Volume 20, Issue 3, March 2020, Page 21-24.

Patient advocacy organizations provide patient- and caregiver-oriented education, advocacy, and support services. PAOs are formally organized nonprofit groups that concern themselves with medical conditions or potential medical conditions and have a mission and take actions that seek to help people affected by those medical conditions or to help their families. Examples of PAOs include the American Cancer Society, the National Alliance on Mental Illness, and the American Heart Association. These organizations advocate for, and provide services to, millions of people with (...) physical and mental conditions — such as cancer, mental illness, diabetes, and cardiovascular disease — via their outreach, meetings, counseling, websites, and published materials. A PAO usually seeks to raise public awareness of a disease’s symptoms, risk factors, and treatment options and promotes research to cure or to prevent that disease. (shrink)

Patient advocacy organizations (PAOs) advocate for increased research funding and policy changes and provide services to patients and their families. Given their credibility and political clout, PAOs are often successful in changing policies, increasing research funding, and increasing public awareness of medical conditions and the problems of their constituents. In order to advance their missions, PAOs accept funding, frequently from pharmaceutical firms. Industry funding can help PAOs advance their goals but can also create conflicts of interest (COI). Research indicates that (...) bias may occur, even among well-meaning professionals, when people and organizations have financial COI. Industry funding may therefore influence PAOs to act in ways that favor the interests of their donors, which may increase the risk of harm to patients. This article extends the analysis developed in the Institute of Medicine report, Conflicts of Interest in Medical Research, Education, and Practice, and applies the analysis to understand PAOs and their relationships with industry. It argues that the preferred goal of institutional COI policies should not be to promote trust, but to promote trustworthiness and appropriately placed trust. (shrink)

Well-designed pragmatic clinical trials (PCTs) are critical for improving healthcare delivery and patient outcomes (Haff and Choudhry 2018), and the article written by Garland et al. (2023) advance...

Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much (...) more likely to influence a decision to pursue or reject aggressive life‐extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor—particularly in the context of an inadequate social safety net—robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision‐making, the irrational distinction between PAD and withdrawal of life‐sustaining care, and the more appropriate focus on the great flaws in the American health care system. (shrink)

Decisions about continuing or terminating a pregnancy touch on profound, individualized questions about bodily integrity, reproductive autonomy, deeply held values regarding one's capacity for parenthood, and, in the case of a high-risk pregnancy, the risks one is willing to take to have a baby. So far as possible, reproductive decisions are made between a patient, in some cases her partner, and her medical provider. However, this standard framework cannot be applied if the patient lacks decision-making capacity. In this essay, we (...) discuss one such case that came before our clinical ethics team. We describe the challenges of respecting a patient's reproductive preferences when the patient cannot share what those preferences are, and we argue that decisions regarding reproductive health care should not be treated with exceptionalism. Rather, they should proceed under the normal processes of surrogate decision-making, including the application of substituted judgment. This approach enables us to take the patient's values into account when considering the questions implicated in reproductive health care, just as we do for other kinds of health care decisions in which a patient's deeply held values are salient. (shrink)

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety and necessity (...) of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future. (shrink)

Volume 20, Issue 4, May 2020, Page 59-61.

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

Lukas J. Meier et al. offer the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence interface. The ultimate goal, we assume, is...

Physicians, scholars, and policymakers continue to be concerned about conflicts of interests among health care providers. At least two main types of objections to conflicts of interest exist. Conflicts of interests may be intrinsically troublesome if they violate providers’ fiduciary duties to their patients or they contribute to loss of trust in health care professionals and the health care system. Conflicts of interest may also be problematic in practice if they bias the decisions made by providers, adversely impacting patient outcomes (...) or wastefully increasing health care costs. This latter objection may be observed in differences in the prescriptions written, procedures performed, or costs billed by health care professionals who have conflicting interests, when compared to those that do not have such financial relationships. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

In this article, we present evidence that in four different cultural groups that speak quite different languages there are cases of justified true beliefs that are not judged to be cases of knowledge. We hypothesize that this intuitive judgment, which we call “the Gettier intuition,” may be a reflection of an underlying innate and universal core folk epistemology, and we highlight the philosophical significance of its universality.

Researchers recently demonstrated a strong direct relationship between judgments about what a person knows and judgments about how a person should act. But it remains unknown whether actionability judgments cause knowledge judgments, or knowledge judgments cause actionability judgments. This paper uses causal modeling to help answer this question. Across two experiments, we found evidence that actionability judgments cause knowledge judgments.

