Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including (...) residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

usually brings to mind images of picket signs held by laborers striking for better wages and benefits. Collective action, however, need not be limited to the withholding of labor. Nor need it involve only the working or middle classes, as airline pilots have recently demonstrated. Finally, collective action need not have as its only purpose the self-interest of the group. Collective action does, however, always involve a joining together of individuals united by common goals or interests in order to consolidate (...) power for the purpose of negotiating with another group or entity. Examples of collective action obviously include striking, other withholding labor actions, and slowdowns, but can also include many other activities. for example, have been threatened or used by house officer organizations in the past. In a paper strike, patient care continues but without documentation, and thus, the institution suffers from absent or delayed financial remuneration. (shrink)

Though trust is essential to relationships between people, including that between patient and clinician, its role in organizational ethics is largely unexplored. Nonetheless, trust is also ideally a part of the relationship between patient and health care institution, both because it is desirable in and of itself, and because it makes for better medical care.

Volume 20, Issue 7, July 2020, Page 6-8.

The American Journal of Bioethics, Volume 11, Issue 8, Page 62-63, August 2011.

Those who advocate higher out-of-pocket spending, especially high deductibles, to keep health care costs better controlled without losing quality use market language to talk about how people should think about health care. Consumers—that is, patients—should hunt for bargains. Clip coupons. Shop around. Patients need to have more “skin in the game.” Consumer-patients will then choose more carefully and prudently and use less unnecessary health care. Unfailingly, “skin” refers to having money at stake. Usually, those arguing for high deductibles express dismay (...) or frustration that patients do not face the full cost of the health services they receive. Unfortunately, a lack of price transparency, the need to unbundle bundled groups of services to discover total price, and the challenge of validly and reliably measuring and disclosing quality make shopping for health care a challenge for even the savviest patient. Urgency, fear, and sickness that impairs peak cognitive function and other aspects of emotionally laden decision-making, even when “shared” with a physician, add obstacles to coupon clipping and tire kicking. Who has more at stake in health decisions than patients? Whose flesh is literally, not just figuratively, at risk? (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 1-2, July 2011.

Health care and public health programs increasingly rely on, and often even require, organizational action, which is facilitated, if not dependent on, trust. Case examples in this essay highlight trust, trustworthiness, and distrust in public and private organizations, providing insights into how trust in health‐related organizations can be betrayed, earned, and justified and into the consequences of organizational trust and trustworthiness for the health of individuals and communities. These examples demonstrate the need for holistic assessments of trust in clinicians and (...) trust in organizations and for organizations, public health, and the medical profession to address questions concerning their own trustworthiness. Normative and empirical assessments of trust and trustworthiness that capture the experiences of those treated within the walls of a health care organization, as well as the care of those outside, will contribute to more trustworthy systems of care. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 13-16, December 2011.

Volume 19, Issue 12, December 2019, Page 57-60.

Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need (...) for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness, while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government. (shrink)

Jecker makes three major points in her article, “A Broader View of Justice” (2008). First, she argues that justice in healthcare relates to justice in the broader social conditions of society as th...

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of (...) six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors’empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners. (shrink)

Lewis's notion of a "natural" property has proved divisive: some have taken to the notion with enthusiasm, while others have been sceptical. However, it is far from obvious what the enthusiasts and the sceptics are disagreeing about. This paper attempts to articulate what is at stake in this debate.

This paper defends the claim that although ‘Superman is Clark Kent and some people who believe that Superman flies do not believe that Clark Kent flies’ is a logically inconsistent sentence, we can still utter this sentence, while speaking literally, without asserting anything false. The key idea is that the context-sensitivity of attitude reports can be - and often is - resolved in different ways within a single sentence.

Plotinus (204/5–270 CE) was the first and greatest of Neoplatonic philosophers. His writings were edited by his disciple Porphyry, who published them sometime between 301 and 305 CE in six sets of nine treatises each (Enneads), with a biography of his master in which he also explains his editorial principles.

This paper is an investigation of the general logic of "identifications", claims such as 'To be a vixen is to be a female fox', 'To be human is to be a rational animal', and 'To be just is to help one's friends and harm one's enemies', many of which are of great importance to philosophers. I advocate understanding such claims as expressing higher-order identity, and discuss a variety of different general laws which they might be thought to obey. [New version: (...) Nov. 4th, 2016]. (shrink)

According to transhumanists who urge the radical enhancement of human beings, humanity’s top priority should be engineering “posthumans,” whose features would include agelessness. Increasingly, transhumanism is critiqued on foundational grounds rather than based largely on anticipated results of its implementation, such as rising social inequality. This expansion is crucial but insufficient because, despite its radical aim, transhumanism reflects beliefs and attitudes that are evident in the broader culture. With a focus on the yearning to eliminate aging, I consider four of (...) these: a disproportionate reliance on science and technology to address major human challenges; the conceptualization of human beings in terms of binaries like “young-old”; a repudiation of vulnerability; and intensifying perfectionism. Illuminating these interlocked commitments both deepens an existing critique of transhumanism and draws our attention to deleterious cultural views that must be vigorously contested if our commitment to human flourishing is to be deep and unwavering. (shrink)

We argue that all comparative expressions in natural language obey a principle that we call Comparability: if x and y are at least as F as themselves, then either x is at least as F as y or y is at least as F as x. This principle has been widely rejected among philosophers, especially by ethicists, and its falsity has been claimed to have important normative implications. We argue that Comparability is needed to explain the goodness of several patterns (...) of inference that seem manifestly valid, that the purported failures of Comparability would have absurd consequences, and that the influential arguments against Comparability are less compelling than they may have initially seemed. (shrink)