Decision-making for the incompetent: Exemplars and questions from Siebert.

I begin my comments with a first-person narrative. I know Octavio, Erotildes, and Nuria from the time I worked at the Institute of Psychiatry and was very close to the field of mental health. They are people whose work I admire and appreciate. I comment on this text from the point of view of someone who has never worked directly in mental health assistance and whose knowledge about severe mental illness therapy has occurred mostly from a third-person perspective. My comments (...) are based on parallels with situations and experiences that I have been studying lately.First of all, I want to say that I fully agree with the authors’ argument that “experiences and narratives about illness, treatment, and recovery are... (shrink)

After retirement, older people often find themselves far from their children and grandchildren, and many spend their last years isolated and alone. As traditional concepts of family and social institutions fragment, social networks weaken, leading to an epidemic of loneliness, and substance abuse and suicide in developed countries. In fact, life expectancy in the US has dropped for the past few years, in large part due to a dramatic increase in suicide and drug overdose. None of these social problems is (...) likely to be solved by metformin. They point to a crisis of identity and meaning, an existential crisis. In this context, one might wonder if we are already seeing the effects of tinkering with our lifespan. There are many more conclusions one could draw about the implications of longevity, many of which have been elegantly described in Beyond Therapy: Biotechnology and the Pursuit of Happiness, published by the President’s Council on Bioethics, which I used as a reference for this talk. I hope I have been successful in providing a 10,000-foot view of the questions of efforts to extend human longevity and its implications that will provoke thought and discussion. I would like to end these reflections by turning back to my favorite transhumans. The reason we love superheroes is not for their superior strength or intelligence, but their characters. They use their powers to protect and serve humanity rather than dominate or annihilate it. It is not their gadgetry that makes them great, but how they use it to save the vulnerable. Even as a small child I knew that if everyone acted the way they did, the world would be a better place. The moral of every story was that the “enhancement” humanity needed would not come as the fruit of technology, but of virtue. (shrink)

This book is the result of a three-year study undertaken by a multidisciplinary working party of the Institute of Medical Ethic (UK). The group was chaired by a moral theologian, and its members included biological and ethological scientists, toxicologists, physicians, veterinary surgeons, an expert in alternatives to animal use, officers of animal welfare organizations, a Home Office Inspector, philosophers, and a lawyer. Coming from these different backgrounds, and holding a diversity of moral views, the members produced the agreed report as (...) a result of detailed and rigorous discussions. The book sets out facts about animal experiments and about animal abilities to experience pain, distress and anxiety. There is a detailed examination of the moral claims related to the benefits likely to accrue from animal research, and of strategies for weighing these benefits against the harm caused to animals, in order to decide whether particular research projects ought or ought not to proceed. This leads to consideration of the statutory and non-statutory controls which safeguard standards in such research. The final section explores a variety of philosophical arguments about the use of animals in research, and offers a philosophical justification for the Working Party's more practical conclusions. Written in clear, nontechnical language, this book is accessible to lay people as well as to scientists. It is the first such document to emerge from a meeting of people with such widely differing views on this highly controversial subject, and represents a major contribution towards informing and raising the quality of contemporary debate. The book is unique in drawing together material and ideas never before found in one volume. It will interest a broad spectrum of readers, from ethicists and animal rights advocates to scientific researchers and laboratory administrators, along with general readers concerned about this compelling issue. (shrink)

