We argue that once a normative claim is developed, there is an imperative to effect changes based on this norm. As such, ethicists should adopt an “implementation mindset” when formulating...

Volume 20, Issue 7, July 2020, Page 82-84.

In almost every clinical interaction, clinicians must navigate interpersonal challenges with near‐instantaneous responses to patients. Yet medical ethics has largely overlooked these small, interpersonal exchanges, instead focusing on “big” ethical problems, such as euthanasia, brain death, or genetic modification. In 1995, Paul Komesaroff proposed the concept of microethics as a nonprinciplist approach to ethics that focuses on “what happens in every interaction between every doctor and every patient.” We aim to develop a microethics framework to guide everyday clinical encounters, with (...) a special focus on communication with patients and family members. We will advance three core insights: First, communication is an ethical act in ways seldom considered. Second, microethics is an essential lens through which to view the ethics of communication. Third, virtue can bridge reflective and automatic processes. Our intuitionist framework for microethics is thus based on this understanding of the role of virtue, and we propose six virtues that contribute to the goal of healing communication. (shrink)

The triadic parent–patient–clinician interaction in pediatrics creates unique ethical challenges when parents and clinicians disagree about treatments or interventions. Rather than an autonomous ro...

In the history of palliative care, all roads lead back to Dame Cicely Saunders, a remarkable social worker/nurse/physician who promoted the concept of total pain and founded the first modern hospic...

My relationship to the guitar can be characterized by the Friday evening distortion of Kirk Hammett (of Metallica) and Dan Auerbach (of The Black Keys) and Sunday morning’s soaring chords of classical musicians Julian Bream and Rafael Andia to anything in between the rest of the week. I have, however, kept my writing and my music away from my professional practice. I am one of those for whom music and poetry offer a refuge, a source of compensation for the emotions (...) built up during clinical work. I need to look outside of my practice for the beauty of the world, in all its harsh reality and breadth, reveling in the splendor to bring me peace. Reading Bryan Sisk’s (2011) reflection on bringing his guitar, his songs, and his free time to the Cleveland Clinic Children’s Hospital challenged me to immerse myself in a different musical and literary universe. A Lasting Effect: Reflections on Music and Medicine is a collection of reflective pieces written when Sisk was a medical student. He des .. (shrink)

In the Hastings Center Report's July‐August 2022 issue, articles by Jessica Amalraj and Kavita Shah Arora and by Inmaculada de Melo‐Martín take up very different concerns under the broad topic of reproductive ethics and public policy. Amalraj and Arora call for public deliberation and consensus building to revise a Medicaid sterilization policy, and de Melo‐Martín argues that social resources should not be used to support reproductive embryo editing but should instead be put toward pre‐ and postnatal interventions that, compared to (...) embryonic genome editing, can help far more people have children who are healthy and genetically related to them. The third article, by Bryan Sisk and James M. DuBois, offers a framework to guide clinicians in their everyday communication with patients and their family members. Elsewhere in the issue are arguments about the responsibilities health care organizations have to address large societal problems affecting well‐being. (shrink)

In an effort to further explore ostensible macroscopic psychokinesis (macro-PK) effects like those previously reported by Batcheldor (1966), Bourgeois (1994), Owen and Sparrow (1976), and Ullman (2001) in a sitter group setting, the first author designed and conducted a series of fifteen experimental sessions in which sitters claiming exceptional abilities attempted to generate a pseudo-spirit named "Daniel," to whom physical phenomena were attributed. To explore possible physical correlates of macro-PK, two approaches to measurement were utilized. In the first, sample data (...) from a local random number generator (RNG) continuously running as part of the Global Consciousness Project were extracted and examined for statistical deviations from randomness occurring in conjunction with the sitter group sessions. In the second, the Multi-Energy Sensor Array (MESA) was used to collect onsite environmental data during one of the sessions. While displays of ostensible macro-PK were observed during several of the sitter group sessions, the RNG data did not show a significant overall correlation with the sessions. The MESA data indicated notable drops in infrared and visual light, as well as changes in DC magnetic field strength, that are comparable to those observed in field studies of haunts. Keywords: sitter groups--macroscopic psychokinesis (macro-PK)--random number generator (RNG)--Multi-Energy Sensor Array (MESA). (shrink)

