Thinking critically in medicine and its ethics: relating applied science and applied ethics

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision-making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision-making.     

Coherence and applied ethics

In order for a moral theory to support application it must be able to provide determinate answers to actual moral problems or, at the least, to significantly narrow acceptable options. It must also support the development of a genuine consensus, one that is disinterested, reasonable, and unbiased. I argue that theories concentrating on principles, or on rules, or on particular cases fail to meet these standards. A full coherence theory, taking into account principles, rules, practices, and judgments holds the greatest promise for successful application. I present a detailed outline of a full coherence theory that is principled, pluralistic, and comprehensive. This coherence theory includes three basic principles (expressed both negatively and positively), but binds these, in terms of their explication and application, to rules and practices. This theory respects current practices but also directs us to change practices and institutions and even the interpretation of basic moral principles. The theory includes ways to determine which aspect of moral experience should take precedence in given circumstances, ways to determine who has particular obligations, and how — by means of a mutuality principle — value may be enhanced under conditions of value conflict.     

History and theory in "applied ethics"

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical grounds in dealing with two problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics.     

AIDS: ethics, justice and social policy

ABSTRACT Principles of justice and equality demand that HIV seropositive individuals and those with AIDS should not be discriminated against in any area of social provision. If social policy on AIDS is constructed in terms of reciprocal obligations, that is if obligations to the HIV seropositive individual and obligations of the HIV seropositive individual are given equal weight, the civil rights of HIV seropositive individuals may be secured and this may create a climate in which HIV seropositive individuals will more readily notify partners, and others at risk of infection, of their HIV status. It is conceivable that such a climate could facilitate greater control of the spread of HIV/AIDS.     

Jewish biomedical ethics and care of the AIDS patient

Jewish biomedical ethics form part of the broader Judeo-Christian ethical system that prescribes appropriate social conduct for most Americans. They are based on law(halachah) that is derived from the Hebrew Bible and its interpretations. The principle on which they center is that every person is sanctified by God and therefore of infinite value. Therefore, every effort must be made to preserve and protect human life. The management of the patient with AIDS engenders many problems of an ethical nature. An appreciation of the Judaic solutions to these problems may assist physicians caring for patients with AIDS in making their management decisions.     

Philip Roth'sPatrimony: Narrative and ethics in a case study

I assess the ethical content of Philip Roth's account of his father's final years with, and death from, a tumor. I apply this to criticisms of the nature and content of case reports in medicine. I also draw some implications about modernism, postmodernism and narrative understandings.A version of the first two sections of this paper was presented at the annual meeting of the Society for Health and Human Values November 6, 1993, Washington, D.C.     

Geography and computer ethics: An Eastern European perspective

Several context-specific social and political factors in Eastern and Central Europe are described — factors that must be considered while developing strategies to introduce Computer Ethics. Poland is used as a primary example. GNP per capita, the cost of hardware and software, uneven and scant distribution of computing resources, and attitudes toward work and authority are discussed. Such “geographical factors” must be taken into account as the new field of Computer Ethics develops.     

The case of Peter: reflections on applied ethics in a neonatal intensive care unit

The case of Peter is reflected upon in order to highlight some of the moral theorising that could be brought to bear in the process of providing palliative care for sick neonates. The situation will be discussed using the theoretical lenses of deontological and virtue ethics. Nursing practice is considered as engaged moral reasoning where the nurse brings his/her beliefs, knowledge and experience into the situation and engages in reflexivity to provide appropriate ongoing patient care. The care should be provided in culturally sensitive manner and tailored to the needs of the newborn and their family. Nurses should initiate early consultations with colleagues, medical staff and families to address concerns about patient well-being in order to enhance the well-being of patients and families and to improve the work environment making it more conducive to care.     

Ethical beliefs and behaviors in applied sport psychology: The AAASP ethics survey

Abstract

AAASP members (N = 508) were surveyed to obtain preliminary data on ethical beliefs and behaviors specific to the practice of applied sport psychology. Completed surveys were received from 165 individuals. On the structured response portion of the survey, there were few differences in ethical beliefs and behaviors as a function of gender, professional/student status, and academic discipline. Nevertheless, a large number of controversial behaviors (N = 24) and difficult judgments (N = 8) were identified. Results of the open-ended portion of the survey indicated that most of the questionable ethical practices cited by respondents corresponded to violations of American Psychological Association (APA) Ethical Standards. The findings lend initial support for AAASP to adopt the APA Ethical Standards and suggest the need for ethics training specific to applied sport psychology.     

