Writing in 1999, legal ethics scholar Brad Wendel noted that “[v]ery little empirical work has been done on the moral decision making of lawyers.” Indeed, since the mid-1990s, few empirical studies have attempted to explore how attorneys deliberate about ethical dilemmas they encounter in their practice. Moreover, while past research has explored some of the ethical issues confronting lawyers practicing in certain specific areas of practice, no published data exists probing the moral mind of health care lawyers. As signaled by (...) the creation of a regular column “devoted to ethical issues arising in the practice of health law” in the Journal of Law, Medicine & Ethics, the time to address the empirical gap in the professional ethics literature is now. Accordingly, this article presents data collected from 120 health care lawyers. Presenting this population with a number of hypothetical scenarios relating to how they would respond when confronting an ethical dilemma without an obvious solution or when facing a situation in which their personal values were in tension with their professional obligations, this article represents a first step toward better understanding how lawyers who practice in health care settings understand and resolve the moral discomfort they encounter in their professional lives. (shrink)

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward “market-driven medicine” at the end of life. For example, the article examines issues raised by an influx of for-profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that (...) end-of-life patient care is inferior among for-profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non-profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., “no margin, no mission”). Given the limitations of existing empirical data and contrasting ideological commitments of for-profit versus non-profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family — a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end-of-life alternative. (shrink)

In our society, some aspects of life are off-limits to commerce. We prohibit the selling of children and the buying of wives, juries, and kidneys. Tainted blood is an inevitable consequence of paying blood donors; even sophisticated laboratory tests cannot supplant the gift-giving relationship as a safeguard of the purity of blood. Like blood, health care is too precious, intimate, and corruptible to entrust to the market.The hospice movement in the United States is approximately 40 years old. During these past (...) four decades, the concept of holistic, multidisciplinary care for patients who are suffering from a terminal illness has evolved from a modest, grassroots constellation of primarily volunteer-run and community-governed endeavors to a multimillion dollar industry where the surviving nonprofits compete with for-profit providers, often publicly traded, managed by M.B.A.-trained executives, and governed by corporate boards. The relatively recent emergence of for-profit hospice reflects an increasing commercialization of health care in the United States, the potentially adverse impact of which has been well documented. (shrink)

Financial ties between physicians and pharmaceutical companies are pervasive and controversial. However, little is known about how patients perceive such ties. This paper describes an experiment examining how a national sample of U.S. adults perceived a variety of financial relationships between physicians and drug companies. Each respondent read a single scenario about a hypothetical physician and his financial ties to the pharmaceutical industry; scenarios varied in terms of payment type of and amount. Respondents then evaluated the physician on several dimensions (...) . Findings revealed that perceptions of the physician were more strongly influenced by payment type than by payment amount. Specifically, respondents were quite critical of doctors who owned drug company stock or received industry payments for meals and lodging, but were more forgiving of physicians who received free drug samples or consulting fees . Interestingly, physicians who received no payments, while seen as honest, were also viewed by some respondents as inexperienced or uninformed about new treatments. Implications for public policy and future research are discussed. (shrink)

Financial relationships and business transactions between physicians and the health care industry are common. These relationships take a variety of forms, including payments to physicians in exchange for consulting services, reimbursement of physician travel expenses when attending medical device and pharmaceutical educational conferences, physician ownership in life science company stocks, and the provision of free drug samples. Such practices are not intrinsic to medical practice, but as the Institute of Medicine described in its 2009 report, these relationships have the potential (...) to produce positive collaborations that improve patient care and public health, and most physicians view it as “ethically proper to accept items ranging from drug samples to a lucrative consultantship.”However, financial relationships between physicians and pharmaceutical, medical device and biotechnology companies can also create negative influences on physician judgment that compromise patient care and jeopardize the public’s trust. (shrink)

