I explore some new directions—suggested by feminism—for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed—e. g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. “Crisis issues” currently dominate medical ethics, to the neglect of what I call “housekeeping issues.” (...) The second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select—and neglect—to study as well as the “games” we play may be sending a message as loud as the words we do speak on ethics. (shrink)

I explore some new directions-suggested by feminism-for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed-e.g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. "Crisis issues" currently dominate medical ethics, to the neglect of what I call "housekeeping issues." The (...) second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select-and neglect-to study as well as the "games" we play may be sending a message as loud as the words we do speak on ethics. (shrink)

It has been observed that some groups in society tend to report their health to be better than would be expected through more objective measures. The available evidence suggests that while variations in self-assessed measures of health may act as good proxies of mortality and morbidity in homogeneous populations, in some groups, such as the Aboriginal and Torres Strait Islander communities of Australia, these subjective measures may provide a misleading picture. Useful insights into the formation of health perceptions can be (...) drawn from a range of disciplines, in particular, from social comparison theories, models of illness behaviour, survey literature and linguistics. These theories and models help to provide an understanding of the different ways in which illness may be perceived, evaluated and acted upon by different kinds of people. Such considerations can have very direct implications for those planning and evaluating public health programs as well as those responsible for funding such programs. (shrink)

Bruno and Arora (2018) present a range of important ethical issues emerging from the development of procedures for uterine transplant (UT). They approach those issues by drawing on parallels to oth...

Open-uterine surgery to repair spina bifida, or ‘fetal surgery of open neural tube defects,’ has generated questions throughout its history—and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University—where the first successful cases of open-uterine repair of spina bifida were carried out—we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering the procedure, with (...) researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design. (shrink)

Despite increased attention to the question of how best to evaluate clinical ethics consultations and emphasis on external evaluation, there has been little sustained focus on how we, as clinicians, make sense of and learn from our own experiences in the midst of any one consultation. Questions of how we evaluate the request for, unfolding of, and conclusion of any specific ethics consultation are often overlooked, along with the underlying question of whether it is possible to give an accurate account (...) of clinical ethics consultants’ experience as experienced by ethics consultants. Before the challenge of submitting one’s accounts or case reports for review and evaluation from others, there is an underlying challenge of understanding and evaluating our own accounts. To highlight this crucial and deeply challenging dimension of actual clinical ethics practice, we present an account of a complex consultation, explicitly constructed to engage the reader in the unfolding experience of the consultant by emphasizing the multiple perspectives unfolding within the consultant’s experience. Written in script format, the three perspectives presented—prototypical clinically descriptive account; didactically reflective and self-evidentiary account often seen in journal presentations; highly self-critical reflective account emphasizing uncertainties inherent to clinical ethics practice—reflect different manners for responding to the ways actual clinical involvement in ethics consultation practice accentuates and refocuses the question of how to understand and evaluate our own work, as well as that of our colleagues. (shrink)

There have been major developments in the understanding of children’s nonhuman concepts, particularly God concepts, within the past two decades, with a body of cross-cultural studies accumulating. Relatively less research has studied those of non-Christian faiths or children’s concepts of popular occult characters. This paper describes two studies, one in Spain and one in England, examining 5- to 10-year-olds’ human and nonhuman agent beliefs. Both settings were secular, but the latter comprised a Muslim majority. Children were given a false-belief task (...) in which they were asked to infer about three humans, three animals and three supernatural beings. Similar false beliefs about humans, with subtle differences in inferences about animals and supernatural beings, were found between the two locations. In London different patterns for God between participants with a family religion, in particular Muslims, and non-affiliates, were identified as well as an association between religious beliefs and practice and inferences about God. Findings are discussed in the light of theory and research on the role of sociocultural inputs in children’s theory of mind development and understanding of agency. (shrink)

Since the concept of the living wills emerged nearly 50 years ago, there have been practical challenges in translating the concept of an advance directive into documents that are clinically useful across various healthcare settings and among different patient populations and cultures. Especially, challenging has been the reliance in most ADs on pre-selected “choices” about specific interventions which either revolve around broad themes or whether or not to utilize particular interventions, both of which about most laypersons know little and, more (...) importantly, lacking context, prove to be of limited meaningfulness. Moreover, whether by foundational frame, decade-long misunderstanding in medicine and bioethics, or different societal customs, these ADs present decision-making responsibility for initiating, continuing, or withdrawing medical interventions as a patient responsibility—creating a burden for which most patients are unprepared—and hence reducing healthcare providers’ responsibility to mere technical application or customer service. At our institution, significant efforts have focused on embracing the unique and complementary responsibilities of patients and physicians for enabling appropriate plans of care. This includes re-structuring our AD form to more accurately represent patient’s values as the frame within which physicians are responsible for determining appropriate care. Rather than specifying interventions, the AD makes patients responsible for specifying what matters to them as well as what they value in terms of function, interaction, and level of acceptable burden, thus providing clear goals for clinicians to pursue—or when goals are not reachable by available medical interventions, to acknowledge and allow for logical shifts to what may be achieved, including, in end of life contexts, care focused on respect and dignity. (shrink)