The ethics and politics of small sacrifices in stem cell research

Pluripotent human stem cell research may offer new treatments for hundreds of diseases, but opponents of this research argue that such therapy comes attached to a Faustian bargain: cures at the cost of the destruction of many frozen embryos. The National Bioethics Advisory Commission (NBAC), government officials, and many scholars of bioethics, including, in these pages, John Robertson, have not offered an adequate response to ethical objections to stem cell research. Instead of examining the ethical issues involved in sacrificing human embryos for the goal of curing fatal and disabling diseases, they seek to either dismiss the moral concerns of those with objections or to find an "accomodation" with those opposed to stem cell research. An ethical argument can be made that it is justifiable to modify or destroy certain human embryos in the pursuit of cures for dread and lethal diseases. Until this argument is made, the case for stem cell research will rest on political foundations rather than on the ethical foundations that the funding of stem cell research requires.     

Scientific misconduct and science ethics: a case study based approach

The Schön misconduct case has been widely publicized in the media and has sparked intense discussions within and outside the scientific community about general issues of science ethics. This paper analyses the Report of the official Committee charged with the investigation in order to show that what at first seems to be a quite uncontroversial case, turns out to be an accumulation of many interesting and non-trivial questions (of both ethical and philosophical interest). In particular, the paper intends to show that daily scientific practices are structurally permeated by chronic problems; this has serious consequences for how practicing scientists assess their work in general, and scientific misconduct in particular. A philosophical approach is proposed that sees scientific method and scientific ethics as inextricably interwoven. Furthermore, the paper intends to show that the definition of co-authorship that the members of the Committee use, although perhaps clear in theory, proves highly problematic in practice and raises more questions that it answers. A final plea is made for a more self-reflecting attitude of scientists as far as the moral and methodological profile of science is concerned as a key element for improving not only their scientific achievements, but also their assessment of problematic cases.     

Elaborative interrogation applied to small and large group contexts

The present study examined the application of elaborative interrogation (EI), a questioning strategy, to ecologically valid classroom contexts. Instruction was provided to individuals, small groups of five, and large groups of 20. Recall performance did not differ as a function of group size. For individuals, small and large groups, EI subjects outperformed repetition control subjects.     

Emotional interactions and an ethics of care: Caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.     

Religion and development ethics in global perspective: a case study of a foreign Christian NGO in China

ABSTRACT

Much academic writing on religion and development tends to focus on the values, beliefs, and modes of operation of religious organizations to examine whether religion contributes ethically to development. A problem with such an approach is its disregard of the contested and evolving nature of religious participation in development in broader national and global contexts. What constitutes ethical religious contribution to development? How can we study the question sociologically? To answer these two questions, I develop Roland Robertson’s notion of the global field to present a framework for analyzing the dynamic interaction between religion and development ethics. In terms of methodological contribution, the framework proposed here prompts us dynamically to contextualize the issue of religious development ethics with reference to four components that make up the global field: the religious agent, the national society, the global civil society, and the global discourse on wellbeing and development. This means that, from an analytical perspective, what is proper or ethical in religious development ethics should not be construed in absolute terms, but in terms of degree and variation. I demonstrate the usefulness of such a contextual approach by drawing on research on ‘GMV’ (pseudonym for an international Christian medical professional services group actively engaged in community development) in China and examining the relationship between religious NGOs, the party-state, and evolving discursive practice of development in the country.     

Communicating HIV/AIDS Through African American Churches in North Carolina: Implications and Recommendations for HIV/AIDS Faith-Based Programs

This study explores HIV/AIDS communication strategies among church leaders at predominately African American churches in a metropolitan city and surrounding areas in North Carolina. The church leaders contacted for the study are members of an interfaith-based HIV/AIDS program. The researchers used semi-standardized interviews to explore how church leaders address HIV/AIDS in the church. The findings indicate that the seven church leaders who participated in the study use a variety of communication channels to disseminate HIV/AIDS information for congregants and their surrounding communities, which include both interpersonal and mass media.