26 found

Year:

  1.  2
    What Justifies Judgments of Inauthenticity?Jesper Ahlin - 2018 - HEC Forum 30 (4):361-377.
    The notion of authenticity, i.e., being “genuine,” “real,” or “true to oneself,” is sometimes held as critical to a person’s autonomy, so that inauthenticity prevents the person from making autonomous decisions or leading an autonomous life. It has been pointed out that authenticity is difficult to observe in others. Therefore, judgments of inauthenticity have been found inadequate to underpin paternalistic interventions, among other things. This article delineates what justifies judgments of inauthenticity. It is argued that for persons who wish to (...)
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  2. Characteristics and Outcomes of Ethics Consultations on a Comprehensive Cancer Center’s Gastrointestinal Medical Oncology Service.Virginia Corbett, Andrew S. Epstein & Mary S. McCabe - 2018 - HEC Forum 30 (4):379-387.
    The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were (...)
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  3. A Tale of Two Countries: Innovation and Collaboration Aimed at Changing the Culture of Medicine in Uruguay.Juan J. Dapueto, Mercedes Viera, Charles Samenow, William H. Swiggart & Jeffrey Steiger - 2018 - HEC Forum 30 (4):329-339.
    This is a case study of a program to address professionalism at the Universidad de la República in Uruguay. We describe a five-year ongoing international collaboration. Relevant characteristics of the context, the program components, activities, and results were analyzed. The expected outcomes were to introduce standards of professional practices in the curricula of medical students and residents and the implementation of a program that might lead to a significant change in the culture of medicine in the University. Traditional didactics, interactive (...)
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  4.  1
    The Pitfalls of Proceduralism: An Exploration of the Goods Internal to the Practice of Clinical Ethics Consultation.Annie B. Friedrich - 2018 - HEC Forum 30 (4):389-403.
    In an age of professionalization and specialization, the practice of clinical ethics is facing an identity crisis. Are clinical ethicists moral experts, ethics experts, or merely quasi-lawyers giving legal advice? Are they extensions of the hospital, always working to advance the hospital’s interests? Or is there another option? Since 1998, when the American Society for Bioethics and Humanities first issued its Core Competencies for Healthcare Ethics Consultation, there has been debate about the role of standardization and proceduralism in clinical ethics (...)
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  5.  1
    The Standard Account of Moral Distress and Why We Should Keep It.Joan McCarthy & Settimio Monteverde - 2018 - HEC Forum 30 (4):319-328.
    In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the (...)
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  6. Philosophy of Healthcare Ethics Practice Statements: Quality Attestation and Beyond.Lauren Notini - 2018 - HEC Forum 30 (4):341-360.
    One element of the American Society for Bioethics and Humanities’ recently-piloted quality attestation portfolio for clinical ethics consultants is a “philosophy of clinical ethics consultation statement” describing the candidate’s approach to clinical ethics consultation. To date, these statements have been under-explored in the literature, in contrast to philosophy statements in other fields such as academic teaching. In this article, I argue there is merit in expanding the content of these statements beyond clinical ethics consultation alone to describe the author’s approach (...)
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  7.  24
    Dr. Google and Premature Consent: Patients Who Trust the Internet More Than They Trust Their Provider.John K. Davis - 2018 - HEC Forum 30 (3):253-265.
    A growing number of patients make up their minds about some medical issue before they see their provider, either by googling their symptoms or asking a friend. They’ve made up their minds before coming in, and they resist their provider’s recommendations even after receiving information and advice from their provider. This is a new kind of medical autonomy problem; it differs from cases of standard consent, futility, or conscientious refusal. Providers sometimes call this problem “Dr. Google.” I call it premature (...)
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  8.  4
    A Republican Argument Against Nudging and Informed Consent.Paul Hamilton - 2018 - HEC Forum 30 (3):267-282.
    I argue that it is impermissible to use nudges as a tool to influence patients in the context of informed consent. The motivation for such nudges is that their use can help reconcile potential conflicts between a physician’s duty of beneficence and duty to respect patient autonomy. I argue that their use places physicians in a position of domination over patients. That is, it violates the republican freedom of patients because it grants physicians the power to arbitrarily interfere. I also (...)
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  9.  1
    Autonomy, Well-Being, and the Value of Genetic Testing for Adopted Persons.Thomas May & Harold Grotevant - 2018 - HEC Forum 30 (3):283-295.
    This paper argues that the value of genetic-relative family health history information and the notion that lack of this information is a disadvantage can be established through its role as a nested goal in comprehensive life projects independent of documentation of particular health outcomes. Health information often plays a significant role in a person's formulation of life goals and projects, as well as in identification of plausible effective means to realize these goals. If health outcomes are valuable in part because (...)
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  10.  28
    Autonomy-Centered Healthcare.Maura Priest - 2018 - HEC Forum 30 (3):297-318.
    In this paper, I aim to demonstrate that the consequences of the current United States health insurance scheme on both physician and patient autonomy is dire. So dire, in fact, that the only moral solution is something other than what we have now. The United States healthcare system faces much criticism at present. But my focus is particular: I am interested in the ways in which insurance interferes with physician and patient autonomy. I will argue in favor of an expansion (...)
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  11.  3
    Autonomy, Competence and Non-Interference.Joseph T. F. Roberts - 2018 - HEC Forum 30 (3):235-252.
    In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon demonstration of (...)
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  12.  4
    Introduction: Autonomy in Healthcare.James Stacey Taylor - 2018 - HEC Forum 30 (3):187-189.
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  13.  4
    Evidence-Responsiveness and the Ongoing Autonomy of Treatment Preferences.Steven Weimer - 2018 - HEC Forum 30 (3):211-233.