This article is a contribution to the revival of `virtue ethics'. If we regard human rights as a crucial development in the establishment of global institutions of justice and equality, then we need to explore the obligations that correspond to such rights. It is argued that cosmopolitan virtue a respect for other cultures and an ironic stance towards one's own culture spells out this obligation side of the human rights movement. Cosmopolitanism of course can assume very different forms. The article (...) traces various cosmopolitan ethics from the Greeks, Roman Stoics and Christian philosophers. Contemporary cosmopolitanism needs to be ironic to function usefully in hybrid global cultures, but it is open to the charge of being culturally `flat' and elitist. These criticisms are examined through the confrontation between Maurizio Viroli and Martha Nussbaum. While American patriotism is not a promising foundation for ironic cosmopolitanism, the republican tradition of virtue does offer a viable method of developing cosmopolitanism. Ironic cosmopolitan care for other cultures is founded on the commonalities of social existence, of which there are two central components: ontological vulnerability and political precariousness. (shrink)

Informed consent is a necessary component of the ethical practice of surgery. Ideally, consent is performed in a setting conducive to a robust patient-provider conversation, with careful consideration of risks, benefits, and outcomes. For patients with medical or surgical emergencies, navigating the consent process can be complicated and requires both careful and expedited assessment of decision-making capacity. We present a recent case in which a patient in need of emergency care refused intervention, requiring urgent capacity assessment and a modification to (...) usual care. (shrink)

At a time of continued consternation about the nature and organisation of educational studies within universities in the United Kingdom, it is apposite to give further exploration to the precise na...

Integrative experiment design is a needed improvement over ad hoc experiments, but the specific proposed method has limitations. We urge a further break with tradition through the use of an enormous untapped resource: Decades of causal discovery artificial intelligence (AI) literature on optimizing the design of systematic experimentation.

This article makes a contribution to the on-going debates about universalism and cultural relativism from the perspective of sociology. We argue that bioethics has a universal range because it relates to three shared human characteristics,—human vulnerability, institutional precariousness and scarcity of resources. These three components of our argument provide support for a related notion of ‘weak foundationalism’ that emphasizes the universality and interrelatedness of human experience, rather than their cultural differences. After presenting a theoretical position on vulnerability and human rights, (...) we draw on recent criticism of this approach in order to paint a more nuanced picture. We conclude that the dichotomy between universalism and cultural relativism has some conceptual merit, but it also has obvious limitations when we consider the political economy of health and its impact on social inequality. (shrink)

Norbert Elias (2001) produced one of the most influential theories on the history of violence in human societies in terms of ‘the civilizing process’. With the transformation of feudalism, the rise of bourgeois society and the development of the modern state, interpersonal violence was increasingly regulated by social norms that emphasized self-restraint and personal discipline. His theory was a moral pedagogics of the body in which the ‘passions’ are self-regulated through detailed social regimes. While his theory is influential, it has (...) also been the subject of systematic criticism. I examine three obvious lacunae in Elias’ theory. First, his theory does not provide an adequate account of the role of religion in the civilizing process, particularly with respect to controlling human violence, and I examine Elias’ theory through a commentary on charisma and the sacred in human society, namely the role of sacred violence. Second, Elias had relatively little to say about the interaction between military technology and interpersonal norms. Modern technology has made it possible, both in peace and war, for the state and modern military institutions to gain control of forms of mass violence that were unimaginable in less civilized societies. We could accept Elias’ proposition about constraint in terms of interpersonal violence, but argue that modern technology has obviously enhanced the capacity of the means of violence in society. This ‘de-personalization’ of violence is consistent with aspects of Elias’ civilization theory. However, the theme of technology was completely understated. Third, apart from Elias’ interest in art and society as a consequence of his teaching appointment in Ghana (1962–4), his theory was primarily concerned to explain aspects of social change in European society. An exploration of the evolution of military violence and charisma among American Plains Indians, especially the Cheyenne, is intended as an elaboration of the debate around Elias’ ‘figurational sociology’. Through an examination of the training of warriors in nomadic Plains culture, their mode of warfare is defined as a form of spiritual violence, because warfare was bound up with religious norms of conduct and their military interaction was highly ritualized. These spiritual technologies are an important illustration of military technologies of self-creation. My account concludes with an examination of the nature of modern conflict between professional armies within an international human rights framework. The democratization of warfare results in the routinization of military charisma and the charismatic hero survives primarily in popular culture as a celebrity. (shrink)