Sex determination in most organisms involves a simple binary fate choice between male or female development; the outcome of this decision has profound effects on organismal biology, biochemistry and behaviour. In the nematode C. elegans, there is also a binary choice, either male or hermaphrodite. In C. elegans, distinct genetic pathways control somatic and germline sexual cell fate. Both pathways share a common set of globally acting regulatory genes; however, germline-specific regulatory genes also participate in the decision to make male (...) or female gametes. The determination of sexual fate in the germline of the facultative hermaphrodite poses a special problem, because first sperm then oocytes are produced. It has emerged that additional layers of post-transcriptional regulation have been imposed to modulate the activities of the global sex-determining genes, tra-2 and fem-3; the balance between these activities is crucial in controlling sexual cell fate in the hermaphrodite germline. BioEssays 23:596–604, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

The authors reject arguments by Professor Joseph Fletcher (author of Situation Ethics) that in some circumstances parents may be held responsible for producing genetically defective offspring, but offer arguments of their own for the same conclusion. Their arguments could, they suggest, justify `wrongful life' claims by the genetically defective infant against the mother. While researching this paper both authors were postdoctoral fellows in medical ethics in the Program on Human Values and Ethics at the University of Tennessee Center for the (...) Health Sciences. (shrink)

The diffusion of technology in the US has taken place in an environment of both regulation and free enterprise. Each has been subject to manipulation by doctors and medical administrators that has fostered unprecedented ethical dilemmas and legal challenges. Understanding these developments and historical precedents may allow a more rational diffusion policy for medical technology in the future.

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy. Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy, improved the safety and non-invasiveness of this method. Electric and magnetic source imaging plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years (...) and underwent surgery at Cook Children's Medical Center. The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography, magnetoencephalography with simultaneous conventional EEG and high-density EEG in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography. Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free. Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

"Thinking like a lawyer" is a phrase familiar to every law student, and the development of these analytical skills are, of course, essential. In this essay, however, I reflect on the value of a more expansive approach to professional formation. I argue that legal education best serves students, the bar, and the society when it takes seriously the importance of moral imagination, interpersonal relationships, and personal wellness.

The empirical literature exploring lawyers and their moral decision making is limited despite the “crisis” of unethical and unprofessional behavior in the bar that has been well documented for over a decade. In particular we are unaware of any empirical studies that investigate the moral landscape of the health lawyer’s practice. In an effort to address this gap in the literature, an interdisciplinary team of researchers at Vanderbilt University designed an empirical study to gather preliminary evidence regarding the moral reasoning (...) of health care attorneys. The primary research question was how health lawyers respond when they encounter ethical or moral dilemmas in their practice for which the law fails to offer a bright-line solution. In exploring this question, we sought to understand better what motivations or influences guide action when health lawyers confront ethical quandaries, and whether there are specific differences, e.g., gender, experience, or religiosity, that are associated with specific responses to situations testing ethical or moral boundaries. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the fetus is (...) a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

This article is a response to Stephen Law's article ‘The evil-god challenge’. In his article, Law argues that if belief in evil-god is unreasonable, then belief in good-god is unreasonable; that the antecedent is true; and hence so is the consequent. In this article, I show that Law's affirmation of the antecedent is predicated on the problem of good (i.e. the problem of whether an all-evil, all-powerful, and all-knowing God would allow there to be as much good in the world (...) as there is), and argue that the problem of good fails. Thus, the antecedent is unmotivated, which renders the consequent unmotivated. Law's challenge for good-god theists is to show that good-god theism is not rendered unreasonable by the problem of evil in the same way that evil-god theism is rendered unreasonable by the problem of good. Insofar as the problem of good does not render belief in evil-god unreasonable, Law's challenge has been answered: since it is not unreasonable to believe in evil-god (at least for the reasons that Law gives) it is not unreasonable to believe in good-god. Finally, I show that – my criticism aside – the evil-god challenge turns out to be more complicated and controversial than it initially appears, for it relies on the (previously unacknowledged) contentious assumption that sceptical theism is false. (shrink)

