Beyond Consent examines the concept of justice, and its application to human subject research, through the different lenses of various research populations: children, the vulnerable sick, captive and convenient populations, women, people of colour, and subjects in international settings. Separate chapters address the evolution of research policies, implications of the concept of justice for the future of human subject research, and the ramifications of this concept throughout the research enterprise.

Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment.Returning the locus of capacity assessment to the attending, the primary care doctor, and (...) even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation. (shrink)

The Heythrop Journal, Volume 63, Issue 3, Page 333-348, May 2022.

The first ethics casebook that integrates clinical ethics (medical, nursing, and dental) and research ethics with public health and informatics. The book opens with five chapters on ethics, the development of interprofessional ethics, and brief instructional materials for students on how to analyze ethical cases and for teachers on how to teach ethics. In today's rapidly evolving healthcare system, the cases in this book are far more realistic than previous efforts that isolate the decision-making process by professions as if each (...) is not embedded in a larger context that involves healthcare teams, hospital policies, and technology. The central claim of this book is that ethics is an important common ground for all of the health professions. Furthermore, when we recognize that our professions converge upon a common goal we will find less conflict and more pleasure in working together. (shrink)

The author of “How Bioethics and Case Law Diverge in Assessments of Mental Capacity: An Argument for a Narrative Coherence Standard” (2020) arrives at a reasonable conclusion; however, it is far le...

Technology tends toward perpetual innovation. Technology, enabled by both political and economic structures, propels society forward in a kind of technological evolution. The moment a novel piece of technology is in place, immediately innovations are attempted in a process of unending betterment. Bernard Stiegler suggests that, contra Heidegger, it is not being-toward-death that shapes human perception of time, life, death, and meaning. Rather, it is technological innovation that shapes human perception of time, life, death, and meaning. In fact, for Stiegler, (...) human evolution has always been part of technological evolution. While one can quibble with the notion of human-technology co-evolution, there is something to be said for the way in which human perception of time, of ageing, and of death seems to be judged against the horizon of perpetual evolution of technological innovation. In this technological imaginary, of which modern medicine is constituent, ageing and death seemingly may be infinitely deferred, and it is this innovating deferral that shapes the contemporary social imaginary around ageing and death in modern medicine. Yet, the reality of living and dying always manifests itself differently than the scripts given to us by the technological imaginary with its myth of endless innovation. In fact, I shall argue that, where the Church created an ars moriendi, the technological imaginary gives us an ars ad mortem when it becomes clear that ageing and death cannot be infinitely deferred. And further, I shall argue that the Church must revivify its ars vivendi—that is to say, its liturgies, its arts, its technics—as a counter narrative to the myth of perpetual innovation that shapes the technological imaginary. (shrink)

After years of skepticism and denials regarding the significance of concussions in sport, the issue is now front and center. This is fitting, given that the impact of concussions in sport is profound. Thus, it is with trepidation that one ventures to direct some attention onto brain injuries other than concussions incurred through sport. Given a closer look, however, it may be that considering various kinds of brain injuries, with different causes, will help us better understand the range and seriousness (...) of brain injuries in sport. My focus is on emotional trauma in sport. I argue that severe emotional pathology is evidence of underlying brain injury. Any attempt to minimize the significance of emotional disturbance that results from emotional trauma as ‘merely’ psychological in nature is thus misguided. (shrink)

This paper explores three phenomena in sport that are connected to narratives of hope: underdogs, upsets, and overachievers. Each of these phenomena is complex. I seek not only to understand the intrinsic nature of these phenomena, but also to explain why they captivate the imagination. After exploring some partial explanations of their enduring appeal, I focus on how the drama associated with underdogs, upsets, and overachievers in sport illuminates the human condition and awakens our sense of possibility when the odds (...) are against us. (shrink)

Despite a century of progress in medical knowledge, many diagnostic odysseys end in disappointment, especially when the child has a developmental disorder. In cases of autism and intellectual disability, relatively few children receive a specific diagnosis, and virtually none of those diagnoses lead to a specific medical treatment. Whole‐genome or ‐exome sequencing offers a quantum leap in the diagnostic odyssey, in that we will always learn something from sequencing—sometimes much more than families bargained for, as discussed elsewhere in this special (...) report. The trick is whether the knowledge gained will help the child and family. A family‐centered approach gives families permission to choose but does not lay all of the responsibility on them. The goal is to pursue the degree of medical diagnostic evaluation that matches the family's values. (shrink)

This book investigates the chaotic end of the Bronze Age in the Aegean and Eastern Mediterranean through the lens of Homeric poetry, with an emphasis on the description of piratical activities described in the Odyssey’s “Second Cretan Lie,” and on the impact of revolutionary seafaring technology in this watershed period in Mediterranean history.