35 million people die annually of non-communicable diseases (NCDs), 80% of them in low- and middle-income countries — representing a marked epidemiological transition from infectious to chronic diseases and from richer to poorer countries. The total number of NCDs is projected to rise by 17% over the coming decade, absent significant interventions. The NCD epidemic poses unique governance challenges: the causes are multifactorial, the affected populations diffuse, and effective responses require sustained multi-sectorial cooperation. The authors propose a range of regulatory (...) options available at the domestic level, including stricter food labeling laws, regulation of food advertisements, tax incentives for healthy lifestyle choices, changes to the built environment, and direct regulation of food and drink producers. Given the realities of globalization, such interventions require global cooperation. In 2011, the UN General Assembly held a High-level meeting on NCDs, setting a global target of a 25% reduction in premature mortality from NCDs by 2025. Yet concrete plans and resource commitments for reaching this goal are not yet in the offing, and the window is rapidly closing for achieving these targets through prevention — as opposed to treatment, which is more costly. Innovative global governance for health is urgently needed to engage private industry and civil society in the global response to the NCD crisis. (shrink)

In their Bioessays review ‘Current views of collagen degradation’, Gillian Murphy and John Reynolds gave an outline of the molecular structure of the members of the collagen family and described their traditional role in providing stable tissue frameworks.1 This short review considers the relationship between the different members of that family and what gene structure reveals about their evolution. Mutation of the collagen structural genes has been discovered in patients suffering from brittle‐bone syndrome and other inherited connective tissue disorders, and (...) here I attempt to rationalize these results into an overall concept of collagen gene mutation and evolution. (shrink)

Contemporary academic interest in the human body is a response to fundamental changes in the relationship between body, economy, technology and society. Scientific advances, particularly new reproductive technologies and therapeutic cloning techniques, have given the human body a problematic status. Ageing, disease and death no longer appear to be immutable facts about the human condition. The emergence of the body as a topic of research in the humanities and social sciences is also a response to the women's and gay liberation (...) movements, and environmentalism, animal rights, anti-globalism, religious fundamentalism and conservative politics. Further, the human body is now central to economic growth in various biotechnology industries, in which disease itself has become a productive factor in the global economy and the body a code or system of information from which profits can be extracted through patents. In modern social theory, the body has been studied in the contexts of advertising and consumerism, in ethical debates about cloning, in research on HIV/AIDS, in postmodern reflections on cybernetics, cyberbodies and cyberpunk, and in the analysis of the global trade in human organs. The body is a central feature of contemporary politics, because its ambiguities, vulnerability and plasticity have been amplified by new genetic technologies. (shrink)

There are broadly five interconnected meanings of the noun ‘discipline’. Disciplinawere instructions to disciples, and hence a branch of instruction or department of knowledge. This religious context provided the modern educational notion of a ‘body of knowledge’, or a discipline such as sociology or economics. We can define discipline as a body of knowledge and knowledge for the body, because the training of the mind has inevitably involved a training of the body. Second, it signified a method of training or (...) instruction in a body of knowledge. Discipline had an important military connection involving drill, practice in the use of weapons. Third, there is an ecclesiastical meaning referring to a system of rules by which order is maintained in a church. It included the use of penal methods to achieve obedience. To discipline is to chastise. Fourth, to discipline is to bring about obedience through various forms of punishment; it is a means of correction. Finally there is a rare use of the term to describe a medical regimen in which ‘doctor's orders’ brings about a discipline of the patient. In contemporary society, there is, following the work of Michel Foucault, the notion of increasing personal regulation resulting in a ‘disciplinary society’ or a society based upon carceral institutions. (shrink)

