Exemplary cases in clinical ethics: commentary on the case of Mr. A

A commentary on a case of a man who is left a "high quad" (ventilator dependant as well as quadriplegic) after an accident discusses the following: The right of patients who sustain catastrophic injuries to choose to discontinue life-sustaining treatment, The role of capacity assessment in treatment decisions and in ethics consultations, The role of advance directives (ADs) for such patients if they lack capacity, Whether a do-not-resuscitate or do-not-attempt-resuscitation order should be seen as "a medical order" or an advance directive, Some hints about what might be intended when a patient refers to the criterion of having a "meaningful life."     

The poehlman case: running away from the truth

Eric T. Poehlman, Ph.D., was an internationally recognized, tenured professor at the University of Vermont (UVM) in Burlington when, in October 2000, a junior member of Poehlman’s laboratory became convinced that he had altered data from a study on aging volunteers from the Burlington area. This suspicion developed into one of the most significant cases of scientific misconduct in the history of the US Department of Health and Human Services’ (HHS) Office of Research Integrity (ORI), launching a US Department of Justice (DOJ) civil and criminal fraud investigation and, eventually, to a much publicized guilty plea and felony conviction. In the end, Dr. Poehlman admitted to 54 findings of scientific misconduct made by the UVM and ORI, agreed to retract or correct ten of his publications and to exclude himself from federal procurement and nonprocurement transactions for life. The United States Government’s handling of this case was distinguished by a highly cooperative approach that integrated the resources of the US Attorney’s Office for the District of Vermont (USAO) and both ORI and the Office of the Inspector General (OIG) in HHS in the common goal of prosecuting research fraud. The content of this article represents the personal views of the authors and does not express the opinion or policy of DHHS or its components. A paper on this topic was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

"Worlds apart": truth telling in the case of Mrs. VV

This article discussed how the views of a terminal cancer patient and her family, who were immigrants from Romania, differed from those of her North American caregivers. It presents evidence about truth telling to cancer patients in Eastern Europe and general cultural differences in attitudes to truth telling. Literature on how to span the gap between different cultural worlds is reviewed. Conclusions address ways to minister to patients who come from "different worlds" than their caregivers.     

De-idealization by commentary: the case of financial valuation models

Is there a unique way to de-idealize models? If not, how might the possible ways of reducing the distortion between models and reality differ from each other? Based on an empirical case study conducted in financial markets, this paper discusses how a popular valuation model (the Discounted Cash Flow model) idealizes reality and how the market participants de-idealize it in concrete market situations. In contrast to Cartwright’s view that economic models are generally over-constrained, this paper suggests that valuation models are under-constrained. This serves as the reason why the relaxation of simplifying assumptions and concretization do not work as methods of de-idealization. The paper finds that financial market participants de-idealize models using commentary that takes the form of judgment. As a conclusion, a hypothesis is formulated that proposes that the more underdetermined the model is the bigger role narrative and other pragmatic elements play in the process of model application.     

The case of Dr. Jekyll and Mr. Hyde: a kinematic study on social intention

The aim of the present study was to investigate the effects of social intentions on action. Participants (N=13) were requested to reach towards, grasp an object, and either pass it to another person (social condition) or put it on a concave base (single-agent condition). Movements' kinematics was recorded using a three-dimensional motion analysis system. The results indicate that kinematics is sensitive to social intention. Movements performed for the 'social' condition were characterized by a kinematic pattern which differed from those obtained for the 'single-agent' condition. Results are discussed in terms of a motor simulation hypothesis, which assumes that the same mechanisms underlying motor intention are sensitive to social intentions.