The COVID-19 pandemic has had an impact on every aspect of our social, cultural and commercial lives, including the world of sport. This book examines the ethical and philosophical dimensions of the intersection of COVID-19 and sport. The book goes beyond simple description of the impact of the pandemic on sport to offer normative judgments about how the sporting world responded to challenges posed by COVID-19, as well as philosophical speculation as to how COVID-19 will change our understanding and appreciation (...) of sport in the long term. It examines the considerations that either influenced - or arguably should have influenced - decisions to continue or to resume the playing of organized sport in the midst of a pandemic. As a part of this analysis, a spotlight is shone on how sport intersected with political issues surrounding COVID-19. It also explores the configuration and meaning of sport in the COVID-19 era, touching on themes such as the nature of sport, and its integrity, and sport's relationship to technology. Other themes include the changed nature of spectatorship, suffering in sport during pandemic times, and the impact of COVID-19 on the Olympic and Paralympic Games. A final chapter looks ahead and asks what sport might look like in a post-COVID world. This is fascinating reading for anybody with an interest in the ethics and philosophy of sport, the sociology of sport, event studies, politics or public health. (shrink)

It has been proposed that inferring personal authorship for an event gives rise to intentional binding, a perceptual illusion in which one’s action and inferred effect seem closer in time than they otherwise would . Using a novel, naturalistic paradigm, we conducted two experiments to test this hypothesis and examine the relationship between binding and self-reported authorship. In both experiments, an important authorship indicator – consistency between one’s action and a subsequent event – was manipulated, and its effects on binding (...) and self-reported authorship were measured. Results showed that action-event consistency enhanced both binding and self-reported authorship, supporting the hypothesis that binding arises from an inference of authorship. At the same time, evidence for a dissociation emerged, with consistency having a more robust effect on self-reports than on binding. Taken together, these results suggest that binding and self-reports reveal different aspects of the sense of authorship. (shrink)

“The Zadeh Scenario,” when taken together with the subsequent layers of peer review and commentary on that peer review, highlights two crucial insights regarding peer review for clinical ethics. The first is one that most of Finder’s peer reviewers miss: peer-reviewers who would give attestation to quality need to be critically attentive to, and reflective about, the evidence supplied to them by candidates. The second is a more significant point: the kind of doing that is clinical ethics consultation is a (...) local form of moral enquiry, seeking not just to achieve medical – or clinical ethical – goals, but to enact human goods. Good peer review thus turns on being clear regarding the goods of ethics consultation. Buried inside “The Zadeh Scenario” one can find several goods of clinical ethics. These goods are subjective, idiosyncratically named and defined by patients, and embedded in an institution of healthcare that purports to be of service to the goods of health. The clinical ethics consultant, at her best, acts as a careful mid-wife, attempting to bring forth the goods desired, the goods possible, and perhaps even the goods that, while desired, are not possible. After all, some goods pursued by patients are not possible due to the limits of medicine. On the other hand, some goods pursued by medicine are not desired by patients. And equally, some goods pursued by clinical ethicists might be limited, provisional, and local. “The Zadeh Scenario” thus acts to problematize the goals of clinical ethics consultation, asking it to focus on the goods that the practice might bring forth. (shrink)

Christians are not immune to psychological and psychiatric illness. Yet, Christians should also be careful not to permit popular cultural trends to shape the way that they think about the use of psychiatric treatment with medication. In this essay, I suggest that the tendencies for default usage of psychiatric medication can be problematic for Christians in contemporary culture where a technological imaginary exists. Modern scientific studies of psychiatric medication are partly constructive of how we imagine ourselves. The typical justification for (...) the usage of technology in contemporary culture is the theme of cocreation with God, where Christians see any usage of technology as equivalent to our participating in God’s ongoing creative activity. I challenge these ideas in the foregoing paper, noting that the modern technological imaginary that animates modern psychiatry is as constricting as it is enabling. I conclude with a different take on what it might mean for Christians to be cocreators with God. (shrink)

Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are “captain of (...) the ship” in the operating theater (leaving anesthesiologists in a subservient role).We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon’s preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia. (shrink)

This is the second issue of Clinical Ethics cases. Every six months we plan to present two cases, each with a few commentaries by ethical, clinical, and legal experts who include ethics consultatio...

Many ethics faculty in medical schools do not include abortion in their required curriculum. On the face of it, this is a singular failure since abortion is certainly an important ethical issue. Th...