The “Embryo Rescue Case” (ERC) refers to a thought experiment that is used to argue against the view that embryos have a right to life (i.e. are persons). I will argue that cognitive science undermines the intuition elicited by the ERC; I will show that whether or not embryos have a right to life, our mental tools will make it very difficult to believe that embryos have said right. This suggests that the intuition elicited by the ERC is not truth (...) indicative. The upshot of this is that we have an undercutting defeater for our intuition that embryos do not have a right to life. (shrink)

P-zombies are creatures that are physically (functionally, behaviorally) like you and I and yet lack phenomenal consciousness. If such creatures are possible, it’s (typically) taken to show property dualism is true: phenomenal consciousness isn’t reducible to—nor does it supervene on—physical states. If inverted qualia are possible, it’s possible that you and I have identical physical states and yet you see tomatoes as green and I see tomatoes as red. If this is the case, then (again) property dualism is (typically) taken (...) to be true. In this article, I’ll show that p-zombies and inverted qualia—if they are actually possible—prove more than previously thought: if one thinks p-zombies or inverted qualia are possible, then she should endorse one of the four following theses: (i) substance dualism, (ii) we have even more reason to reject p-zombies and inverted qualia since they entail an even more radical conclusion than previously thought (i.e. substance dualism), (iii) eliminativism about selves, or (iv) friends of p-zombies and inverted qualia have homework: they need to show a relevant, plausible disanalogy between arguments for p-zombies and inverted qualia as traditionally stated and my parallel arguments that entail substance dualism. My purpose here isn’t to defend any of these particular options. Instead, my purpose is to highlight that these are the four options available to take. (shrink)

This study investigates the determinants of paternal investment by birth fathers and stepfathers. Inclusive fitness theory predicts higher parental investment in birth children than stepchildren, and this has consistently been found in previous studies. Here we investigate whether paternal investment varies with childhood co-residence duration and differs between stepfathers and divorced birth fathers by comparing the investment of (1) stepfathers, (2) birth fathers who are separated from the child’s mother, and (3) birth fathers who still are in a relationship with (...) her. Path analysis was conducted using cross-sectional data from adolescents and younger adults (aged 17–19, 27–29, and 37–39 years) from the German Family Panel (pairfam), collected in 2010–2011 (_n_ = 8326). As proxies of paternal investment, we used financial and practical help, emotional support, intimacy, and emotional closeness, as reported by the children. We found that birth fathers who were still in a relationship with the mother invested the most, and stepfathers invested the least. Furthermore, the investment of both separated fathers and stepfathers increased with the duration of co-residence with the child. However, in the case of financial help and intimacy, the effect of childhood co-residence duration was stronger in stepfathers than in separated fathers. Our findings support inclusive fitness theory and mating effort theory in explaining social behavior and family dynamics in this population. Furthermore, social environment, such as childhood co-residence was associated with paternal investment. (shrink)

Throughout history, many scholars have offered up definitions of curiosity. These definitions range far and wide. Some attempt to amass all the elements of curiosity, systematize them, and propose a unified theory. Some characterize curiosity as a conceptual unit with two primary dimensions (e.g. epistemic and perceptual), as two distinct kinds of things (e.g. bona et mala curiositas), or as one side of a binary (e.g. curiosity vs. care). What is curiosity? Which characterization is most apt to curiosity itself and (...) which best illuminates its ethical and political stakes? In this essay, I argue that curiosity is best characterized modally. That is, it is best described through its modes rather than defined by its essence. To support this argument, I canvas the history of philosophy and identify three models of curiosity, which I name by their correlative literary figures: the busybody, the hunter, and the dancer. The curious person is repeatedly described as drawn to gossip, hunting down secrets and discoveries, and taking leaps of creative imagination. I develop an account of the unique kinesthetic signatures of each mode. I then close with ethical considerations, interrogating issues of responsibility relevant to each. In doing so, this chapter reimagines both curiosity itself and its role in our political ecology today. (shrink)

