Contemporary healthcare environments are becoming increasingly informationally demanding. This requires patients, and those supporting them, to engage with a broad range of expert knowledge. At the same time, patients must find ways to make sense of this information in the context of their own values and needs. In this article, we confront the problem of communication in our current age of complexity. We do this by focusing on a field that has already had to grapple with these issues directly: genetic (...) counseling. We articulate an empathy-based framework that provides a way to integrate the teaching and counseling models of genetic counseling. As well as being useful for those providing genetic counseling in the era of genomic medicine, this framework has the potential to address challenges of communication in healthcare settings beyond genetic counseling. Furthermore, it has important ramifications for ethical debates about autonomy and decision-making. (shrink)

The underreporting of suspected adverse drug reactions hinders pharmacovigilance. Solutions to underreporting are oftentimes directed at clinicians and health care professionals. However, given the recent rise of public inclusion in medical science, solutions may soon begin more actively involving patients. I aim to offer an evaluative framework for future possible proposals that would engage patients with the aim of mitigating underreporting. The framework may also have value in evaluating current reporting practices. The offered framework is composed of three criteria that (...) are bioethical, social-epistemic, and pragmatic: (i) patients should not be exposed to undue harms, e.g., nocebo effects; (ii) data should be collected, analyzed, and communicated prioritizing pharmacovigilance’s aims, i.e., free from industry bias; and (iii) proposals should account for existing and foreseeable pragmatic constraints like clinician ‘buy in’ and existing reporting infrastructure. Proposals to engage patients in pharmacovigilance that fulfil or address these criteria are preferable to those that do not. (shrink)

The underreporting of suspected adverse drug reactions hinders pharmacovigilance. Solutions to underreporting are oftentimes directed at clinicians and healthcare professionals. However, given the recent rise of public inclusion in medical science, solutions may soon begin more actively involving patients. I aim to offer an evaluative framework for future possible proposals that would engage patients with the aim of mitigating underreporting. The framework may also have value in evaluating current reporting practices. The offered framework is composed of three criteria that are (...) bioethical, social-epistemic, and pragmatic: (i) patients should not be exposed to undue harms, for example, nocebo effects; (ii) data should be collected, analyzed, and communicated while prioritizing pharmacovigilance’s aims, that is, free from industry bias; and (iii) proposals should account for existing and foreseeable pragmatic constraints like clinician “buy in” and existing reporting infrastructure. Proposals to engage patients in pharmacovigilance that fulfil or address these criteria are preferable to those that do not. (shrink)

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM’s goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion, while others think that HPM’s practices should aim, like all other branches of medicine, at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that (...) if HPM’s practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM’s practices were to aim at health. According to the ars moriendi, flourishing at the end of one’s life requires that persons exercise their agency and pursue the goods most important to them. On this view, HPM’s practices should promote patients’ health to enable them to pursue these goods. (shrink)

Philosophers throughout history have long been drawn to big, important ideas that bubble up to the surface in interesting ways in myriads of disparate contexts. Following this tradition, authors in this issue engage with big ideas that percolate into clinical ethics, such as hope in healthcare, empathy in genetic counseling, the ramifications of Western cultural assumptions in clinical ethics, the proper aims of palliative hospice and palliative medicine, and the proper role of the public in pharmacovigilance.