Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly (...) plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society. (shrink)

Anne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision‐making. The bottom line is that, even if an undisclosed placebo might be marginally more effective for a particular patient in the short term, over the long haul the integrity of the patient‐physician relationship relies (...) on doctors being honest with their patients. Even when it comes to placebos, honesty remains the best policy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Conflicts—and Consensus—about Conflicts of Interest in MedicineMatthew K. Wynia and Bette–Jane Crigger*This fascinating collection of essays about individual experiences of conflict of interest leaves little doubt that physicians remain divided about the importance, impact and meaning of conflicts of interest in their work. These essays offer differing views about what conflicts of interest look and feel like “on the ground” and about whether specific conflicts of (...) interest are bad, just a fact of life, or maybe even good.Conflict, Conflict EverywhereThese essays situate conflict of interest in a variety of contexts: the treatment recommendations a physician makes for an individual patient; the relationship between teaching physician and medical student or practicing physician and health care organization; the interaction between academic researchers and industry collaborators or professional bodies and industry supporters. In this, the narratives taken together reflect the scope of concern about conflict of interest in medicine familiar in the literature. In his classic 1993 essay, Dennis Thompson noted that concerns about conflict of interest encompass issues of physician self–referral, risk sharing between physicians and health care institutions, gifts from industry, hospital purchasing practices, as well as sponsored research and research with patients (Thompson 1993). To that list have subsequently been added relationships with industry in medical education at all levels, physicians’ service as consultants to industry or members of industry speakers bureau, and development of clinical practice guidelines (Lo & Fields 2009).That almost none of these essays draw attention to some widely publicized situations of conflict of interest—for example, gifts to physicians or the provision of drug samples—should, we think, be seen more as an artifact of the authors’ varied individual experiences than as a failure by the authors to engage key concerns in the ongoing professional and public debate. It could also be that the authors, asked to submit personal stories, assumed that yet another essay about the ‘traditional’ issues in the conflicts of interest literature would be seen as redundant, routine or even boring. Or, there is the tantalizing possibility that the absence of some of the more familiar conflicts from these narratives is the early fruit of efforts to address these traditional issues through policies governing interactions between physicians and industry promulgated by academic medical centers and health systems, medical specialty societies, and industry.One significant area of concern that has emerged in recent years is conflict of interest in the development of clinical practice guidelines. E.g., Choudry et al. 2002; Sniderrman & Furberg 2009; Guyatt et al. 2010. Although none of the essays in this [End Page 101] collection address it head on, Perlmutter touches on several key issues. His depiction of how an FDA committee process limited the input he was able to provide as an expert, undermined his potential to contribute to the professional dialogue, and raised concerns about the objectivity of the drug approval process echoes concerns about objectivity, the role of expert opinion, and the presence on guideline development panels of individuals with financial interests in the recommendations to be developed that have been explored at some length in the literature, most recently by the Institute of Medicine in reports on evidentiary standards (Eden et al 2011) and principles for guideline development (Graham et al. 2011).Conflict of Interest or Dual Agency?Several essays set out physicians’ experience in navigating situations of diverging expectations. Bierut, for example, reflects on the disjunction between the goals and products of academic researchers and commercial sponsors. She saw herself advancing basic knowledge and was forced to grapple with the reality of sponsors’ goals to advance commercial ends as well. Nagldinne and Mikulec each recall struggles to reconcile their obligation to exercise professional judgment on behalf of patients with the demands of health care organizations focussed also on the bottom line. Cruz–Flores attests to the challenge of making recommendations for care when one is both a practicing clinician and a clinical investigator engaged in research that might offer benefit to a patient for whom there are limited options.Thompson defined conflicts of interest as “a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of... (shrink)

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians’ nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content (...) online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA’s Code of Medical Ethics). (shrink)

Beginning Bioethics introduces students to the language of philosophical ethics before leading them in Part Two through six major issues in bioethics. The author gives clear explanations of all sides of a given issue and engages with several major contributions to the debate. This book can stand alone, but was written also to accompany the third edition of Bette-Jane Crigger's Cases in Bioethics, providing the philosophical counterpart to cases discussed there by US medical practitioners. Both books originate (...) with St Martin's Press in the United States. (shrink)

Abstract In this paper I undertake an in-depth examination of an oft mentioned but rarely expounded upon state: suspended judgment. While traditional epistemology is sometimes characterized as presenting a “yes or no” picture of its central attitudes, in fact many of these epistemologists want to say that there is a third option: subjects can also suspend judgment. Discussions of suspension are mostly brief and have been less than clear on a number of issues, in particular whether this third option should (...) be thought of as an attitude or not. In this paper I argue that suspended judgment is (or at least involves) a genuine attitude. Content Type Journal Article Pages 1-17 DOI 10.1007/s11098-011-9753-y Authors Jane Friedman, St Catherine’s College, University of Oxford, Oxford, OX1 3UJ UK Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116. (shrink)

There has been much discussion about whether traditional epistemology's doxastic attitudes are reducible to degrees of belief. In this paper I argue that what I call the Straightforward Reduction - the reduction of all three of believing p, disbelieving p, and suspending judgment about p, not-p to precise degrees of belief for p and not-p that ought to obey the standard axioms of the probability calculus - cannot succeed. By focusing on suspension of judgment (agnosticism) rather than belief, we can (...) see why the Straightforward Reduction is bound to fail. I argue that, in general, suspending about p is not just a matter of having some specified standard credence for p, and in the end I suggest some ways to extend the arguments that will put pressure on other credence-theoretic accounts of belief and suspension of judgment as well. (shrink)

