Medical ethics, principles, persons, and perspectives is discussed under three headings: History, Theory, and Practice. Under Theory, the author will say something about some different approaches to the study and discussion of ethical issues in medicine—especially those based on principles, persons, or perspectives. Under Practice, the author will discuss how one perspectives based approach, hermeneutics, might help in relation first to everyday ethical issues and then to public controversies. In that context some possible advantages of moving from controversy to conversation (...) will be explored; and that will then be illustrated with reference to a current controversy about the use of human embryos in stem cell therapy research. The paper begins with history, and it begins in the author’s home city of Edinburgh. (shrink)

This volume consists of autobiographical by the following scholars, together with pictures and autographs: Raven I. McDavid, Jr., Henry M. Hoenigswald, John B. Carroll, William G. Moulton, Archibald A. Hill, Yakov Malkiel, Charles F. Hockett, Harold B. Allen, William Bright, Einar Haugen, George S. Lane, Frederic G. Cassidy, James B. McMillan, Winfred P. Lehmann, Fred W. Householder, and Dell Hymes. A master list of references, and an index of persons conclude the volume.

AIDSThe sudden appearance of a truly new disease is a wake-up call. A new global pandemic of an infectious agent, transmitted through sexual contact and blood, affecting alienated and/or deprived people and communities, infectious throughout, that causes a slowly progressive breakdown of defence against other infectious diseases, as well as causing dementia in some, and leads to a premature death, occurring in an era of extensive travel and rapid communication, is a veritable tocsin. These crude ingredients of AIDS as a (...) medical and social phenomenon, blended with the poignant personal histories revealed to clinical professionals, spiced — as if this were necessary — by the fear, the prejudice, the wild theorising and the voyeurism, have presented a substantial challenge to practical medical ethics.Familiar ethical debates have been reopened with new perspective and insight, others have been examined thoroughly for the first time. Building on the major developments in medical ethics over recent decades, AIDS has provided an opportunity, indeed a necessity, for its maturation. It continues to present new issues for debate, while those that were present from the outset continue to perplex us, as this issue of the journal should show. In teaching, AIDS offers a plethora of examples to illustrate most of the central tenets and tensions of medical ethics. As an exemplar, it has provided preparation and precedent for addressing some of the issues emerging from new challenges, such as screening for susceptibility to genetic disease.AJPBereavementThe word comes from the same germanic root as “to be robbed excessively”. Bereavement is an intensely personal and disorienting experience, to which people can react with denial, anger, guilt or depression, sometimes prolonged. In Western countries nowadays it is most commonly experienced in mid-life through the death of a parent, or in old age through that of a …. (shrink)

The symposium in this issue, on equality and disability, helps to clarify some areas of continuing disagreement in disability studies, but also uncovers substantial consensus. All of the contributors appear to endorse John Harris's statement that “No disability, however slight, nor however severe, implies lesser moral, political or ethical status, worth, or value”.1 It seems safe to assume, moreover, that few if any readers of the Journal of Medical Ethics are likely to disagree with this, or indeed to challenge Kate (...) Diesfeld's initial assumption that “Generally speaking, it is both immoral and unlawful to discriminate between people on the ground of disability”.2Some, of course, might challenge Diesfeld's choice of the word “between” rather than “against”. What is generally agreed to be both immoral and unlawful is discrimination in the modern sense of treating people unjustly on the basis of distinctions that are not morally relevant to the matter in hand. It is neither immoral nor illegal, for example, for a transport employee to discriminate between members of the travelling public in order to offer some but not others the use of a wheelchair or a wheelchair ramp. Nor is it immoral or illegal for society to discriminate between its members through legislation which offers, to some but not others, special forms of aid or protection, based on the recognition of their respective disabilities.Legislation designed to protect people …. (shrink)

Was society’s response adequate in the cases of Mrs Pretty and Ms B?On the 11th of May, less than two weeks after losing her final legal appeal, Mrs Diane Pretty died, under sedation and in the care of a hospice. It was not the end she had pursued through the English High Court, the Court of Appeal, the House of Lords, and the European Court of Human Rights. Paralysed by motor neurone disease and unable to take her own life, Mrs (...) Pretty wanted her husband to be allowed to help her to die when they decided the time had come. But in England, assisting suicide is a crime, although suicide itself no longer is, and the English courts refused Mrs Pretty’s request to grant her husband legal immunity. In turning to the European Court of Human Rights, Mrs Pretty argued that the English courts’ refusal had violated the European Convention on Human Rights.The European court, however, judged that there had been no violation. The right to life could not be construed as conferring a “right to die”, and consequently the state could not be required to “sanction actions intended to terminate life” in order to protect Mrs Pretty from the “inhuman or degrading treatment” to which she claimed the law on assisted suicide subjected her. The right to respect for private life , moreover, had to be exercised “in accordance with the law” of the state concerned. “States were entitled to regulate through the operation of the general criminal law activities which were detrimental to the life and safety of other individuals”; and such activities were what the English law against assisting suicide was designed to prevent. Exceptions to this law could not be allowed without undermining the …. (shrink)

