It is generally agreed that physicians should not provide futile interventions, for the obvious reason that an intervention without utility causes harm without benefit. However, despite efforts to standardize a definition, there is a lack of universal consensus as to what constitutes “futility.” Two recent policy statements object to the terminology of futility based on the lack of a universal definition. Schneiderman, Jecker, and Jonsen object to the proposed alternative terminology of “inappropriate.” These differing opinions about the most apt terminology (...) raise the question of whether definitions are helpful or counterproductive in addressing disputes that... (shrink)

A forty-year-old man is brought to the emergency room by his wife at five in the morning, two hours after he fell down the stairs at home, hitting his head and injuring his arm. He tells the ER physician that he got up to get a drink of water and tripped in the dark. His speech is slurred, and he smells strongly of alcohol. Lab results reveal elevated liver enzymes, and his blood alcohol level is 0.1. His medical history is (...) unremarkable. When asked about his alcohol consumption, he says he usually has one or two drinks a night with dinner but that he drinks more on holidays and special occasions. He admits he had more to drink than usual last night because it had been a stressful day at work, but he is vague about how much he drank. His wife takes the ER physician aside and describes a very different situation. She says that her husband regularly has three or four drinks a night. She always goes to bed before he does and thinks he stays up later so he can continue to drink. She says that he often has no memory of conversations they had the night before and is concerned because he makes work-related calls at night. When asked what he does for a living, she hesitates, and then answers that he is an internist. He does not work at this hospital but works at one of its affiliated clinics. The ER doctor is concerned that his patient is an impaired physician. Yet when the admitting hospitalist, to whom he explains the situation, asks if he really wants to “go there,” he shrugs his shoulders. “I suppose,” she replies, “you might as well call an ethics consult.”. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Context Physicians are regularly confronted with research that is funded or presented by industry. Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: ‘presenter conflict’, ‘researcher conflict’ and ‘no conflict’. Participants 515 randomly selected (...) Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy. Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies. (shrink)

The paper discusses Dr. Floris Tomasini's paper “What Is Bioethics: Notes toward a New Approach?”. Based on Tomasini's account of methodological and ethical pluralism, the paper explores the demarcation problem of bioethics and suggests a full methodological laissez-faire.

The authors argue that the time is ripe for national and corporate leaders to move consciously towards the development of global ethics. This papers presents a model of global ethics, a rationale for the development of global ethics, and the implications of the model for research and practice.

The conduct of research in settings affected by disasters such as hurricanes, floods and earthquakes is challenging, particularly when infrastructures and resources were already limited pre-disaster. However, since post-disaster research is essential to the improvement of the humanitarian response, it is important that adequate research ethics oversight be available. We aim to answer the following questions: 1) what do research ethics committee members who have reviewed research protocols to be conducted following disasters in low- and middle-income countries perceive as the (...) key ethical concerns associated with disaster research?, and 2) in what ways do REC members understand these concerns to be distinct from those arising in research conducted in non-crisis situations? This qualitative study was developed using interpretative description methodology; 15 interviews were conducted with REC members. Four key ethical issues were identified as presenting distinctive considerations for disaster research to be implemented in LMICs, and were described by participants as familiar research ethics issues that were amplified in these contexts. First, REC members viewed disaster research as having strong social value due to its potential for improving disaster response, but also as requiring a higher level of justification compared to other research settings. Second, they identified vulnerability as an overarching concern for disaster research ethics, and a feature that required careful and critical appraisal when assessing protocols. They noted that research participants’ vulnerabilities frequently change in the aftermath of a disaster and often in unpredictable ways. Third, they identified concerns related to promoting and maintaining safety, confidentiality and data security in insecure or austere environments. Lastly, though REC members endorsed the need and usefulness of community engagement, they noted that there are significant challenges in a disaster setting over and above those typically encountered in global health research to achieve meaningful community engagement. Disaster research presents distinctive ethical considerations that require attention to ensure that participants are protected. As RECs review disaster research protocols, they should address these concerns and consider how justification, vulnerability, security and confidentially, and community engagement are shaped by the realities of conducting research in a disaster. (shrink)

Anderson and Csima :245–264, 2014) defined a jump operator, the bounded jump, with respect to bounded Turing reducibility. They showed that the bounded jump is closely related to the Ershov hierarchy and that it satisfies an analogue of Shoenfield jump inversion. We show that there are high bounded low sets and low bounded high sets. Thus, the information coded in the bounded jump is quite different from that of the standard jump. We also consider whether the analogue of the (...) Jump Theorem holds for the bounded jump: do we have A≤bTB\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$A \le _{bT}B$$\end{document} if and only if Ab≤1Bb\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$A^b \le _1 B^b$$\end{document}? We show the forward direction holds but not the reverse. (shrink)

As transnational interactions increase, cross-cultural conflict concerning ethical issues is inevitable. This article presents a model for assisting decision makers in selecting appropriate strategies for addressing cross-cultural ethical conflict. A theoretical framework for the model is developed based on the literature on international business ethics and on conflict resolution. The model is illustrated through several case examples. Implications for future research and practice are discussed.

John Stuart Mill's Utilitarianism continues to serve as a rich source of moral and theoretical insight. This collection of articles by top scholars offers fresh interpretations of Mill's ideas about happiness, moral obligation, justice, and rights. Applying contemporary philosophical insights, the articles challenge the conventional readings of Mill, and, in the process, contribute to a deeper understanding of utilitarian theory as well as the complexity of moral life.

2. There can be, and is, analogy among external relations, attributive, metaphorical or symbolic analogies, but such analogy is not metaphysical because the latter analogy is found only in the being of things and hence concerns only intrinsic relations.

The properly metaphysical dimension of Augustine's thought has received little special attention among scholars - even "Scholastics. " The Thomist metaphysicians - especially we "Anglo-Saxon" ones - receive first honors for being the most neglectful of all. Why? I t is a puzzling phenomenon particularly in the light of the fact (recognized by almost every Thomist) that the very existence of Thomas the theologian is inconceivable apart from his pre-eminent Christian mentor in the intellectual life, the Bishop of Hippo. It (...) is a puzzling phenomenon because, although the Christian metaphysics of Thomas Aquinas is not the Christian metaphysics of Augustine, these metaphysics could not be simply opposed to one another, else the theologies wherein they exercise the indispensable function of vital rational organs would themselves be discordant. But what respectable "Scholas tic" would deny that, in their essential teaching about God and the things of God, the thought of these two masters is remarkably congruent? May I suggest that one of the major reasons for this paradoxical neglect of Augustinian metaphysics on the part of Thomists (above all, in the English-speaking world) is their simplistic assumption that whereas Aquinas was an Aristotelian in phi losophy, Augustine was a Platonist, despite the fact that in theology they were substantially at one - as if there could be theological agreement, formally speaking, even where there is metaphysical disagreement, formally speaking. (shrink)

The latter quality can be cultivated by the metaphysician through considering the intimate link between signification and being. The impossibility of separating the two is highlighted by the fact that even "non-being" is significant as a sign of the simple negative judgment, x is not. For this sign assuredly is. And a "square circle," mathematically and physically nonexistent, has the "being" of an incompatible conjunction of signs severally significant.