(Wide) pro-theism is the view that the world is better overall if theism is true. (Wide) anti-theism is the view that our world would be better overall if atheism is true. Arguments for pro-theism and anti-theism typically make use of traditional theism (the view that an omni-God exists) and generic atheism (the view that an omni-God doesn’t exist). In my view, when the debate between pro-theists and anti-theists makes use of traditional theism and generic atheism, pro-theism clearly comes out on (...) top. In this paper, I consider whether this result (i.e. pro-theism’s advantage over anti-theism) changes if we bring axiarchism into the mix: I compare axiarchistic theism and axiarchistic atheism. General axiarchism is the view that the world exists because it is good that it exists, and extreme axiarchism is the view that the world exists because it is the best possible world. When we take general axiarchistic theism and general axiarchistic atheism as our worldviews for comparison, I argue that there is no significant change with respect to anti-theism and pro-theism: neither position is able to capture goods that are traditionally associated with the other position, and so pro-theism still wins out. However, if we instead compare extreme axiarchistic atheism with extreme axiarchistic theism there is a significant change: while the case for pro-theism remains the same (because, I argue, it is not able to capture any of the goods of anti-theism), the case for anti-theism is greatly strengthened, because it is able to capture nearly all of the goods of pro-theism (e.g. the good of an afterlife, of cosmic justice, of there being no gratuitous evil). In other words, given extreme axiarchism, atheistic worlds can (and will) house goods that are traditionally associated with theistic worlds (e.g. those listed prior). This means that, given extreme axiarchism, pro-theists can’t appeal to those goods as favoring their position: they obtain whether our world is atheistic or theistic. Thus, they don’t favor pro-theism over anti-theism; the case for anti-theism has been strengthened. (Alternatively, we may say that the case for pro-theism has been weakened.) Ultimately, there is one good that extreme axiarchistic atheism does not enable anti-theism to capture—namely, God’s intrinsic unlimited goodness—and I argue that this shows that there is still a gap between pro-theism and anti-theism; while the gap has been substantially narrowed, it has not been eliminated. Thus, I suggest that the best route forward for anti-theists is to cast doubt on the view that God’s intrinsic goodness is unlimited. (shrink)

In this article I discuss a number of issues raised by Professor Jules Coleman's recent article "Beyond the Separability Thesis." I suggest, to begin, that Coleman is correct that neither a narrow nor a broad formulation of the separability thesis takes us very far towards a robust distinction between legal positivism and legal non-positivism. I then offer a brief discussion of methodology in jurisprudence, suggesting that Coleman accepts, at least implicitly, what I call a "methodology of necessary features." Since there (...) is reason to think that law possesses some necessary features that are non-normative (or descriptive) and others that are moral in character, the promise of this pluralistic approach is that it will be capable of bridging the gap between so-called "descriptive" and "normative" theories of methodology in jurisprudence. Since the distinction between descriptive and normative methodological theories is sometimes taken to be one way, among others, of drawing a distinction between positivist and non-positivist theories of law, the pluralism of the "methodology of necessary features" gives us yet one more reason to think that the distinction between positivism and non-positivism is not a theoretically fundamental one. Finally, I discuss Coleman's "moral semantics claim," i.e., the idea that "legal content is best understood as moral directives about what is to be done and who is to decide what is to be done." Coleman acknowledges that the moral semantics claim, when taken together with the social facts thesis, raises a well-known problem: How can social facts create content-independent reasons for action? I suggest that we are most likely to find the answer to this question by focusing directly on whether or not law's claimed moral authority—meaning its claimed moral power—can be justified, rather than by focusing indirectly, as many theorists have done, on the existence or non-existence of a general obligation to obey the law. (shrink)

The philosophy of George Herbert Palmer, by C. M. Bakewell.--Personal traits of George Herbert Palmer, by E. W. Hocking--Faculty minute on the life and service of Professor Palmer.