Advance directives are critically important for capable individuals who wish to avoid the burdens of life-prolonging interventions in the advanced stages of dementia. However, this paper will argue that advance directives should have less application to questions about feeding patients during the clinical course of dementia than often has been presumed. The argument will be framed within the debate between Ronald Dworkin and Rebecca Dresser regarding the moral authority of precedent autonomy to determine an individual’s future end-of-life care plan. We (...) will use a brief analysis of the positions taken in two important papers that come out of the Dworkin/Dresser debate and a hypothetical patient, John, who will be followed from diagnosis of dementia to death, to show how advance directives should apply to key points in the progression of his disease, particularly in relation to food and nutrition. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (shrink)

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa. A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity (...) in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile. (shrink)

When patients are admitted to the hospital, they are generally expected to remain in or within close proximity to their assigned rooms in order to promote their safety and appropriate medical care. Although there are circumstances when patients may safely leave their hospital room or floor, guidance within the medical literature for the management of patient movement within the hospital are lacking. Excessive restrictions on patient movement may be seen as overly paternalistic, while lax requirements may interfere with high quality (...) care, patient safety and efficient hospital practice. As a result, guidance in the form of institutional policy is warranted. Such policy development should take into consideration the potential clinical, legal, and ethical concerns in balancing the competing values of patients’ preferences and respect for autonomy, while ensuring high quality, safe, and efficacious medical care. This paper will provide a framework for hospitals to create institution-specific patient movement policies that are fair, systematic, and transparent. (shrink)

This article aims to read feminist new materialisms (Barad), together with ‘postulated’ linguistic or cultural primacy of Queer Theory (Butler), to show how both are engaged in similar critical-ethical endeavours. The central argument is that the criticism of Barad and new materialisms misses Butler’s materialistic insights due to a narrow interpretation of Butler's alleged social-constructivist position. There is, therefore, a specific focus on where they both make similar ethical appeals. Moreover, the article relies on Adorno's negative dialectic to highlight an (...) interpretation of Barad and Butler as being part of the same dialectical movement, in which materialism and idealism fluctuate in their mutual criticisms, thus continuing the procession towards 'new knowledge' and emancipation, or freedom, through their motions back and forth. (shrink)

McCarthy, Homan, and Rozier’s presentation of theological anthropology and its contribution to secular bioethics suffers from three primary limitations. First, the article re...

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

The case recapitulates many of the core issues in geriatric ethics that the aging American population will increasingly present to ethics consultation services. The classic ethical dilemma: autonom...

Bianchi and colleagues have written an important article that proposes a harm reduction approach to eating disorders that mediates the ethical tension in the l...

Traditional approaches to human subjects protections in the United States focus on the ethical principles from the Belmont Report: respect for persons, beneficence, and justice. Since research regu...

The definitive book on ethics for chemical dependency treatment professionals.

It is our privilege to be invited to write a commentary on the "Interface of Ethics and Psychiatry: A Philosophical Case Consultation on Psychiatric Ethics on the Ground." The article presents an innovative collaboration between a philosopher and a psychiatrist reasoning together through the ethical aspects of three clinical cases. The case consultation also offers a unique opportunity to reflect on the teaching of psychiatric ethics in clinical settings. This commentary explores those areas of the article from the perspective of (...) a teacher and trainee whose mentoring relationship is grounded in their shared interest in philosophy and psychiatric ethics.A quick search on PubMed and Google Scholar confirms my own... (shrink)

The development of transplantation technology increasingly places before society a multitude of diverse, complex ethical and legal problems. The subject is the more complex because of the various divergent interests involved. There are the interests of the donor of organs, who has a right to protection of his legal position, and those of the patient in need of an often lifesaving organ. There are also the interests of the donor’s relatives, after his death, and those of the transplantation surgeons. The (...) international dimension of transplantation technology makes the picture even more complicated. Though this article is devoted to the European situation, the problems are similar all over the world. (shrink)

The development of transplantation technology increasingly places before society a multitude of diverse, complex ethical and legal problems. The subject is the more complex because of the various divergent interests involved. There are the interests of the donor of organs, who has a right to protection of his legal position, and those of the patient in need of an often lifesaving organ. There are also the interests of the donor’s relatives, after his death, and those of the transplantation surgeons. The (...) international dimension of transplantation technology makes the picture even more complicated. Though this article is devoted to the European situation, the problems are similar all over the world. (shrink)

Catastrophic risk raises questions that are not only of practical importance, but also of great philosophical interest, such as how to define catastrophe and what distinguishes catastrophic outcomes from non-catastrophic ones. Catastrophic risk also raises questions about how to rationally respond to such risks. How to rationally respond arguably partly depends on the severity of the uncertainty, for instance, whether quantitative probabilistic information is available, or whether only comparative likelihood information is available, or neither type of information. Finally, catastrophic risk (...) raises important ethical questions about what to do when catastrophe avoidance conflicts with equity promotion. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

First Published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

Suppose that a decision-maker's aim, under certainty, is to maximise some continuous value, such as lifetime income or continuous social welfare. Can such a decision-maker rationally satisfy what has been called "continuity for easy cases" while at the same time satisfying what seems to be a widespread intuition against the full-blown continuity axiom of expected utility theory? In this note I argue that the answer is "no": given transitivity and a weak trade-off principle, continuity for easy cases violates the anti-continuity (...) intuition. I end the note by exploring an even weaker continuity condition that is consistent with the aforementioned intuition. (shrink)

Many philosophers think that we should use a lottery to decide who gets a good to which two persons have an equal claim but which only one person can get. Some philosophers think that we should save identified persons from harm even at the expense of saving a somewhat greater number of statistical persons from the same harm. I defend a principled way of justifying both judgements, namely, by appealing to the decreasing marginal moral value of survival chances. I identify (...) four desiderata that, I contend, any such justification should satisfy, and explain how my account meets these desiderata, unlike some previous accounts. (shrink)

In this paper we briefly examine and evaluate Quine’s physicalism. On the supposition, in accordance with Quine’s views, that there can be no change of any sort without a physical change, we argue that this point leaves plenty of room to understand and accept a limited autonomy of the special sciences and of other domains of disciplinary and common-sense inquiry and discourse. The argument depends on distinguishing specific, detailed programs of reduction from the general Quinean strategy of reduction by explication. (...) We argue that the details of the relations of particular sciences, disciplines and domains of discourse depend on empirical evidence and empirical-theoretical developments and that the generalized approach of reduction by explication is also subject to related empirical-theoretical constraints. So understood, physicalism lacks much of the controversial force and many of the implications sometimes associated with it. (shrink)

Is the procreation asymmetry intuitively supported? According to a recent article in this journal, an experimental study suggests the opposite. Dean Spears (2020) claims that nearly three-quarters of participants report that there is a reason to create a person just because that person’s life would be happy. In reply, I argue that various confounding factors render the study internally invalid. More generally, I show how one might come to adopt the procreation asymmetry for the wrong reasons by misinterpreting one’s intuitions.