Inadequacies with the ACOG and AAP statements on managing ethical conflict during the intrapartum period

[The American College of Obstetricians and Gynecologists] takes the view that respect for the autonomy of the pregnant woman should be almost absolute and [the American Academy of Pediatrics] takes the view that respect for the autonomy of the pregnant woman should be limited or prima facie in character. ACOG's reading of this central bioethical principle admits of virtually no exceptions, while AAP's reading does allow exceptions....A complete account of obstetric ethics that would apply in clinical practice during the intrapartum period must take into account both negative and positive autonomy-based rights of the pregnant woman and beneficence-based obligations to the at-term fetus -- and to the pregnant woman, as well. Such an account will be, we believe, more clinically applicable than the accounts offered by ACOG and AAP.     

An analysis of indefinite probability statements

An analysis of indefinite probability statements has been offered by Jackson and Pargetter (1973). We accept that this analysis will assign the correct probability values for indefinite probability claims. But it does so in a way which fails to reflect the epistemic state of a person who makes such a claim. We offer two alternative analyses: one employing de re (epistemic) probabilities, and the other employing de dicto (epistemic) probabilities. These two analyses appeal only to probabilities which are accessible to a person who makes an indefinite probability judgment, and yet we prove that the probabilities which either of them assigns will always be equivalent to those assigned by the Jackson and Pargetter analysis.     

Application of the APA ethics code for psychologists working in integrated care settings: Potential conflicts and resolutions

ABSTRACT

Increasingly, there is evidence of the potential benefits of an integrated care model. In fact, the American Psychological Association (APA) supports the role of psychologists in integrated healthcare given the positive outcomes for patients in primary care settings such as increased access to mental health services, reduced mental illness stigma, and improved health associated with recognizing the impact of psychosocial factors on physical wellbeing. Less attention has been paid, however, to ethical dilemmas that may arise for psychologists working in integrated healthcare. This paper explores considerations for resolving potential ethical conflicts that may arise for psychologists working in integrated care settings.     

儒佛政治伦理的冲突与融合——以沙门拜俗问题为中心

中国佛教徒曾经长期以"高尚其迹"相标榜,坚持出家不拜俗的印度传统.一些固守儒家传统的人士攻击佛教"无父无君",损害了封建纲常名教.从东晋至唐朝,朝廷举行了多次关于沙门拜俗的争论,其中以东晋成康、元兴、唐高宗龙朔二年的争论最为激烈.中国佛教僧人在元代彻底地改变了出家人不拜俗的戒条,接受了儒家忠孝至上的政治伦理原则.中国佛教与王权的关系体现了中国佛教以出世的精神服务于现实政治的伦理关怀,体现了中国传统政治的民主精神和对外来宗教文化的宽容态度,体现了儒家的忠孝伦理在中国传统社会的主导价值,体现了佛教"契机契理"的圆融精神.     

An analysis of ethics consultation in the clinical setting

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.     

Reflections on teaching health care ethics on the web

As web instruction becomes more and more prevalent at universities across the country, instructors of ethics are being encouraged to develop online courses to meet the needs of a diverse array of students. Web instruction is often viewed as a cost-saving technique, where large numbers of students can be reached by distance education in an effort to conserve classroom and instructor resources. In practice. however, the reverse is often true: online courses require more of faculty time and effort than do many traditional classes. Based on personal experience teaching an online course in health care ethics for students in the Allied Health Professions, it is evident that there are both benefits and challenges in teaching online courses, particularly in ethics. Examples of benefits are (1) the asynchronous nature of web instruction allows students to progress through the course at their own pace and at times that are convenient given their clinical responsibilities; (2) web courses allow for a standardization of content and quality of instruction over a diversity of programs; and (3) examples can be tailored to the differing experiences of students in the course. Some challenges to teaching online ethics courses include (1) the fact that online instruction benefits visual learners and disadvantages those lacking good reading comprehension or strong writing skills; (2) developing meaningful student-student and student-instructor interaction; and (3) teaching ethics involves teaching a process rather than a product. Allowing students to apply their knowledge to real-world cases in their disciplines and encouraging them to share experiences from clinical practice is an effective way to meet several of these challenges. Building an online community is another good way to increase the interaction of students and their engagement with the material.     

Integrating justice and care in animal ethics

In this paper I argue that the standoff between justice and care approaches to animal ethics presents us with a false dilemma. We should take justice's focus on reasoning from principles, and care's use of sympathetic awareness, as two integrated deliberative capacities necessary for the consideration of arguments for extending moral concern to animals. Such an integrated approach rests on a plausible account of the psychology of moral deliberation. I develop my argument as follows. Section I summarizes the nature of the debate between justice and care approaches to animal ethics, focusing on Brian Luke's arguments against justice approaches. Section II provides pro-justice rebuttals to Luke's objections. These rebuttals, while largely successful against Luke's objections, do not account for the intuition that sympathy does play a central epistemological role in animal ethics. Section III explains how sympathy cognitively simulates the perspective of the other, and thus can play an epistemological role in animal ethics. I argue that the abilities to simulate the perspective of the other and to reason from moral principles can complement each other. In section IV, I argue that though it may not be desirable to use both sympathy and reasoning from principles in all moral deliberation, it is a desirable aim when offering, and considering, moral arguments for what I will term the "extensionist project" of extending over moral concern to animals. I make this idea plausible by elucidating the claim that arguments for this project are best thought of as second-order deliberations about our first-order deliberative life.     