Eduard Pernkopf’s Atlas of Topographical and Applied Human Anatomy is a four-volume anatomical atlas published between 1937 and 1963, and it is generally believed to be the most comprehensive, detailed, and accurate anatomy textbook ever created. However, a 1997 investigation into “Pernkopf’s Atlas,” raised troubling questions regarding the author’s connection to the Nazi regime and the still unresolved issue of whether its illustrations relied on Jewish or other political prisoners, including those executed in Nazi concentration camps. Following this investigation, the (...) book was removed from both anatomy classrooms and library bookshelves. A debate has ensued over the book’s continued use, and justification for its use has focused on two issues: there is no definitive proof the book includes illustrations of concentration camp prisoners or Jewish individuals in particular, and there is no contemporary equivalent to this text. However, both points fail to address the central importance of the book, not simply as part of anatomy instruction, but also as a comprehensive historical narrative with important ethical implications. Having encountered a first edition copy, these authors were given a unique opportunity to engage with the text through the respective humanities lenses of history, ethics, and narrative. In doing so, an instructive and profound irony has surfaced: Nazis, including Pernkopf, viewed specific groups of people as less than human, giving rise to unthinkable atrocities perpetuated against them. However, these same individuals became the sources for the creation of the Atlas, which served as the model for primary instruction on the human form for more than half of the twentieth century. In this article, we recount the difficult and somewhat opaque provenance of this book, engage the ethical questions surrounding both its creation and its use, and ultimately propose a pedagogical methodology for its continued use in medical education. (shrink)

Jane Grant's book explores the need to redefine the social compact in twenty-first century America. It proposes a new compact that would honor the expansion of civil, political, and social rights in America, and would integrate these rights within a new civic procedural ethos, clarifying our obligations to each other, future generations, other nations, and other species.

The recently revised Common Rule requires that donors of biospecimens for research be informed if their specimens might be used for commercial profit. The Common Rule, however, does not apply to sharing or selling de-identified biospecimens that are “leftover” from clinical uses. As a result, many medical researchers remain uncertain of their legal and ethical obligations when a commercial entity expresses interest in these specimens.

Backround Education in ethics and professionalism should reflect the realities medical students encounter in the hospital and clinic. Method We performed content analyses on Case Observation and Assessments (COAs) written by third-year medical students about ethical and professional issues encountered during their internal medicine and paediatrics clinical clerkships. Results A cohort of 141 third-year medical students wrote 272 COAs. Content analyses identified 35 subcategories of ethical and professional issues within 7 major domains: decisions regarding treatment (31.4%), communication (21.4%), professional duties (...) (18.4%), justice (9.8%), student-specific issues (5.4%), quality of care (3.8%), and miscellaneous (9.8%). Conclusions Students encountered a wide variety of ethical and professional issues that can be used to guide pre-clinical and clinical education. Comparison of our findings with results from similar studies suggests that the wording of an assignment (specifying “ethical” issues, “professional” issues, or both) may influence the kinds of issues students identify in their experience-based clinical narratives. (shrink)

_Strange Wonder_ confronts Western philosophy's ambivalent relationship to the Platonic "wonder" that reveals the strangeness of the everyday. On the one hand, this wonder is said to be the origin of all philosophy. On the other hand, it is associated with a kind of ignorance that ought to be extinguished as swiftly as possible. By endeavoring to resolve wonder's indeterminacy into certainty and calculability, philosophy paradoxically secures itself at the expense of its own condition of possibility. _Strange Wonder_ locates a (...) reopening of wonder's primordial uncertainty in the work of Martin Heidegger, for whom wonder is first experienced as the shock at the groundlessness of things and then as an astonishment that things nevertheless _are_. Mary-Jane Rubenstein traces this double movement through the thought of Emmanuel Levinas, Jean-Luc Nancy, and Jacques Derrida, ultimately thematizing wonder as the awesome, awful opening that exposes thinking to devastation as well as transformation. Rubenstein's study shows that wonder reveals the extraordinary in and through the ordinary, and is therefore crucial to the task of reimagining political, religious, and ethical terrain. (shrink)

_Strange Wonder_ confronts Western philosophy's ambivalent relationship to the Platonic "wonder" that reveals the strangeness of the everyday. On the one hand, this wonder is said to be the origin of all philosophy. On the other hand, it is associated with a kind of ignorance that ought to be extinguished as swiftly as possible. By endeavoring to resolve wonder's indeterminacy into certainty and calculability, philosophy paradoxically secures itself at the expense of its own condition of possibility. _Strange Wonder_ locates a (...) reopening of wonder's primordial uncertainty in the work of Martin Heidegger, for whom wonder is first experienced as the shock at the groundlessness of things and then as an astonishment that things nevertheless _are_. Mary-Jane Rubenstein traces this double movement through the thought of Emmanuel Levinas, Jean-Luc Nancy, and Jacques Derrida, ultimately thematizing wonder as the awesome, awful opening that exposes thinking to devastation as well as transformation. Rubenstein's study shows that wonder reveals the extraordinary in and through the ordinary, and is therefore crucial to the task of reimagining political, religious, and ethical terrain. (shrink)