An Institute of Medical Ethics working party argues that an ethically desirable relationship of mutual empowerment between patient and clinician is more likely to be achieved if patients understand the ground rules of medical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice of different doctors and specialties. Matters might be clarified, it suggests, by identifying moral factors which tend to recur in medical decisions about maintaining or (...) breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients. (shrink)

An Institute of Medical Ethics working party supports the view that explicit permission should normally be sought in the case of testing for HIV antibody. It discusses this in relation to anonymised HIV testing for epidemiological purposes, concluding that this is to be welcomed, given certain safeguards. It next argues that pregnant women may have a greater and more immediate need than others to know their HIV status. It concludes that this need does not justify testing them without their permission, (...) but can be met by voluntary diagnostic testing on an 'opting-out' basis, supported by adequate briefing. (shrink)

The authors report and comment on student reactions to a clinical example of moral choice in the microallocation of scarce resources. Four patients require dialysis simultaneously, but only one kidney machine is available. What moral, as opposed to clinical, criteria are available to determine who should have priority?

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.2 (2003) 73-79 [Access article in PDF] Does Film Weaken Spectator Consciousness? R.D. Boyd and S.K. Wertz The role of spectator is crucial for an actor, for there are "no actors without spectators." 1 At times the success of the actor depends upon the role taken by the spectator. Thornton Wilder's "Our Town" depends upon an active,creative, involved audience. Other artists expect their (...) audience to be passive,almost unconscious. Whether the medium of creativity is film or the printedpage, examples of both dependencies abound. The focus of this essay is ona classic piece in the literature about film. In the Theory of Film, Siegfried Kracauer provides us with a mesmerizing printed discussion of film. 2 In this essay we wish to examine his reasoning that is in a self-contained argument by analogy. Since Kracauer does not use or mention the argument thereafter, we feel that we can isolate the argument from its context and deal with it as it stands. After an extended analysis of the argument, we will relate some of the points to the literature on film. The following analogical argument is our focus. Films...tend to weaken the spectator's consciousness. Its withdrawal from the scene may be furthered by the darkness in moviehouses. Darkness automatically reduces our contacts with actuality, depriving us of many environmental data needed for adequate judgments and other mental activities. It lulls the mind....Devotees of film and its opponents alike have compared the medium to a sort of drug and have drawn attention to its stupefying effects....Doping creates dope addicts. It would seem a sound proposition that the cinema has its habitues who frequent it out of an all but physiological urge. They are not prompted by a desire to look at a specific film or to be pleasantly entertained; what they really crave is for once to be released from the grip of consciousness, lose their identity in the dark, and let sink in, [End Page 73] with their senses ready to absorb them, the images as they happen to follow each other on the screen. 3To support his main point, "Films...tend to weaken the spectator's consciousness," Kracauer develops three intermediate arguments (IA's), which support his major argument (MA). If each sentence in the above passage were numbered one through nine, with the last full sentence being broken into two sentences at the semicolon, the following schema emerges. In English the chain of reasoning is: IA-1 Some habitues of film are not prompted by a desire to look at a specific film or to be pleasantly entertained. What they really crave is release fromthe grip of consciousness, to lose their identity in the dark, and let sink in, with their senses ready to absorb them, the images as they happen to follow each other on the screen. Therefore, the cinema has its habitues who frequent it out of an all but physiological urge.IA-2 Some habitues of film frequent it out of an all but physiological urge. Doping creates dope addicts. Therefore, devotees of film and its opponents alike have compared the medium to a sort of drug and have drawn attention to its stupefying effects.IA-3 Darkness automatically reduces our contacts with actuality, depriving us of many environmental data needed for adequate judgments and other mental activities. Darkness lulls the mind. Therefore, consciousness withdrawal from the scene may be furthered by the darkness in moviehouses.MA Devotees of film and its opponents alike have compared the medium to a sort of drug and have drawn attention to its stupefying effects. Consciousness withdrawal from the scene may be furthered by the darkness in moviehouses. Therefore, films...tend to weaken the spectator's consciousness. The above chain of arguments influences us, the spectators, to embrace his main point. However, before we are lulled into accepting his reasoning, it will be helpful to examine and evaluate each link. [End Page 74]IA-1 Some habitues of film are not prompted by a desire to... (shrink)

Men have been talking of death from time immemorial - sometimes sublimely in prose and poetry, in painting and sculpture and in music - till silence seemed to fall in the recent past. Now men are again talking about death - interminably but colloquially. They talk on television, on the radio, in books and in pamphlets. Dr Kenneth Boyd therefore finds it entirely timely to offer this historical sketch of attitudes to death. The earlier part of his paper covers (...) fairly familiar ground but his final and longest section on the work of a social historian, Philippe Ariès, may be new to many. Ariès is reinterpreting the long history of attitudes to death in a form which may well interest those who today are concerned with helping modern man to accept his own death - death which still, for most people, is the death of another, not of oneself. (shrink)

This commentary focuses on two moral values implied by the case study but not specified in the working party's conclusions, namely equitable treatment of the most vulnerable and the value of political government.