Background/purpose:Research from other disciplines demonstrates that ethical position, idealism, or relativism predicts ethical decision-making. Individuals from diverse cultures ascribe to various religious beliefs and studies have found that religiosity and culture affect ethical decision-making. Moreover, little literature exists regarding undergraduate nursing students’ ethical position; no studies have been conducted in the United States on students’ ethical position, their self-identified culture, and intrinsic religiosity despite an increase in the diversity of nursing students across the United States.Participants and Research Context Objectives:The study’s (...) two aims were to determine the relationship of self-identified culture, religiosity, and ethics position of undergraduate nursing student and whether students’ level of education and past ethics courses taken related to idealism. Two hundred and twelve volunteer undergraduate students participated.Research design:A descriptive cross-sectional study was designed for participants who completed the Ethical Position Questionnaire, The intrinsic subscale of the Religious Orientation Scale, and a Demographic, Cultural, Ethnicity Form. To test the five hypotheses, analyses included t-tests, correlations, and ANOVA.Ethical Considerations:The study was approved by the Institutional Review Board at Adelphi University.Results:Idealism and intrinsic religiosity were significantly related. Differences were observed for intrinsic religiosity and idealism for cultural identity and cultural dimensions such as parents’ place of birth, and if participants were US born. Students’ level of education or participation in past courses on ethics did not influence idealism.Conclusions:The study’s findings were similar to most of the research from other disciplines on culture, ethics position, and religiosity. Generic courses on ethics taken prior to clinical work may not assist nursing students in integrating principles into complex ethical dilemmas. Self-identified culture, religion, and intrinsic religiosity related to ethics position; completing ethics courses and level of education, juniors compared with seniors, did not influence idealism. Faculty should consider integrating students’ culture, religious orientation, and ethics position into teaching ethics for all levels of nursing education. (shrink)

Recent philosophy of mind has had a mistaken conception of the nature of psychological concepts. It has assumed too much similarity between psychological judgments and those of natural science and has thus overlooked the fact that other people are not just objects whose thoughts we may try to predict and control but fellow creatures with whom we talk and co-operate. In this collection of essays, Jane Heal argues that central to our ability to arrive at views about others' thoughts (...) is not knowledge of some theory of the mind but rather an ability to imagine alternative worlds and how things appear from another person's point of view. She then applies this view to questions of how we represent others' thoughts, the shape of psychological concepts, the nature of rationality and the possibility of first person authority. This book should appeal to students and professionals in philosophy of mind and language. (shrink)

The influence of the French psychoanalyst Jacques Lacan has extended into nearly every field of the humanities and social sciences—from literature and film studies to anthropology and social work. yet Lacan's major text, Ecrits, continues to perplex and even baffle its readers. In Reading Lacan, Jane Gallop offers a novel approach to Lacan's work based on his own theories of language. Lacan locates truth in the letter rather than in the spirit-in the ways statements are expressed rather than in (...) their intended meaning. Gallop here grapples with six of Lacan's essays from Ecrits: "The Seminar on 'The Purloined Letter,' " "The Mirror Stage," "The Freudian Thing,'' "The Agency of the Letter in the Unconscious,'' "The Signification of the Phallus," and "The Subversion of the Subject." While other commentators have chosen not to confront Lacan's notoriously problematic style in their discussions of his ideas, Gallop addresses herself directly to the problem and the practice of reading Lacan. She takes her direction from Lacan's view of subjectivity and offers a deeply personal, feminist reading of Ecrits. Concentrating on the relation of desire and interpretation, she opens up the rich implications of Lacan's thought, for psychoanalytic theory, for the act of reading, and for knowledge itself. Forceful and revealing, yet utterly candid about its own areas of uncertainty, Gallop's book will be indispensable to readers of Lacan and to scholars and students who have felt his impact. (shrink)

Contemporary theories of Virtue Ethics are often presented as being in opposition to Kantian Ethics and Consequentialism. It is argued that Virtue Ethics takes as fundamental the question, “What sort of character would a virtuous person have?” and that Kantian Ethics and Consequentialism take as fundamental the question, “What makes an action right?” I argue that this opposition is misconceived. The opposition is rather between Virtue Ethics and Kantian Ethics on the one hand and Consequentialism on the other. The former (...) two are concerned with, respectively, the development of a virtuous character and a good will, whereas Consequentialism is essentially a doctrine that just provides a justification of the right option without specifying how this is to be achieved. Furthermore, I show that Consequentialism, interpreted as a justificatory doctrine, is both an impoverished doctrine and one that cannot be enriched by taking a “pick and mix” approach to other ethical theories in the way that Consequentialists advocate. I argue that there is at least one reason to prefer Kantian Ethics: Kantian Ethics necessarily avoids the objection of selfcenteredness, whereas the avoidance of this objection is only contingent in the case of Virtue Ethics. (shrink)

We have investigated the emotional profile of dreams and the relationship between dream emotion and cognition using a form that specifically asked subjects to identify emotions within their dreams. Two hundred dream reports were collected from 20 subjects, each of whom produced 10 reports. Compared to previous studies, our method yielded a 10-fold increase in the amount of emotion reported. Anxiety/fear was reported most frequently, followed, in order, by joy/elation, anger, sadness, shame/guilt, and, least frequently, affection/eroticism. Unexpectedly, there was no (...) significant difference in the profiles of emotion reported by men and women. When the reports were scored for bizarreness, a significant correlation was found between the occurrence of bizarreness and major shifts in emotion. These results support the conclusion that dreaming is a mental state whose general emotional features are widely shared across individuals and strongly linked to cognitive features within individual dreams. (shrink)