Can applied ethics be effective in health care and should it strive to be?

Drawing upon his work in medical centers, Caplan explores the question of how well ethicists function in hospitals. He asks if their use of the "engineering model" of applied ethics, which emphasizes conceptual clarification, mastery of ethical theory, and impartiality, has made any difference in the way medicine is practiced. Noting that ethicists have been more effective in influencing heatlh policy at the national than at the institutional level, Caplan concludes that they have been less successful in teaching medical ethics, working with health personnel, and helping to formulate hospital policies. He attributes their difficulties primarily to the inadequacies of the engineering model of applied ethics for solving problems in a clinical setting. Caplan cautions ethicists to be aware both of the limitations of the engineering model and of the motives of health personnel in asking for help which may have little to do with resolving moral dilemmas.     

Sex-role attitudes: Who should raise consciousness?

Attitudes of teachers and counselors-in-training toward women's roles, sex-role identity, and tolerance for gender-role norm violators were examined following a semistructured consciousness-raising group. Significant differences were found between the two treatment groups on the Attitudes Towards Women Scale. The results are discussed in terms of social reinforcement of a feminist model as instructor. The study casts doubt on the generalizability of traditional attitudes among helping professionals and raises the practical question of who should teach courses and workshops in sex-fair counseling.     

The state,human rights and the ethics of war termination: what should a just peace look like? A critical appraisal

The concept of jus post bellum deals with moral considerations in the aftermath of conflict and is concerned with how a just peace should look like. This paper analyses the concept of jus post bellum as developed by contemporary Just War theorists. Its aim is to provide a critical perspective on the proposed substantial scope of this concept. In other words, it will consider the question: in restoring peace after war, is it justified for just combatants to change the political structure of a defeated aggressor? The piece will be divided into two main parts. First, through a review of the literature, I define the current state of the art on jus post bellum thinking in relation to a number of key aspects of this concept. What does241 it entail? Which principles is it made of? What sort of activities do just war theorists speak about when they speak of creating a just peace? Second, I focus on the principle of ‘political rehabilitation’ of the defeated state: is it permissible? Under what circumstances? While considering these questions and authors' views on this matter, the paper will provide a critical reappraisal of the current debate on the justifiability of political reconstruction in post-conflict states.     

The dead donor rule: how much does the public care...and how much should we care?

In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as death" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding an individual's definition of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics.     

Mandating vaccination: what counts as a "mandate" in public health and when should they be used?

Recent arguments over whether certain public health interventions should be mandatory raise questions about what counts as a "mandate." A mandate is not the same as a mere recommendation or the standard of practice. At minimum, a mandate should require an active opt-out and there should be some penalty for refusing to abide by it. Over-loose use of the term "mandate" and the easing of opt-out provisions could eventually pose a risk to the gains that truly mandatory public health interventions, such as childhood vaccines, have provided over the last 50 years. Already, confusion about what counts as a mandate, and about what criteria should be used to determine when a public health intervention should be implemented as a mandate, has led to some inappropriate public policy decisions. For instance, by any reasonable criteria, the yearly influenza vaccine should be mandatory for health care workers. To enforce this mandate, those who refuse vaccination should be required to sign a waiver, and patients - especially those at high risk from flu - should be informed when they receive care from unvaccinated practitioners.     

Water clubs in residential care: Is it the water or the club that enhances health and well-being?

Recent research suggests that establishing water clubs in care homes can counteract the dangers of dehydration and enhance residents’ health and well-being. This study provided an experimental test of this idea, and also explored the possibility that it is the social interaction that clubs provide which delivers health-related benefits. Consistent with this hypothesis, the study found no evidence that, on its own, increased focus on water consumption enhanced residents’ health or well-being. However, residents who took part in water clubs showed improved levels of perceived social support, and those who participated in water and control clubs showed beneficial outcomes in terms of the number of General Practitioner calls they required. Consistent with a social identity approach to health and well-being, a mediation analysis also indicated that clubs achieve these positive outcomes by providing social support that helps to build a shared sense of social identity among residents.     

Plausible assumptions, questionable assumptions and post hoc rationalizations: Will the real IAT, please stand up?

In a recent article, we described psychometric limitations to the Implicit Association Test (IAT). These limitations restrict the utility of this measure and render it problematic for testing many psychological theories that posit a causal role for implicit attitudes. Past failures to recognize this may have promoted faulty conclusions in the literature. In a critique of our article, Nosek and Sriram rejected our entire analysis. They asserted that our original article was based on faulty assumptions and argued that the IAT performs nicely when these assumptions are replaced by other, more plausible assumptions. We show that these plausible assumptions have all the hallmarks of post hoc rationalizations. They make little theoretical sense, are buttressed by deceptive statistical practices, contradict statements these same researchers have made in the past and do little to advance research and theory on implicit attitudes. We close by considering the vigor with which IAT researchers have dismissed meaningful criticisms of their measure.     