The influence of neuroscience looms large today. In this introductory essay, we provide some context for the volume by acknowledging the expansion of applied neuroscience to everyday life and the proliferation of neuroscientific disciplines. We also observe that some individuals have sounded cautionary notes in light of perceived overreach of some claims for neuroscience. Then we briefly summarize the articles that comprise this volume. This diverse collection of papers represents the beginning of a conversation focused on the intersection of sport, (...) ethics and neurophilosophy. As such, the essays also represent a new mode of interaction between philosophy and science with sport in the center of the discussion. (shrink)

Abstract:Epode 16, Horace's famous decline poem about Rome before Actium, has long been viewed as a cynical response to Vergil's prophecy of a returning Golden Age in Eclogue 4. In this article, I argue that there is another, unrecognized intertext for Epode 16—Pindar's Olympian 2—to which Horace's bleak poem alludes in a "window reference" refracted through Vergil's bucolic. As such, Horace's cynicism represents, in fact, a lament over the lost simplicity and timelessness of Greek oral poetry, and an attempt to (...) reclaim for his listeners/readers the originary experience of listening. In so doing, Horace takes up the Pindaric mantle of poet-prophet. (shrink)

Technology is evolving at a rate faster than human evolution, especially human moral evolution. There are those who claim that we must morally bioenhance the human due to existential threats (such as climate change and the looming possibility of cognitive enhancement) and due to the fact that the human animal has a weak moral will. To address these existential threats, we must design human morality into human beings technologically. By moral bioenhancement, these authors mean that we must intervene technologically in (...) the biology of the human animal in order to get it to behave morally to address these existential threats. I will bring the idea of moral bioenhancement into conversation with two philosophers of technology. Bernard Stiegler has argued that technology and culture, and thus technology and human beings, have always evolved hand in hand. Peter-Paul Verbeek notes that we have always designed morality into technology, and thus he sees technology as mediating human morality. When we offload human intentionality onto technology, Verbeek argues, technological objects and systems participate in shaping the moral subjectivity of the human actor. I will show that modern technological bioenhancement obliterates human being. Whereas in the past, human culture was handed from generation to generation through the mediation of technology, in the modern era, the human becomes the raw material upon which a technological will (imperative) rides. (shrink)

It is commonly held that Christian ethics generally and Christian bioethics particularly is the application of Christian moral systems to novel problems engaged by contemporary culture and created by contemporary technology. On this view, Christianity adds its moral vision to a technology, baptizing it for use. In this essay, I show that modern technology is a metaphysical moral worldview that enacts its own moral vision, shaping a moral imaginary, shaping our moral perception, creating moral subjects, and shaping what we imagine (...) as moral intentions. In fact, modern technics has its own liturgics, which is foreign to Christian Divine Liturgy. Divine Liturgy is world forming, showing us a different world than the one that comes into relief in the ersatz liturgy of modern medical technics. (shrink)

This paper examines varieties of naiveté manifested in the world of sport. In particular, I examine epistemological, ethical, and metaphysical naiveté. My contention is that virtually from cradle to grave forms of naiveté toward sport are present. We are tempted and all too often succumb to the temptation to accept appearances. But the initial appearances of sport often disappoint, and the underlying reality that confronts us is sometimes a hard reality. Faced with disappointment and exposed illusions, one’s next step may (...) be to adopt a hermeneutics of suspicion towards sport. There is no going back to the earlier naive stance. But is this the final word on the matter? Once one has adopted a critical perspective towards sport, is it possible to join the hermeneutics of suspicion to what Wendy Doniger refers to as a “hermeneutics of retrieval”? That is, after the first naiveté toward sport is exposed as inadequate, is it possible to arrive at what the philosopher Paul Ricoeur calls a “second naiveté.. (shrink)

I, along with others, have been critical of the social construction of brain death and the various social factors that led to redefining death from cardiopulmonary failure to irreversible loss of brain functioning, or brain death. Yet this does not mean that brain death is not the best threshold to permit organ harvesting—or, as people today prefer to call it, organ procurement. Here I defend whole-brain death as a morally legitimate line that, once crossed, is grounds for families to give (...) permission for organ donation. I do so in five moves. First, I make the case that whole-brain death is a social construction that transformed one thing, coma dépassé, into another thing, brain death, as a result of social pressures. Second, I explore the way that the 1981 President’s Commission tried to establish the epistemological certainty of brain death, hoping to avoid making arcane metaphysical claims and yet still utilizing metaphysical claims about human beings. Third, I explore the moral meaning of the social construction of a definition that cannot offer metaphysical certainty about the point at which somebody becomes just some body. Fourth, I describe how two moral communities—Jewish and Catholic—actually ground their metaphysical positions with regard to brain death in the normativity of prior social relations. Finally, I conclude with a reflection on the aesthetic-moral enterprise of the metaphysical-epistemological apparatus of brain death, concluding that only such an aesthetic-moral approach is sufficiently strong to stave off the utility-maximizing tendencies of late-modern Western cultures. (shrink)