This volume offers an original and innovative collection of fresh approaches to the investigation of the idea of taste. It is divided into three sections: the concept of taste; taste and culture; and gustatory taste. The papers in all three parts deal with the way that aesthetics interpenetrates discussions of food, political conflict, art appreciation, aesthetic judgement, and education. These are fresh, never-before published contributions from a range of scholars, using the most recent literature in their areas of expertise. There (...) is no other book available that collects the latest research in this field, and, as such, it represents a key contribution to recent aesthetic, and more broadly philosophical, interest in matters of taste. (shrink)

The first 1000 days of life, from conception to 2 years, are a critical window for the influence of environmental exposures on the assembly of the oral microbiome, which is the precursor to dental caries (decay), one of the most prevalent microbially induced disorders worldwide. While it is known that the human microbiome is susceptible to environmental exposures, there is limited understanding of the impact of prenatal and early childhood exposures on the oral microbiome trajectory and oral health. A barrier (...) has been the lack of technology to directly measure the foetal "exposome", which includes nutritional and toxic exposures crossing the placenta. Another barrier has been the lack of statistical methods to account for the high dimensional data generated by‐omic assays. Through identifying which early life exposures influence the oral microbiome and modify oral health, these findings can be translated into interventions to reduce dental decay prevalence. (shrink)

Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end of life discussions. Patients have (...) the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options. (shrink)

The subject of this book is young children's emotional-social learning and development within early childhood care and education settings in Aotearoa-New Zealand. The focus on emotional complexity fills a gap in early childhood care and education research where young children are frequently framed narrowly as 'learners,' ignoring the importance of emotional functioning and the feelings with which children make sense of themselves and the world. This book draws on original data in the form of narrative-like framed events to creatively illustrate (...) the complexities in children's diverse ways of feeling, thinking, playing, being, and becoming. Events illuminate the feelings and meanings of observed experiences in holistic and contextualised gestalts. Awareness of unconscious processes, the feeling of feelings, and cultural dimensions of development and meaning-making are addressed. The book emphasises the emergent and psychodynamic nature of children's development and learning with strong links to the role of play and playfulness in the events, drawing on two ethnographically inspired research projects that present theory, experience and practice in real-life events. (shrink)

BackgroundSuicide research aims to contribute to a better understanding of suicidal behaviour and its prevention. However, there are many ethical challenges in this research field, for example, regarding consent and potential risks to participants. While studies to-date have focused on the perspective of the researchers, this study aimed to investigate the views and experiences of members of Human Research Ethics Committees (HRECs) in dealing with suicide-related study applications.MethodsThis qualitative study entailed a thematic analysis using an inductive approach. We conducted semi-structured (...) interviews with a purposive sample (N = 15) of HREC Chairs or their delegates from Australian research-intensive universities. The interview guide included questions regarding the ethical concerns and challenges in suicide-related research raised by HREC members, how they dealt with those challenges and what advice they could give to researchers.ResultsThe analysis identified four main themes: (1) HREC members’ experiences of reviewing suicide-related study applications, (2) HREC members’ perceptions of suicide, suicide research, and study participants, (3) Complexity in HREC members’ decision-making processes, and (4) HREC members’ relationships with researchers.ConclusionsReliance on ethical guidelines and dialogue with researchers are crucial in the assessment of suicide-related study applications. Both researchers and HREC members may benefit from guidance and resources on how to conduct ethically sound suicide-related studies. Developing working relationships will be likely to help HRECs to facilitate high quality, ethical suicide-related research and researchers to conduct such research. (shrink)