Water clubs in residential care: is it the water or the club that enhances health and well-being?

Recent research suggests that establishing water clubs in care homes can counteract the dangers of dehydration and enhance residents' health and well-being. This study provided an experimental test of this idea, and also explored the possibility that it is the social interaction that clubs provide which delivers health-related benefits. Consistent with this hypothesis, the study found no evidence that, on its own, increased focus on water consumption enhanced residents' health or well-being. However, residents who took part in water clubs showed improved levels of perceived social support, and those who participated in water and control clubs showed beneficial outcomes in terms of the number of General Practitioner calls they required. Consistent with a social identity approach to health and well-being, a mediation analysis also indicated that clubs achieve these positive outcomes by providing social support that helps to build a shared sense of social identity among residents.     

Age rationing and the just distribution of health care: is there a duty to die?

The author analyzes the argument that a policy involving distributive justice in the allocation of scarce health care resources, based on the strategy of rational self interest maximation under a veil of ignorance (Rawls/Daniels), would result in an age rationing system of voluntary, socially encouraged, direct termination of the lives of the elderly rather than their medical abandonment. She maintains that such a policy would be a fair response only in a situation of substantial scarcity of resources that cannot be relieved without introducing greater injustices. Battin suggests that some of the current pressure on resources could be reduced by pruning waste and the expenses attributable to paternalistic imposition of treatment and to the practice of defensive medicine. She also advocates reconsideration of societal priorities assigned to various social goods.     

Normative influence on retirement savings decisions: Do people care what employers and the government want?

The need for Australians to increase retirement savings has been widely promoted. Yet our understanding of the motivations of individuals to save at a higher rate remains sparse. This article reports the findings of a survey of superannuation fund members and their intentions to contribute more to superannuation and to manage their investment strategy. The article uses the theory of planned behaviour to focus on the important motivational influence of social norms. Formative research identified a number of influential social referents. Among identified referents, the study found that spouses appear to be the primary source of social influence for retirement savings decisions. The government and employers appear to exert little influence, and financial advisors and superannuation funds take up the middle ground of social influence. Possibilities for interventions designed to influence behaviour are discussed; however, conclusions are tempered by the fact that correspondence between intention and behaviour is not tested in the present research.     

A blessing in disguise? Empowering Catholic health care institutions in the current health care environment.

Health care institutions, including Roman Catholic institutions, are in a time of crisis. This crisis may provide an important opportunity to reinvigorate Roman Catholic health care. The current health care crisis offers Roman Catholic health care institutions a special opportunity to rethink their fundamental commitments and to plan for the future. The author argues that what Catholic health care institutions must first do is articulate the nature of their identity and their commitments. By a renewed commitment to the praxis of health care on their own distinctive terms, Roman Catholic health care institutions may reestablish a vision of human nature and human service in an increasingly secular society. Health care could then reclaim its place as a powerful setting for the expression of Roman Catholic faith, life and witness.     

Roman Catholic health care identity and mission: does Jesus language matter?

This article examines the current use of Jesus language in a convenience sample of twenty-five mission statements from Roman Catholic hospitals and health care systems in the United States. Only twelve statements specifically use the words "Jesus" or "Christ" in their mission statements. The author advocates the use of explicit Jesus language and modeling. While the witness of Jesus in the Gospel healing narratives is not only the corrective to current abuses in the health care delivery system, it is foundational to the integrity of Roman Catholic health care identity and mission. An analysis of Gospel healing narratives is used to illustrate the prophetic dimension of Jesus' wisdom, word, and witness.     

Why treat the wounded? Warrior care, military salvage, and national health

Because the goal of military medicine is salvaging the wounded who can return to duty, military medical ethics cannot easily defend devoting scarce resources to those so badly injured that they cannot return to duty. Instead, arguments turn to morale and political obligation to justify care for the seriously wounded. Neither argument is satisfactory. Care for the wounded is not necessary to maintain an army's morale. Nor is there any moral or logical connection between the right to health care (a universal human right) and the duty to defend one's nation (a local political duty). Once badly wounded, soldiers enjoy the same right to medical care as any similarly ill or injured individual. National health care systems grasp this point and offer few additional health care benefits to veterans. In the United States, however, lack of universal health coverage skews the debate to focus on special entitlements for veterans without considering the health care rights that other citizens enjoy.