In this case study, I address the procedural ethics of conversation analysis (CA) and the collection of naturally occurring mundane interactions. I draw from the challenges that emerged from the institutional ethics review of the HIV, health and interaction study (the H2I Study), a CA project that sought to identify the practices through which normative assumptions of HIV and other health conditions are produced in conversations. Consistent with CA’s preference for naturally occurring interactions, the H2I Study collected and analysed everyday (...) telephone calls involving people living with HIV. This article offers practical strategies CA researchers might use to navigate two ethical concerns raised about the collection of naturally occurring mundane interactions. The first questions the merits of collecting naturally occurring mundane interactions. For those unfamiliar with CA, the specific advantages of analysing naturally occurring mundane interactions may not be self-evident. This places an evidentiary burden on CA researchers to warrant the collection of this type of data. To address this concern, I suggest demonstrating in ethics applications the analytic value of CA using publicly available interactions. The second concern questions the use of verbal consent necessary for the collection of naturally occurring mundane interactions. Like most CA research, the H2I Study required flexible informed consent protocols appropriate for spontaneous and unpredictable interactions. Drawing from within and outside the CA literature, I offer three rationales for the use of verbal consent. This article is written as a practical resource for conversation analysts seeking approval from their research ethics board (REB) and for REBs who might be unfamiliar with CA research. This article contributes to a small but growing body of literature that documents not only the kinds of challenges CA researchers encounter from institutional ethics review, but the specific procedural ethics they may employ to secure ethics approval. (shrink)

Of Goals and Goods and Floundering About: A Dissensus Report on Clinical Ethics Consultation Content Type Journal Article Pages 275-291 DOI 10.1007/s10730-009-9101-1 Authors Jeffrey P. Bishop, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Mark J. Bliton, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, (...) Suite 400 Nashville Tennessee 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 3. (shrink)

Volume 47, Issue 2, July 2020, Page 322-325.

A reader confronting this collection of essays might wonder if something went awry in Jacksonville, Florida, in February 2014, when conference organizers gathered pediatric bioethicists and international child rights advocates to discuss the application of the U.N. Convention on the Rights of the Child to the work of clinical bioethics in the United States. Surely a document proclaiming a worldwide consensus on child rights would strengthen the hand of ethicists advising clinicians and researchers who face difficult decisions. Yet the conference (...) discussion—and resulting manuscripts—depict a deep divide: bioethicists largely rejected the notion that the CRC is a useful.. (shrink)

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured (...) by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions. (shrink)

This chapter explores the relations of different kinds of power, philosophically understood – sovereign power, disciplinary power, and biopower – and argues that the politics of the Star Wars galaxy is animated by an ontology, or metaphysical picture, centered on power. It further argues that The Mandalorian criticizes this power ontology with the introduction of the Child, Grogu, who generates a different kind of Force: a relational ontology of love. Grogu and the love he generates point to a different way (...) of being in the world than power. Ultimately, The Mandalorian offers a different ontology of power – an ontology of love – as a radical alternative to the bindings of political power. Palpatine is correct that power dynamics shape the confrontational relationship between the Jedi and Sith, which is fed by the Jedi's disavowal of strong attachments. (shrink)

Transhumanism traces its roots to Enlightenment humanism and claims to be the harbinger of the next phase of humanistic activity through designer evolution. In this essay, I briefly trace medicine’s relationship with transhumanist philosophy to the philosophy of medicine and show that each accepts a kind of ambiguity of the body at the heart of its metaphysical assumptions. I show that these metaphysical assumptions are committed to a power ontology, and that this power ontology is fundamentally at odds with the (...) traditional Christian lifeworld. (shrink)

Erratum to: Echo Calling Narcissus: What Exceeds the Gaze of Clinical Ethics Consultation? Content Type Journal Article Pages 171-171 DOI 10.1007/s10730-010-9132-7 Authors Jeffrey P. Bishop, Saint Louis University Tenet Chair of Health Care Ethics, Albert Gnaegi Center for Health Care Ethics Salus Center, Room 527, 3545 Lafayette Ave St. Louis MO 63104-1314 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Ave., 4th Floor, Suite 400 Nashville TN 37203 USA Mark J. Bliton, Vanderbilt (...) University Center for Biomedical Ethics and Society 2525 West End Ave., 4th Floor, Suite 400 Nashville TN 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 22 Journal Issue Volume 22, Number 2. (shrink)