This symposium discussed bioethics teaching, research and documentation and also research ethics committees. An international convention for the protection of the integrity of the human body was called for, as was a new European Committee on Ethics. 'The genetic impact' was a major preoccupation of the symposium.

This paper relates two experiences of teaching medical ethics, the first to a small group of clinical medical students, the second to a larger group of GP trainees.

The Edinburgh Medical Group Research Project is unique in Britain. Part of its function is to experiment with teaching medical ethics both inside and outside of the Medical School. The papers which follow have been written by two full-time reseach fellows working with the Project and two of the professional advisers, one nursing and one medical. Together they give a picture of the wide scope of exerimental teaching taking place in Edinburgh and present some preliminary results from these experiments.

The author of this comment suggests that some of the important points made by Dr Adrian Rogers are vitiated by a tendency to contrast the worst of modern medical practice with an over-idealised view of the past. The state of medical ethics today, the author suggests, is more hopeful than Dr Rogers allows.

For much of human history the idea of a right to life has not seemed self-evident. The credibility of the idea appears to depend on a particular kind of intuition concerning the nature of the world. In this paper, the kind of intuition involved is related to the idea of a covenant, illustrated by that of marriage. The paper concludes by suggesting that talk about responsibilities may be more fruitful than talk about rights.

Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80–90% of studies with industry affiliation found no harm from the product, while only about 10–20% of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between mercury exposure (...) and autism spectrum disorder show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no “consistent” evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest. (shrink)

Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80–90 % of studies with industry affiliation found no harm from the product, while only about 10–20 % of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between (...) mercury exposure and autism spectrum disorder show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no “consistent” evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to date, finding that of the studies with public health and/or industry affiliation, 86 % reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 19 % find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest. (shrink)

Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80–90% of studies with industry affiliation found no harm from the product, while only about 10–20% of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between mercury exposure (...) and autism spectrum disorder show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no “consistent” evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion on (...) the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)

Background: The Declaration of Helsinki, the World Medical Association’s statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.Methods: A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.Results: There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, (...) 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.Interpretation: Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA. (shrink)

Whenever we make a claim about a fictional entity, we seem to embroil ourselves in familiar problems of reference. This appearance is misleading, because what a sentence is about bears a greater resemblance to a Fregean sense than to a reference. All previous attempts to define 'about' consist of two approaches: "metalinguistic" theories of 'about', proposed by Ryle and Carnap, which fail to counterexamples wherein transparent contexts generate paradoxical consequences; and "semantic" theories of 'about' proposed by Putnam and by Goodman, (...) which fail to counterexamples wherein no term refers to that which the sentence is about. ;An untried alternative is to replace 'S is about k ' with 'S is about k for person p '. Clearly, such a definition need not confine itself to sentences, but may apply to works of art as well. A detailed examination of how one actually goes about arguing to an audience that some work of art W is about some topic, yields a definition that approximates normal usage, yet avoids many problematic notions, such as 'beliefs', 'ideas', and 'intentional states'. Necessary and sufficient truth conditions for 'W is about k for p at time T' turn out to include as major elements a causal chain leading from W to a set of "explicit thoughts" and dispositions, and the lack of an "aesthetic environment" which excludes W. (shrink)

The anti-realist argument from underconsideration focuses on the fact that, when scientists evaluate theories, they only ever consider a subset of the theories that can account for the available data. As a result, when scientists judge one theory to be superior to competitor theories, they are not warranted in drawing the conclusion that the superior theory is likely true with respect to what it says about unobservable entities and processes. I defend the argument from underconsideration from the objections of Peter (...) Lipton. I argue that the inconsistency that Lipton claims to find in the argument vanishes once we understand what the anti-realist means when she claims that scientists are reliable. I also argue that collapsing the distinction between relative and absolute evaluations, as Lipton recommends, has its costs. Finally, I briefly examine Richard Boyd's influential defence of realism. (shrink)

The notion of whether people focus on the past, present or future, and how it shapes their behaviour is known as Time Perspective. Fundamental to the work of two of its earliest proponents, Zimbardo and Boyd (2008), was the concept of balanced time perspective and its relationship to wellness. A person with balanced time perspective can be expected to have a flexible temporal focus of mostly positive orientations (past-positive, present-hedonistic, and future) and much less negative orientations (past-negative and present-fatalistic). (...) This study measured deviation from balanced time perspective (DBTP: Zhang, Howell, and Stolarski, 2013) in a sample of 243 mature adults aged 45 to 91 years and explored relationships to Retirement Planning, Depression, Anxiety, Stress, Positive Mood, and Negative Mood. Results indicate that DBTP accounts for unexplained variance in the outcome measures even after controlling for demographic variables. DBTP was negatively related to Retirement Planning and Positive Mood and positively related to Depression, Anxiety, Stress and Negative Mood. Theoretical and practical implications regarding balanced time perspective are discussed. (shrink)