Hospitals are traditional sites, not only of care, but of knowledge production. The word ‘hospital’ is derived from ‘hospitality’, and is also associated with ‘spital’, ‘hotel’ and ‘hospice’. In medieval society, the hospice was a place of rest, security and entertainment. The Knights Hospitallers were an order of military monks that took its historical origin from a hospital founded in Jerusalem in 1048. Before the rise of the modern research hospital, these spitals had a more general function as charitable institutions (...) for the care and maintenance of the aged, infirm and impoverished. Hospitals were important in the historical emergence of the university, but with the dominance of bio-medical sciences medical faculties have become increasingly separated geographically and administratively from other faculties. Medical research is dominated by private corporations and increasingly medical knowledge exists outside the conventional procedures and norms of scientific research. (shrink)

The N‐terminal domain of histone H4 has been implicated in various nuclear functions, including gene silencing and activation and replication‐linked chromatin assembly. Many of these have been identified by using H4 mutants in the yeast S. cerevisiae. In a recent paper, Megee et al.(1) use this approach to show that mutants in which all four N‐terminal H4 lysines are substituted with glutamines accumulate increased levels of DNA damage. A single lysine, but not an arginine, anywhere in the N‐terminal domain suppresses (...) this phenotype. It is suggested that histone H4 plays a role in maintaining genome integrity through the cell cycle, possibly by a mechanism involving lysine acetylation. (shrink)

Logic is concerned with the design or structure of arguments. It describes the forms of valid argument and is concerned with the public presentation and reception of arguments. Hence it has a close connection with politics and the public sphere, and with rhetoric as the science of persuasion. Philosophers have analysed the objective conditions of validation, that is, the justifiability of assertions about the world. This quest for objective and scientific validity in argumentation about the nature of reality dominated much (...) of the development of logic in the 20th century. Logical arguments are held to be successful as a result of the ‘force of reason’ rather than because one's opponents have been bribed or coerced. Logic involves the study of the abstract, deductive moves in argumentation rather than an empirical study of how actual arguments are conducted. However, there is also a tension between rhetoric and philosophy; Plato drew a clear distinction between knowledge and persuasion. Logic is intended to give security to the former. The historical drift of logic is towards abstraction, especially the use of mathematical forms of representation. The study of logic is an important component of any project on encyclopaedic knowledge, that is, with knowledge that circulates in the public sphere, but the globalization of culture has raised an important problem about the universalistic claims of traditions of logic, namely, are there different forms of logical reasoning? (shrink)

Logic is concerned with the design or structure of arguments. It describes the forms of valid argument and is concerned with the public presentation and reception of arguments. Hence it has a close connection with politics and the public sphere, and with rhetoric as the science of persuasion. Philosophers have analysed the objective conditions of validation, that is, the justifiability of assertions about the world. This quest for objective and scientific validity in argumentation about the nature of reality dominated much (...) of the development of logic in the 20th century. Logical arguments are held to be successful as a result of the ‘force of reason’ rather than because one's opponents have been bribed or coerced. Logic involves the study of the abstract, deductive moves in argumentation rather than an empirical study of how actual arguments are conducted. However, there is also a tension between rhetoric and philosophy; Plato drew a clear distinction between knowledge and persuasion. Logic is intended to give security to the former. The historical drift of logic is towards abstraction, especially the use of mathematical forms of representation. The study of logic is an important component of any project on encyclopaedic knowledge, that is, with knowledge that circulates in the public sphere, but the globalization of culture has raised an important problem about the universalistic claims of traditions of logic, namely, are there different forms of logical reasoning? (shrink)

Religion was one of the most important issues for early sociology, as is amply demonstrated by the work of Emile Durkheim and Max Weber. This set draws together the formative works on this subject, including key works in social anthropology. The collection includes a volume of important early essays, and an original introduction by the editor.

(1998). Universities, elites and the nation‐state: A reply to Delanty. Social Epistemology: Vol. 12, Sites of Knowledge Production: The University, pp. 73-77.