While dominant management thinking is steered by profit maximisation, this paper proposes that sustained organisational growth can best be stimulated by attention to the common good and the capacity of corporate leaders to create commitment to the common good. The leadership thinking of Kautilya and Ashoka embodies this principle. Both offer a common good approach, emphasising the leader's moral and legal responsibility for people's welfare, the robust interaction between the business community and the state, and the importance of moral training (...) of leaders in identifying and promoting the common good. We argue that the complex process of re‐orientating corporate priorities towards the common good requires alertness and concerted effort if both business and society are to truly benefit. As Ashoka said: ‘A good deed is a difficult thing’. (shrink)

While much of the empirical accounting literature suggests that, if differences do exist, Big Four employees are more ethical than non-Big Four employees, this trend has not been evident in the recent media coverage of Big Four tax practitioners acting for multinationals accused of aggressive tax avoidance behaviour. However, there has been little exploration in the literature to date specifically of the relationship between firm size and ethics in tax practice. We aim here to address this gap, initially exploring tax (...) practitioners’ perceptions of the impact of firm size on ethics in tax practice using interview data in order to identify the salient issues involved. We then proceed to assess quantitatively whether employer firm size has an impact on the ethical reasoning of tax practitioners, using a tax context-specific adaptation of a well-known and validated psychometric instrument, the Defining Issues Test. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part ILaura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part One of a two part Scope Note on Religious Perspectives on Bioethics. Part Two will be published in the December 1994 issue of this Journal. This Scope Note has been organized in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1Part 2I.GeneralI.Native AmericanII.African Religious TraditionsReligious TraditionsIII.Bahá'í (...) FaithII.Protestantism—willIV.Buddhism and Confucianisminclude a general sectionV.Eastern Orthodoxyand sections focused onVI.Hinduismspecific denominations.VII.IslamIII.Roman CatholicismVIII.JainismIX.JudaismIntroductionThe many religions of the world bring diverse, and occasionally divergent, attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and [End Page 155] health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing in bioethics; for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith, but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.Specific citations about a region or country were chosen because of the predominance of a religious tradition within the population. In all cases, variation in spelling represents author usage. This Scope Note treats only the literature published in English, and every attempt has been made to identify English language sources for these faiths.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Dictionaries and EncyclopediasMelton, J. Gordon, ed. Encyclopedia of American Religions. Fourth edition. Detroit: Gale Research, 1993. 1217 p. Basic information about the history, sacred texts, membership, educational facilities, publications, and North American addresses are provided for 1,730 churches, denominations, sects, and cults. Bibliographies for many faiths supplement this extensive resource.Reich, Warren T., ed. Encyclopedia of Bioethics. New York: Free Press, Macmillan, 1978. 4 volumes. Articles on all the major religions as they relate to bioethics are included in this highly-regarded encyclopedia. In addition, many of the topical essays feature a section on the views of various faiths on the topic under discussion. For the best use of the Encyclopedia, see the subject index in volume 4. (Note: a revised, second edition is due to be published by Macmillan in late 1994.)GeneralAmerican Psychiatric Association. Committee on Religion and Psychiatry. Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitment and Psychiatric Practice. American Journal of Psychiatry 147 (4): 542, April 1990. The American Psychiatric Association recommends that psychiatrists respect their patients' religious beliefs and that they not impose their own [End Page 156] beliefs on their patients.Bankowski, Z., and Bryant, J. H. Health Policy, Ethics and Human Values: Proceedings of the XVIIth CIOMS Round Table Conference, Athens Greece. Geneva: Council for International Organizations of Medical Sciences, 1985. 336 p. Many sections of this volume address issues where religion impacts health policymaking. Africa, the Middle East, Europe, Latin America, and Asia are highlighted for the varied ways in which their religions and cultures are integrated into the provision of health care.Batchelor, Edward, ed. Abortion: The Moral Issues. New York: Pilgrim Press, 1982. 246 p. Batchelor compiles a collection of essays by experts on religious ethics as they relate to abortion. Includes... (shrink)

Telepolitics, the politics of the electronic media, is a new reality, an order of existence that has radically transformed man's relationship with his fellow man.