Given the centrality of arguments from vicious infinite regress to our philosophical reasoning, it is little wonder that they should also appear on the catalogue of arguments offered in defense of theses that pertain to the fundamental structure of reality. In particular, the metaphysical foundationalist will argue that, on pain of vicious infinite regress, there must be something fundamental. But why think that infinite regresses of grounds are vicious? I explore existing proposed accounts of viciousness cast in terms of contradictions, (...) dependence, failed reductive theories and parsimony. I argue that no one of these accounts adequately captures the conditions under which an infinite regress—any infinite regress—is vicious as opposed to benign. In their place, I suggest an account of viciousness in terms of explanatory failure. If this account is correct, infinite grounding regresses are not necessarily vicious; and we must be much more careful employing such arguments to the conclusion that there has to be something fundamental. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:158 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. María Fernanda Olarte-Sierra and Tania Pérez-Bustos Careful Speculations: Toward a Caring Science of Forensic Genetics in Colombia Feminist Science and Technology Studies (STS) has recently opened up the question of care as a set of practices related to the sustainability of life.1 The field of feminist studies more broadly has extensively 1. This literature mostly comes from (...) Northern contexts and started to flourish with the seminal work of María Puig de la Bellacasa, “Matters of Care in Technoscience: Assembling Neglected Things,” Social Studies of Science 41, no. 1 (2010): 85–106. This essay gathers scattered feminist STS reflections on these issues and looks at them through the lens of care, including authors such as Susan Leigh Star, Donna Haraway, Isabelle Stengers, Hilary Rose, and Annemarie Mol. The concept of care orienting this exercise of rereading these authors is proposed by Berenice Fisher and Joan Tronto, “Toward a Feminist Theory of Caring,” in Circles of Care: Work and Identity in Women’s Lives, ed. Emily K. Abel and Margaret K. Nelson (Albany: State University of New York Press, 1990), 35–62. Before and after that essay came out, Puig de la Bellacasa published several other papers related to this issue, including “Touching Technologies, Touching Visions. The Reclaiming of Sensorial Experience and the Politics of Speculative Thinking,” Subjectivity 28, no. 1 (2009): 297–315; “‘Nothing Comes without Its World’: Thinking with Care,” The Sociological Review 60, no. 2 (2012): 197– 216; “Ethical Doings in Naturecultures,” Ethics, Place & Environment 13, no. 2 (2010): 151–69; “Making Time for Soil: Technoscientific Futurity and the Pace of Care,” Social Studies of Science 45, no. 5 (2015): 691–716; and Matters of Care: Speculative Ethics in More than Human Worlds (Minneapolis: University of Minnesota Press, 2017). All these publications have been widely cited by other authors, particularly in a special issue of Social Studies of Science on the politics of care published in 2015 (volume 45, issue 5). Other examples María Fernanda Olarte-Sierra and Tania Pérez-Bustos 159 studied how care, and associated practices such as transnational care chains, are feminized and precarious—involving an ethos embodied by those who actively work to maintain or preserve another’s life. Feminists have focused on the politics of care embedded in invisible jobs related to aesthetics, domestic work, child and elder care, and sexual activities and see all these tasks as related to the reproduction of life and culture.2 Central to this conceptualization of care is the understanding that these jobs are typically women’s work. There is a common association between this care and notions of “motherhood” as it relates to values such as compassion, love, and respect, which have been constructed as universally feminine. However, the main goal of feminist studies of care has been to deconstruct this association, particularly because it is imbued with the white, wealthy, heteronormative ideal of femininity that underlies a gendered division of labor. The reality is that class, race, nation, and gender determine who cares for whom, whether or not labor is paid, and to what extent care is exploitative. One strand of recent research problematizes both valorizing and criticizing care practices on the grounds that they are based on a rather homogeneous understanding of the feminine. Instead, these scholars seek to resurrect valuable feminist work without relying on essentialism of authors contributing to this discussion on care as an ethos for science include Ruth Müller and Martha Kenney, “Agential Conversations: Interviewing Postdoctoral Life Scientists and the Politics of Mundane Research Practices,” Science as Culture 24, no. 4 (2014): 537–59; Charis Thompson, Good Science: The Ethical Choreography of Stem Cell Research (Cambridge, MA: MIT Press, 2013); and Carrie Friese, “Realizing Potential in Translational Medicine: The Uncanny Emergence of Care as Science,” Current Anthropology 54 (S7): S129-S138. 2. From Latin America, see, for example, Luz Gabriela Arango Gaviria, Adira Amaya Urquijo, Tania Pérez-Bustos, and Javier Pineda Duque, eds., Género y cuidado: teorías, escenarios y políticas (Bogotá: Universidad Nacional de Colombia, 2018); Pascale Molinier and Luz Grabriela Arango Gaviria, eds., El trabajo y... (shrink)

This article explores ways in which the Revision Theory of Truth can be expressed in the object language. In particular, we investigate the extent to which semantic deficiency, stable truth, and nearly stable truth can be so expressed, and we study different axiomatic systems for the Revision Theory of Truth.