    To be an autonomous agent is to determine one’s own path in life. However, this cannot plausibly be seen as a one-off affair. An autonomous agent does not merely set herself on a particular course and then lock the steering wheel in place, so to speak, but must maintain some form of ongoing control over her direction in life—must keep her eyes on the road and her hands on the wheel. Circumstances often change in important and unexpected ways, after all, (...)
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  14.  65
    The Need for Authenticity-Based Autonomy in Medical Ethics.Lucie White - 2018 - HEC Forum 30 (3):191-209.
    The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of “authenticity”, the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of medical (...)
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  15.  3
    Two Troubling Trends in the Conversation Over Whether Clinical Ethics Consultants Have Ethics Expertise.Abram Brummett & Christopher J. Ostertag - 2018 - HEC Forum 30 (2):157-169.
    In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence of ethical (...)
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  16.  5
    Why Are There So Few Ethics Consults in Children’s Hospitals?Brian Carter, Manuel Brockman, Jeremy Garrett, Angie Knackstedt & John Lantos - 2018 - HEC Forum 30 (2):91-102.
    In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians (...)
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  17. The Just War Tradition: A Model for Healthcare Ethics.Chaplain John D. Connolly - 2018 - HEC Forum 30 (2):133-152.
    Healthcare ethics committees, physicians, surgeons, nurses, families, and patients themselves are constantly under pressure to make appropriate medically ethical decisions concerning patient care. Various models for healthcare ethics decisions have been proposed throughout the years, but by and large they are focused on making the initial ethical decision. What follows is a proposed model for healthcare ethics that considers the most appropriate decisions before, during, and after any intervention. The Just War Tradition is a model that is thorough in its (...)
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  18.  3
    Inclusion of Assistive Technologies in a Basic Package of Essential Healthcare Service.Fiachra O’Brolcháin & Bert Gordijn - 2018 - HEC Forum 30 (2):117-132.
    This paper outlines the potential and necessity of the development of assistive technologies for people with intellectual disabilities. We analyse a policy recommendation designed to determine the contents of a basic health package supplied by the state, known as the Dunning Funnel. We contend that the Dunning Funnel is a useful methodology, but is weakened by a potentially relativistic understanding of “necessity” in relation to the requirements of people with IDs. We remedy this defect by using the capabilities approach as (...)
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  19.  1
    Clinical Ethics Consultation After God: Implications for Advocacy and Neutrality.J. Clint Parker - 2018 - HEC Forum 30 (2):103-115.
    In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, (...)
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  20. Are Handbooks Still Useful? Yes and No; It Depends on How You Use Them.Bryan Pilkington - 2018 - HEC Forum 30 (2):153-156.
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  21.  3
    Against Inflationary Views of Ethics Expertise.Lisa M. Rasmussen - 2018 - HEC Forum 30 (2):171-185.
    Abram Brummett and Christopher Ostertag offer critiques of my argument that clinical ethics consultants have expertise but are not “ethics experts”. My argument begins within our less-than-ideal world and asks what a justification of a clinical ethics consultation recommendation might look like under those conditions. It is a challenge to what could be called an “inflationary” position on ethics expertise that requires agreement on or rational proof of metaethical facts about the values at stake in clinical ethics consultation. Brummett and (...)
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  22.  12
    Understanding and Resolving Conflicting Traditions: A MacIntyrean Approach to Shared Deliberation in Medical Ethics.Jessica Adkins - 2018 - HEC Forum 30 (1):57-70.
    The position of clinical ethicist exists to help resolve conflicts in the hospital. Sometimes these conflicts arise because of fundamental cultural differences between the patient and the medical team, and such cases present special challenges. Should the ideology of modern medicine reject the wishes of those who hold ideologies from differing cultures? How can the medical ethicist help resolve such conflicts? To answer these questions, I rely on the works of Alasdair MacIntyre. Using MacIntyre’s philosophy, we can better understand why (...)
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  23.  20
    Re A and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?Kartina A. Choong & Mohamed Y. Rady - 2018 - HEC Forum 30 (1):71-89.
    The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death (...)
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  24.  3
    From Paternalistic to Patronizing: How Cultural Competence Can Be Ethically Problematic.Ruaim A. Muaygil - 2018 - HEC Forum 30 (1):13-29.
    Cultural competence literature and training aim to equip healthcare workers to better understand patients of different cultures and value systems, in an effort to ensure effective and equitable healthcare services for diverse patient populations. However, without nuanced awareness and contextual knowledge, the values embedded within cultural competence practice may cripple rather than empower the very people they mean to respect. A narrow cultural view can lessen cultural understanding rather than grow it. In its first part, this paper argues that a (...)
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  25.  9
    Same Principles, Different Worlds: A Critical Discourse Analysis of Medical Ethics and Nursing Ethics in Finnish Professional Texts.Salla Saxén - 2018 - HEC Forum 30 (1):31-55.
    This qualitative social scientific study explores professional texts of healthcare ethics to understand the ways in which ethical professionalism in medicine and nursing are culturally constructed in Finland. Two books in ethics, published by Finnish national professional organizations—one for nurses and one for physicians—were analyzed with the method of critical discourse analysis. Codes of ethics for each profession were also scrutinized. Analysis of the texts sought to reveal what is taken for granted in the texts as well as to speculate (...)
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  26.  8
    Advance Directives and the Descendant Argument.Jukka Varelius - 2018 - HEC Forum 30 (1):1-11.
    By issuing an advance treatment directive, an autonomous person can formally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to autonomously decide about her treatment. While many jurisdictions and medical associations endorse them, advance treatment directives have also been criticized. According to an important criticism, when a person irreversibly loses her autonomy what she formerly autonomously desired ceases to be of importance in deciding about her treatment. (...)
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