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.     

Fry's concept of care in nursing ethics

Sara T. Fry maintains that care is a central concept for nursing ethics. This requires, among other things, that care is a virtue rather than a mode of being. But if care is a central virtue of ethics and medical ethics then the claim that care is a central concept for nursing ethics is trivial. Otherwise, it is implausible.     

Jewish medical ethics in the care of the cancer patient

The care of the patient with cancer requires the development not only of a medical plan, but an ethical plan as well. This plan should integrate the physician's and the patient's perceptions of medical and ethical propriety. Jewish biomedical ethical principles are based on the teaching of the Old Testament and its various interpretations. In this paper, I discuss how these principles can be used to help guide the physician caring for the patient with cancer. Other ethical systems could be applied in a similar fashion.     

Codes of medical ethics and the exportation of less-than-standard care

Recently a number of AIDS/AZT research studies, carried out by U.S. universities, have come under intense ethical scrutiny. In these studies, control groups of HIV-positive pregnant women were being given a placebo rather than AZT. Such research protocols would be illegal if practiced in the U.S. I examine a number of lamentable ethical lapses in the studies, and conclude that at least some of these ethical problems are traceable to a troubling contradiction between differing international codes of ethics. In a word, some international codes mandate that all research subjects (including control groups) receive the best standard of care available in the country sponsoring the research, while others suggest that providing only a "local" standard of care is ethically appropriate. I argue that these two ethical mandates cannot both be satisfied, and that host country populations will remain subject to exploitation unless this contradiction is resolved.     

Ethics, theism and metaphysics: An analysis of the theocentric ethics of James Gustafson

Modern ethics has been shaped by two dominant philosophical assumptions: (1) that there can be no theoretical knowledge of God, i.e., denial of metaphysics, and (2) that moral claims can be redeemed independently of theistic affirmations, i.e., morality does not require theism. These assumptions have influenced much of modern theological ethics. Yet, insofar as theological ethics accepts that morality does not require any explicit or implicit religious beliefs, it affirms that a secularistic morality is possible. But this affirmation is directly at odds with the essence of theism, namely, that God is the source and end of all things, including the moral life. By accepting the dominant consensus, therefore, theological ethics undermines its fundamental theistic claim. Focusing on James Gustafson's theocentric ethics, I seek to show the price that theological ethics pays for subscribing to the dominant consensus. I argue that: (1) Gustafson embraces an inconsistent self-understanding, which undermines his theocentric claim, (2) this is due to his dismissal of metaphysics, and (3) his theocentric ethic would be more compelling if formulated in terms of Whitehead's process metaphysics.     

Comradery,community, and care in military medical ethics

Medical ethics prohibits caregivers from discriminating and providing preferential care to their compatriots and comrades. In military medicine, particularly during war and when resources may be scarce, ethical principles may dictate priority care for compatriot soldiers. The principle of nondiscrimination is central to utilitarian and deontological theories of justice, but communitarianism and the ethics of care and friendship stipulate a different set of duties for community members, friends, and family. Similar duties exist among the small cohesive groups that typify many military units. When members of these groups require medical care, there are sometimes moral grounds to treat compatriot soldiers ahead of enemy or allied soldiers regardless of the severity of their respective wounds.     

An ethics of expertise based on informed consent

Ethicists widely accept the notion that scientists have moral responsibilities to benefit society at large. The dissemination of scientific information to the public and its political representatives is central to many of the ways in which scientists serve society. Unfortunately, the task of providing information can often give rise to moral quandaries when scientific experts participate in politically charged debates over issues that are fraught with uncertainty. This paper develops a theoretical framework for an “ethics of expertise” (EOE) based on the notion that scientists have responsibilities to provide information in a way that promotes autonomous decision-making on the part of the public and its representatives. Moreover, insofar as the principle of informed consent has developed in biomedical ethics as a way for physicians to promote autonomous decision-making on the part of their patients, this paper suggests that the informed-consent concept may suggest a set of criteria and guidelines that can help scientists to fulfill their similar ethical responsibilities to the public. In order to illustrate how the resulting EOE could provide practical guidance for scientific experts, the paper examines a case study involving the dissemination of information about the low-dose biological effects of toxic chemicals and carcinogens.     

Precarious life and the ethics of care: Subjectivity in an Indian religious phenomenon

This article relates certain figures of the subject in an emergent Indian pilgrimage. On the basis of ethnographic research and 15 in-depth interviews, I show that these religious subjectivities, phenomenologically immersed in highly precarious material conditions, are radically relational. Observations on the pilgrimage (en)counter the cognitivist assumptions of a body of scholarly opinion on contemporary religious practice. The analyst's attention to pilgrimage rituals and narratives traverses sociological, phenomenological, and psychoanalytic theories, and is, thereby, drawn to important questions of self, ethics, and time.