Integrative Feminisms presents a unique discussion of feminist radicalism in North America in the context of feminism's global development since the 1960s. Across divergent agendas, Angela Miles illuminates the transformative power she argues is common to apparently diverse radical, eco-, Black, socialist, lesbian and "third world" feminists. Drawing on interviews with activists, historical and documentary research, and her own participation, she provides powerful analysis of concentric feminisms in a transnational context. The book shows how transformative practices have led these various (...) feminisms in their own ways to refuse industrial/patriarchal categories, and how they have sustained their own projects against great odds. Skating the edge of controversy, Miles argues that the charges of political naivete, utopianism and essentialism levelled against these integrative feminisms are reductionist denials of the most progressive aspects of North American feminism, aspects central to the rapidly developing feminisms in the "third world." Within this original framework the author takes on the issues of pornography, prostitution, identity politics, postmodern feminism, and censorship, all of which continue to be hotly debated among feminists, the media and the courts. (shrink)

If intense pain is “world-destroying,” as Elaine Scarry has argued, one of the ways nurses respond to that loss is by re-enacting the commonplace—both in practice and in writing—through daily, accumulating acts of care. Such care poses a critique of medicine’s emphasis on the exceptional moment and stresses forms of physical tending that are quotidian rather than heroic, ongoing rather than permanent or conclusive. I develop this view of care through the writings of nurses like Walt Whitman, Louisa May Alcott, (...) Cortney Davis and Joyce Renwick. (shrink)

A portrait of Australian flying fox life in the Anthropocene illuminates startlingly familiar stories. These animals are participants in most of the major catastrophic events, as well as contestations about rescue, of contemporary life on Earth: warfare, man-made mass death, famine, urbanisation, emerging diseases, climate change, biosecurity, conservation, and local/international NGO aid. They are endangered, and are involved in all four of the major factors causing extinctions: habitat loss, overexploitation, introduced species, and extinction cascades. My account of flying foxes in (...) Australia rests on the understanding of species articulated both vigorously and eloquently by Donna Haraway : we and others are entangled in knots of species who are co-shaping each other in layers of reciprocating complexity. I seek to engage both the living, warm-blooded beings whose lives are threatened, and the excruciatingly dynamic deathscape that is surrounding them/us. Positioned, like much of life on Earth today, in zones of increasing conflict and terror, the lives and deaths of flying foxes tell us that in the Anthropocene there is no way out of entanglements within multispecies communities. Rather than seeking to erect more impenetrable barriers against others, relational ethics for living and dying in the Anthropocene urge us to assume ever greater mutuality and accountability as intradependent members of the suffering family of life on Earth. (shrink)

There is at present, amongst Hegel scholars and in the interpretative discussions of Hegelrsquo;s social and political theories, the flavour of old-style lsquo;apologyrsquo; for his liberal credentials, as though there exists a real need to prove he holds basic liberal views palatable to the hegemonic, contemporary political worldview. Such an approach is no doubt motivated by the need to reconstruct what is left of the modern moral conscience when Hegel has finished discussing the flaws and contradictions of the Kantian model (...) of moral judgement. The main claim made in the following pages is that the critique of lsquo;subjectiversquo; moralities is neither the sole nor even the main reason for the adoption of an immanent doctrine of ethics. This paper will look to Hegelrsquo;s mature theory of action as motivating the critique of transcendentalism rather than merely filling in the hole left when one rejects Kant and it will discuss what the consequences of this approach are for the role of the moral conscience within the political sphere, arguing that Hegelrsquo;s own conditions of free action would not be met unless the subjective moral conscience was operative in the rational state. (shrink)

