian agent as well. Moreover, suppose that thoseagents want the probabilities and utilities attached to this group agent to be aggregated from theindividual probabilities and utilities in reasonable ways. Two ways of aggregating their individual data areavailable to them, viz., ex ante aggregation and ex post aggregation. The former aggregatesexpected utilities directly, whereas the latter aggregates probabilities and utilities (...) separately.A number of recent formal results show that both approaches have problematic implications. This studydiscusses the philosophical issues arising from those results. In this process, I hope to convincethe reader that these results about Bayesian aggregation are highly significant to decision theorists, butalso of immense interest to theorists working in areas such as ethics and political philosophy. (shrink)

Logic; Islamic philosophy; Islam--doctrines.

This article explores the effects of our technological way of war, for the first time driving toward total combatant immunity, on the psyche of combatants and the ethos of a warrior. It is a plea for the preservation of a warrior spirit, or at least a warrior class, that views war in a philosophical and personal manner. The article posits that without a sense of the tragic, without a personal test of will and skill often at great individual risk, we (...) can find no real meaning in war. It argues that the warrior dimension of immunity in warfare has somehow altered our experience of war, yet the effects of this ‘virtual war’ are still ambiguous – we do not yet know whether executing warfare through long-distance video desensitizes the ‘remote warrior’ or enhances his/her experience of killing. We do not yet know how combatants ‘commuting’ to war from home and being transported 7000 miles into battle through this ‘miracle’ of technology will handle the consequences of what the nation is asking them to do. We kn.. (shrink)