Studies with captive fowl have revealed that they possess greater cognitive capacities than previously thought. We now know that fowl have sophisticated cognitive and communicative skills, which had hitherto been associated only with certain primates. Several theories have been advanced to explain the evolution of such complex behavior. Central to these theories is the enlargement of the brain in species with greater mental capacities. Fowl present us with a conundrum, however, because they show the behaviors anticipated by the theories but (...) do not have the expected changes in the brain. Consequently fowl present two challenges of interest to us here. One is a scientific challenge to explain their remarkable capabilities. The other is an ethical challenge regarding our treatment of animals with higher cognitive skills. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Environmental Goodness and the Challenge of American CultureSandra Jane Fairbanks (bio)Until recently, Western virtue ethics has never recognized nature-focused virtues. This is not surprising, since western philosophies and religions have promoted the ideas that humans are superior to nature and that there are no moral principles regulating our relationship to nature. Environmentalists call for a radical change in our attitude towards nature if we are to meet the (...) challenge posed by today’s environmental problems. Thus, recognition of new virtues governing human attitudes and behavior towards nature is highly desirable, both by way of addressing an egregious lacuna in western thought, and as a necessary condition for anything like a viable planet. Unfortunately, a capitalist, consumer culture such as that of the United States presents a variety of serious obstacles to the successful inculcation of any new environmental virtues. Hence, inculcation of environmental virtues should not be the sole focus of environmental education. Such education should also appeal to human self-interest, at least until such time as the very idea of environmental virtue will not seem contrarian relative to prevailing views of the good life.IntroductionWhile there is room for disagreement over details and cases, it is safe to say that traditional Western philosophies and religions have generally [End Page 79] promoted domination and exploitation of the environment. Traditional, predominantly anthropocentric views such as Christianity or Greek philosophy, conjoined with a consumerist model of the good life, have conditioned the attitudes, values, and beliefs of human beings, with disastrous consequences for the environment. As a result, we face a variety of environmental problems—global warming, destruction and depletion of natural resources and wilderness areas, explosive population growth, toxic waste, and so on—that are serious right now, and that may well be catastrophic for future generations. Environmental philosophers, including biocentrists, ecocentrists, and ecofeminists, call for a shift away from anthropocentric theories to theories that emphasize the intrinsic value of nonhuman life, or that of nature in general.All of these environmental philosophies call for a radical change in our attitude towards nature if we are to meet the challenge posed by today’s environmental problems. Since this change in attitude is intended to ground novel and more adequate ways of behaving toward the environment, environmentally-sensitive writers are in the business, implicitly or explicitly, of promoting a new environmental virtue, or a new set of environmental virtues.1 Until recently, Western virtue ethics has never recognized a nature-focused virtue. This is not surprising, since western philosophies and religions have generally promoted the ideas that humans are superior to nature and that there are no moral principles regulating our relationship to nature, except (as, famously, in Kant2) for indirect duties toward humans. The idea that nature, including nonhuman life, natural objects, and ecological wholes has intrinsic value and, hence, moral standing, is a very recent development in Western philosophy.Thus recognition of new virtues governing human attitudes and behavior towards nature is highly desirable, both by way of addressing an egregious lacuna in Western thought, and as (almost certainly) a necessary condition for anything like a viable planet. Unfortunately, as I will argue, a capitalist, consumer culture such as that of the United States—on which I will focus due to its paradigm status—presents a variety of obstacles to the successful inculcation of any new environmental virtues. Thus, inculcation of environmental virtues should not be the sole, and perhaps not even the primary, focus of environmental education, at least in the short term. As I will argue, such education should also appeal, importantly, to human self-interest, at least until such time as the very idea of environmental [End Page 80] virtue will not seem contrarian relative to prevailing views of the good life.The structure of the discussion is as follows: First, I develop a brief sketch of an environmentally good person. I do so by compiling a set of environmental virtues recommended by various prominent biocentrists, ecocentrists and ecofeminists. Second, I address problems posed by American culture for the development of these environmental virtues. Finally, I conclude with practical suggestions for influencing American culture in the direction of environmental awareness and... (shrink)