Bruno Latour’s long term project is to compare the felicity and infelicity conditions of the different values dearest to the heart of those who have ‘never been modern’. According to him, this is the only way to develop an anthropology of the Moderns. After his work on science, on technology and, more recently, on law, this book explores the truth conditions of religious speech acts.Even though there is no question that religion is one of the values that has been intensely (...) cherished in the course of history, it’s also clear that it has become immensely difficult to tune in to its highly specific mode of enunciation. Every effort to speak in the right key sounds awkward, reactionary, pious or simply empty. Hence the necessity of devising a way of writing that brings to the fore this elusive form of speech to render it audible again. In this highly original book, the author offers a completely different tack on the endless ‘science and religion’ conflict by protecting them both from the confusion with the notion of information. Like The Making of Law, this book is one more attempt at developing this ‘inquiry on modes of existence’ that provides an alternative definition of society. (Publisher's abstract). (shrink)

_The Social Work Psychoanalyst's Casebook_ begins with an interview with Dr. Sanville, who reflects on her evolution as a social work analyst, theoretician, writer, teacher, and leader. These reminiscences are followed by accounts of nine analytic treatments, each of which offers an unusual window into what actually transpired between analyst and analysand during the treatment hours. These case studies concern particularly troubled, often traumatized patients-the very "hard to reach" or "difficult to treat" clients with whom social workers have long been (...) familiar. They include a reanalysis by the same analyst of a patient whose first therapy ended in a stalemate; an account of transference and countertransference phenomena during termination; a report on the analysis of a young woman who experienced both chronic and stress-related trauma; and an account of the special issues involved in the treatment of an aging woman. Most of the case studies reflect the influence of Dr. Sanville, whose work has long evinced the therapeutic imagination and disciplined creativity to which all the contributors aspire. Tthe contributors to this volume offer the salutary reminder that analytic work is built on a relationship of respect and empathy and that treatment success follows from the therapist's willingness to accommodate the unique needs of individual patients. In honoring Jean Sanville, _The Social Work Psychoanalyst's Casebook_ speaks to the robustness of a multidisciplinary approach to psychopathology that transcends the bounds of any single profession-an approach in which contemporary psychoanalysis is enlarged by the insights and emphases of social work just as social work is enriched by the clinical wisdom of psychoanalysis. (shrink)

In a recent paper, Shaun Nichols (2002) presents a theory that offers an explanation of the cognitive processes underlying moral judgment. His Affect-Backed Norms theory claims that (i) a set of normative rules coupled with (ii) an affective mechanism elicits a certain response pattern (which we will refer to as the “moral norm response pattern”) when subjects respond to transgressions of those norms. That response pattern differs from the way subjects respond to violations of norms that lack the affective backing (...) (here referred to as the “conventional norm response pattern”). In response, Daniel Kelly and colleagues (2007) present data that, the authors claim, undermine Nichols’ Affect-Backed Norms theory by showing that there are novel cases in which (i) and (ii) are in place, yet subjects respond in the way typical of the conventional response pattern. In Section I of this paper we summarize the challenge to the Affect-Backed Norms theory from the novel cases introduced by Kelly et al. We then show how the challenge is potentially flawed because no verification was provided that subjects were experiencing affect when reading the cases, nor was level of affect controlled for. In Section II, we describe the study we conducted to determine what level of affect was induced when subjects read the novel cases. In Section III, we present our findings, namely that subjects respond to the novel cases with different levels of affect, which tracks their judgments of the severity of the transgressions in the cases. In Section IV, we discuss the results and show that the Affect-Backed Norms theory can explain subjects’ responses to the novel cases given this new 2 information about affective response. In Section V, we conclude with a thought about how these findings inform the traditional moral/conventional distinction. (shrink)

Residual categories such as »not elsewhere categorized« densely populate modern information systems. This article roughly categories two types of modern information surveillance and notification systems, statistical and event-based. It examines the nature of residual categories arising from each, and proposes some methodological considerations for how these impact moral order within information infrastructure. The article concludes with comments about how the inclusion of lived experience might ameliorate a sort of moral gridlock often encountered today in large-scale information systems.

This study provides a basic introduction to agent-based modeling (ABM) as a powerful blend of classical and constructive mathematics, with a primary focus on its applicability for social science research. The typical goals of ABM social science researchers are discussed along with the culture-dish nature of their computer experiments. The applicability of ABM for science more generally is also considered, with special attention to physics. Finally, two distinct types of ABM applications are summarized in order to illustrate concretely the duality (...) of ABM: Real-world systems can not only be simulated with verisimilitude using ABM; they can also be efficiently and robustly designed and constructed on the basis of ABM principles. (shrink)