The disputed issues that comprise the recovered memories controversy are so important that they deserve the most careful and intellectually honest scholarship that the academic and professional community can muster. Drawing partly on illustrative material from the recentHealth Care Analysis paper by Goodyear-Smithet al. and associated commentaries, it is argued that the controversy is not being well served. The rules of scholarship are too often broken, with the result that the products are often superficial, containing what should have been readily (...) avoided factual errors, and are sometimes even misleading. (shrink)

The disputed issues that comprise the recovered memories controversy are so important that they deserve the most careful and intellectually honest scholarship that the academic and professional community can muster. Drawing partly on illustrative material from the recentHealth Care Analysis paper by Goodyear-Smithet al. and associated commentaries, it is argued that the controversy is not being well served. The rules of scholarship are too often broken, with the result that the products are often superficial, containing what should have been readily (...) avoided factual errors, and are sometimes even misleading. (shrink)

Rosamond Rhodes calls for a reconceptualization of research ethics and a fundamental shift in attitude toward both research subjects and scientific investigators. She recognizes the limits of the e...

This study explored attention and interpretation biases in processing facial expressions as correlates of theoretically distinct self-reported anger experience, expression, and control. Non-selected undergraduate students completed cognitive tasks measuring attention bias, interpretation bias, and Spielberger’s State-Trait Anger Expression Inventory. Attention bias toward angry faces was associated with higher trait anger and anger expression and with lower anger control-in and anger control-out. The propensity to quickly interpret ambiguous faces as angry was associated with greater anger expression and its subcomponent of anger (...) expression-out and with lower anger control-out. Interactions between attention and interpretation biases did not contribute to the prediction of any anger component suggesting that attention and interpretation biases may function as distinct mechanisms. Theoretical and possible clinical implications are discussed. (shrink)

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of (...) the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

The papers in the 2010 “Clinical Ethics” number of the Journal of Medicine and Philosophy explore issues along La Frontera, the borders and boundaries of clinical ethics. The first three papers in this “Clinical Ethics” number of the Journal explore borders and boundaries drawn within clinical ethics, concerning the moral standing of complementary and alternative medicine, palliative sedation, and induced abortion and feticide. The fourth and fifth papers explore the borders and boundaries between research ethics and clinical ethics.

We offer a critique of one prominent understanding of the principle of respect for autonomy and of analyses of medical paternalism based on that understanding. Our main critique is that understanding respect for autonomy as respect for freedom from interference is mistaken because it is overly influenced by four-alarm cases, because it fails to appreciate the full dimensions of legal self-determination (one of its main sources), because it conflates the research and therapeutic settings, and because it fails to appreciate themes (...) of authority and power that have historically shaped the principle of respect for freedom from interference. We argue that respect for autonomy involves more than just freedom from interference and, on this basis, offer a critique of prevailing accounts of medical paternalism. (shrink)

The return of genetic research results after death in the pediatric setting comes with unique complexities. Researchers must determine which results and through which processes results are returned. This paper discusses the experience over 15 years in pediatric cancer genetics research of returning research results after the death of a child and proposes a preventive ethics approach to protocol development in order to improve the quality of return of results in pediatric genomic settings.

Book reviewed in this article: Long Term Care: Principles, Programs and Policies. By Rosalie A. Kane and Robert L. Kane. Long Term Health Care: providing a Spectrum of Services to the Aged. By Philip W. Brickner, Anthony J. Lechich, Roberta Lipsman, and Linda K. scharer.

Book reviewed in this article: Long Term Care: Principles, Programs and Policies. By Rosalie A. Kane and Robert L. Kane. Long Term Health Care: providing a Spectrum of Services to the Aged. By Philip W. Brickner, Anthony J. Lechich, Roberta Lipsman, and Linda K. scharer.

Elwyn Richardson’s experimental approach to teaching and learning and Oruaiti was officially sanctioned, but the history of education in Aotearoa/new Zealand shows that teachers have been typically conformist. In this article, I suggest that positivist paradigms from the industrial age continue to shape classroom teaching, partly because of norms of individualism, and partly because neoliberal understandings have become central in the functioning of our schools and society. Teaching is an activity that promotes the ethics of a community or society by (...) promulgating some ideas and marginalising others. In Aotearoa/new Zealand, many of our students struggle with the collective orientation of their community traditions and the societal emphasis on individualism. Modernist beliefs in social progress through technology still permeate education policy. Promoting communitarian understandings requires more open-ended approaches to teaching such as Richardson demonstrated. With digital technologies gaining progressively greater influence in schools, the opportunities for social connectedness have been enhanced alongside an increasing emphasis on individual devices. This article briefly explores interconnections between experimentation, context and community. (shrink)

It is well-recognized that uncertainty is an endemic feature and limitation of clinical judgment and practice that cannot be eliminated in many cases. Among the tasks of clinical ethics is the responsible management of uncertainties, first articulated in E. Haavi Morreim’s very nice concept of the "moral management of medical uncertainty." The papers in the 2012 Clinical Ethics issue of the Journal provide philosophically innovative and clinically applicable accounts of the varieties of uncertainty in clinical medicine and therefore in clinical (...) ethics: epistemic uncertainty, metaphysical uncertainty, and relational uncertainty. (shrink)

This paper introduces the 2011 number of the Journal on Clinical Ethics. Philosophical critical appraisal is essential for the success of philosophical analysis and argument in clinical ethics. To clear away conceptual underbrush, papers in this Clinical Ethics number of the Journal address genetic engineering, conscience-based objections to forms of health care, placebos, and preventing exploitation of patients to be recruited to become research subjects.

The morally responsible practice of clinical medicine depends on many factors, the integrity of clinical judgment chief among them. Responsible clinical judgment requires that it be deliberative. The disciplines of the humanities, all of which contribute to clinical ethics—as the papers that follow illustrate—teach that deliberative reasoning includes critical self-awareness and self-scrutiny. Critical appraisal proves essential to achieving both. The papers in the 2013 Clinical Ethics number of the Journal provide distinctive critical appraisals of clinical judgment: concepts of race; narrative; (...) stewardship; and the Rule of Rescue. By becoming commonplace, such critical appraisals of clinical judgment become essential to clinical ethics. (shrink)

The five papers in the 2008 “Clinical Ethics” number of the journal address the conceptual and empirical foundations of clinical ethics. Three articles take up the concept of professionalism in medicine, exploring its possibilities and implications. The fourth article provides a distinctive, phenomenological account of the “placebo effect,” a vexing topic of surprising durability in the clinical setting. The final article, a systematic review of the qualitative literature on bedside rationing of resources, creates an empirical foundation for philosophical analysis and (...) argument of a distinctive kind. (shrink)

Central concepts and consensus views in clinical ethics are marked by instability. The papers in this number of the Journal take up two such central concepts, quality of life and moral status, and two such consensus views, that germ-line gene transfer should not be undertaken for the purposes of enhancement of human traits and that the ethical obligation of physicians to treat HIV infected patients rests on consent of the physician. One outcome of these philosophical investigations is that these two (...) concepts and consensus views are less stable than one might have thought. I explore the possibility of generalizing this outcome in a reflection on clinical ethics as the management of instability and incompleteness, including the instability and incompleteness of clinical ethics itself. In the course of this reflection I liken clinical ethics to abstract expressionism in mid-twentieth century Western art. (shrink)

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and (...) English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)