“If philosophy is essentially this activity of questioning and responding, that is, dialogue…” ∼ R.M. Zaner (The Way of Phenomenology)“Not to philosophize is to philosophize still.” E. Lévinas (“Go...

Language, like other human traits, could only have evolved during one or more stages of development. We enlist the theoretical framework of human life history to account for certain aspects of linguistic evolution, with special reference to initial phases in the process. It is hypothesized that selection operated at several developmental stages, the earlier ones producing new behaviors that were reinforced by additional, and possibly more powerful, forms of selection during later stages, especially adolescence and early adulthood. Peer commentaries have (...) provided opportunities to explain human life history more comprehensively, and to add details to our account of spoken language. We made no attempt to explain syntax in the target article, but we propose here that selection for “vocal plumage” may have increased our species’ capacity for utterance complexity, a development that would have benefited all levels of language. (shrink)

I articulate what I refer to as Jefferson’s “land ethic,” drawing primarily from his Notes on the State of Virginia. In the first section, I discuss Jefferson’s conception of the intimate relationship between the natural and political constitution of America and his vindication of both. In the second section, I examine the centrality of the environment in Jefferson’s political vision for America: a landbasedrepublicanism. In the third section, I elaborate Jefferson’s view as to the proper relationship between human beings (...) and their environment by focusing on the form of nature to which he believes human beings most intimately relate: one’s estate. Jefferson’s understanding of the land draws from John Locke’s theory of property, but whereas Locke’s concept of property is closely associated with the economic values that facilitate human destruction of the environment, Jefferson’s environmentalism focuses on the other side of the relation: the ways in which a particular nature—a climate, one’s landholding, the New World in general–can influence human nature and politics. (shrink)

A more complete methodology for normative ethics is needed, and Kierkegaard's philosophy, which emphasizes the individual's role in moral decision-making, can help to meet this need. This essay discusses two ways in which Kierkegaard sought to expand a commonly accepted conception of morality. First, he stressed that the agent changes as part of the process of moral decision-making, with personal experience and insight integral parts of that process. Second, Kierkegaard included within the realm of morality decisions (e.g., about occupation) which (...) are normally viewed as simply matters of personal preference. (shrink)

Against the background assumptions that knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through (...) a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect – the reason for request – raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating ‘moral space’ for colleagues to process their moral experiences. (shrink)

Volume 19, Issue 10, October 2019, Page 43-46.

Clinical ethics consultants (CECs) work in complex environments ripe with multiple types of expectations. Significantly, some are due to the perspectives of professional colleagues and the patients and families with whom CECs consult and concern how CECs can, do, or should function, thus adding to the moral complexity faced by CECs in those particular circumstances. We outline six such common expectations: Ethics Police, Ethics Equalizer, Ethics Superhero, Ethics Expediter, Ethics Healer or Ameliorator, and, finally, Ethics Expert. Framed by examples of (...) requests for ethics consultation that illustrate each kind, along with brief descriptions, we argue that while these expectations ought to be resisted for clear and practical reasons, they also create opportunities for CECs to articulate, educate, and ultimately be responsible to the professional demands of clinical ethics work. Recognizing, acknowledging, and at times resisting those expectations thus become key activities and responsibilities in the performance of ethics consultation. (shrink)

I articulate what I refer to as Jefferson’s “land ethic,” drawing primarily from his Notes on the State of Virginia. In the first section, I discuss Jefferson’s conception of the intimate relationship between the natural and political constitution of America and his vindication of both. In the second section, I examine the centrality of the environment in Jefferson’s political vision for America: a landbasedrepublicanism. In the third section, I elaborate Jefferson’s view as to the proper relationship between human beings (...) and their environment by focusing on the form of nature to which he believes human beings most intimately relate: one’s estate. Jefferson’s understanding of the land draws from John Locke’s theory of property, but whereas Locke’s concept of property is closely associated with the economic values that facilitate human destruction of the environment, Jefferson’s environmentalism focuses on the other side of the relation: the ways in which a particular nature—a climate, one’s landholding, the New World in general–can influence human nature and politics. (shrink)

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

(2003). Ethical and Professional Demands for Forensic Mental Health Professionals in the Post-Atkins Era. Ethics & Behavior: Vol. 13, No. 1, pp. 3-9.

It has long been claimed that Homo sapiens is the only species that has language, but only recently has it been recognized that humans also have an unusual pattern of growth and development. Social mammals have two stages of pre-adult development: infancy and juvenility. Humans have two additional prolonged and pronounced life history stages: childhood, an interval of four years extending between infancy and the juvenile period that follows, and adolescence, a stage of about eight years that stretches from juvenility (...) to adulthood. We begin by reviewing the primary biological and linguistic changes occurring in each of the four pre-adult ontogenetic stages in human life history. Then we attempt to trace the evolution of childhood and juvenility in our hominin ancestors. We propose that several different forms of selection applied in infancy and childhood; and that, in adolescence, elaborated vocal behaviors played a role in courtship and intrasexual competition, enhancing fitness and ultimately integrating performative and pragmatic skills with linguistic knowledge in a broad faculty of language. A theoretical consequence of our proposal is that fossil evidence of the uniquely human stages may be used, with other findings, to date the emergence of language. If important aspects of language cannot appear until sexual maturity, as we propose, then a second consequence is that the development of language requires the whole of modern human ontogeny. Our life history model thus offers new ways of investigating, and thinking about, the evolution, development, and ultimately the nature of human language. (shrink)

This paper addresses the Harmful Dysfunction Analysis of mental disorder. We argue that some mental conditions meet both of its criteria —the dysfunction criterion and the harm criterion— and yet should not count as mental disorders because of their value. We contend that the harm criterion, by taking harm as a proxy for disvalue, is an inadequate normative criterion in these cases. Therefore, further ethical considerations should be included as a normative criterion. To illustrate our view, we draw on the (...) experience and reflections of Jean Améry, a philosopher and Holocaust survivor who resisted the diagnosis of KZ-Syndrom. (shrink)

Although all natural languages are spoken, there is no accepted account of the evolution of a skill prerequisite to language—control of the movements of speech. If selection applied at sexual maturity, individuals achieving some command of articulate vocal behavior in previous stages would have enjoyed unusual advantages in adulthood. I offer a parental selection hypothesis, according to which hominin parents apportioned care, in part, on the basis of their infants’ vocal behavior. Specifically, it is suggested that persistent or noxious crying (...) reduced care to individuals who would have had difficulty learning complex behaviors, and that cooing and babbling increased social interaction and care as well as control over complex oralmotor activity of the sort required by spoken language. Several different tests of the hypothesis are suggested. (shrink)

It has long been asserted that the evolutionary path to spoken language was paved by manual–gestural behaviors, a claim that has been revitalized in response to recent research on mirror neurons. Renewed interest in the relationship between manual and vocal behavior draws attention to its development. Here, the pointing and vocalization of 16.5-month-old infants are reported as a function of the context in which they occurred. When infants operated in a referential mode, the frequency of simultaneous vocalization and pointing exceeded (...) the frequency of vocalization-only and pointing-only responses by a wide margin. In a non-communicative context, combinatorial effects persisted, but in weaker form. Manual–vocal signals thus appear to express the operation of an integrated system, arguably adaptive in the young from evolutionary times to the present. It was speculated, based on reported evidence, that manual behavior increases the frequency and complexity of vocal behaviors in modern infants. There may be merit in the claim that manual behavior facilitated the evolution of language because it helped make available, early in development, behaviors that under selection pressures in later ontogenetic stages elaborated into speech. (shrink)

Parallels to Shanker & King's (S&K's) proposal for a model of language teaching that values dyadic interaction have long existed in language development, for the neotenous human infant requires care, which is inherently interactive. Interaction with talking caregivers facilitates language learning. The “new” paradigm thus has a decidedly familiar look. It would be surprising if some other paradigm worked better in animals that have no evolutionary linguistic history.

Falk claims that human language took a step forward when infants lost their ability to cling and were placed on the ground, increasing their fears, which mothers assuaged prosodically. This claim, which is unsupported by anthropological and psychological evidence, would have done little for the syllabic and segmental structure of language, and ignores infants' own contribution to the process.