The Hastings Center and the early years of bioethics

The Hastings Center was founded in 1969 to study ethical problems in medicine and biology. The Center arose from a confluence of three social currents: the increased public scrutiny of medicine and its practices, the concern about the moral problems being generated by technological developments, and the desire of one of its founders (Callahan) to make use of his philosophical training in a more applied way. The early years of the Center were devoted to raising money, developing an early agenda of issues, and identifying a cadre of people around the country interested in the issues. Various stresses and strains in the Center and the field are identified, and some final reflections are offered on the nature and value of the contributions made by bioethics as an academic field.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Ethics and Nanopharmacy: Value Sensitive Design of New Drugs

Although applications are being developed and have reached the market, nanopharmacy to date is generally still conceived as an emerging technology. Its concept is ill-defined. Nanopharmacy can also be construed as a converging technology, which combines features of multiple technologies, ranging from nanotechnology to medicine and ICT. It is still debated whether its features give rise to new ethical issues or that issues associated with nanopharma are merely an extension of existing issues in the underlying fields. We argue here that, regardless of the alleged newness of the ethical issues involved, developments occasioned by technological advances affect the roles played by stakeholders in the field of nanopharmacy to such an extent that this calls for a different approach to responsible innovation in this field. Specific features associated with nanopharmacy itself and features introduced to the associated converging technologies- bring about a shift in the roles of stakeholders that call for a different approach to responsibility. We suggest that Value Sensitive Design is a suitable framework to involve stakeholders in addressing moral issues responsibly at an early stage of development of new nanopharmaceuticals.     

Bridging Conversations: Discussing the Intra‐professional Relationship between Medical Family Therapy and Family Therapy

This article examines the conceptual and practice relationship between medical family therapy (MedFT) and its parent field, family therapy, with MedFT viewed as the extension of relational sense‐making and understanding into a specific venue; that of medicine. The extension of this relational meaning system into medicine is typified by the ability of the therapist to negotiate and connect three main areas of conceptual difference that often account for conflictual relationships between mental and biomedical healthcare providers: (i) patient and provider conceptualizations of issues and goals, (ii) linear and circular understanding of issues and goals and (iii) consultative and expert positions on issues and goals. Two case examples are offered to describe how these three areas of tension are reconciled in practice.     

Andre Hellegers and Carroll House: architect and blueprint for the Kennedy Institute of Ethics

The Newman programs established at secular colleges and universities provided an opportunity for intellectual, spiritual, and social growth among the Catholic student population. As a young physician and junior medical faculty member, Andre Hellegers took part in the early organization and ongoing work of Carroll House, the Newman Center at the Johns Hopkins Medical Institutions. Helleger's experience at Carroll House enabled him to develop a clear blueprint of an academic center of excellence for the scientific, theological, and philosophical exploration of the many problems that he had seen and foresaw in medicine. That center would become Georgetown's Kennedy Institute of Ethics.     

Teaching Ethics to Engineers: Ethical Decision Making Parallels the Engineering Design Process

In order to fulfill ABET requirements, Northern Arizona University’s Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to “grey” or multiple possible solution technical problems. To identify and solve these problems, the engineering design process is used. Ethical problems are also “grey” problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue.     

Further extensions of precision medicine to behavior analysis: A demonstration using functional communication training

The potential applicability of concepts and methods of the paradigm of precision medicine to the field of applied behavior analysis is only beginning to be explored. Both precision medicine and applied behavior analysis seek to understand and classify clinical problems through identification of their causal pathways. Both aim to develop treatments directly targeting those causal pathways, which also requires an understanding of the mechanisms by which treatments produce change (treatment-action pathways). In the current study, we extend the data-analytic methods and concepts described by Hagopian et al. (2018) toward the identification of variables that predict response to functional communication training (FCT). We discuss emerging conceptual issues, including the importance of distinguishing predictive behavioral markers from predictor variables based on their purported involvement in the causal or treatment-action pathways. Making these discriminations is a complex undertaking that requires knowledge of these mechanisms and how they interact.     

Freitas on Disease in Nanomedicine: Implications for Ethics

This paper critically examines the volitional normative model of disease and its underlying nanotechnologic vision of medicine both defended by Robert Freitas. Having provided an account of this vision, we explicate the highlight of the model, which is a concept of disease based on individual values and preferences. The model’s normative positions are then critiqued based on our argument that the epistemic basis of Freitas’s vision of nanotechnologic medicine and, by extension, of his volitional normative model of disease is scientifically flawed. An ethical and social critique of the model is then conducted on the basis of the model’s implicit ethical underpinnings. We argue that Freitas fails to justify the normativity of his model by not addressing the ethical issues that permeate it, one of which is the question of responsibility regarding the development of medical nanotechnology and the practice of new forms of medicine such as the one he envisions. We conclude that, due to its radically individualistic position, the model implies an unjustified view of nanoethics and relegates this field of ethics to the periphery of discussions of nanomedicine.     

From method to hermeneutics: which epistemological framework for narrative medicine?

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice.     

“And Let Us Make Us a Name”: Reflections on the Future of the Religion and Health Field

After years of marginality, research on religion and health is entering the academic mainstream. Scholarship on this topic has evolved into a large, productive field. As in any emerging field, there are competing visions for what the field should be about and what research questions should be pursued. Different opinions exist as to which constructs should be researched. Words like religion, spirituality, faith, and prayer, and health, healing, medicine, and healthcare, imply different things. The study of their various interconnections can thus take myriad forms. This article argues for a welcoming approach open to the widest range of research subjects. An earlier version of this article was presented as a Visiting Scholar Seminar, Duke Center for Spirituality, Theology, and Health, Duke University Medical Center, Durham, NC, March 6, 2008.     

Community Science: Creating an Alternative Place to Stand?

This article comments on two emerging views of community psychologys approaches to the use of research for responding to social problems in contemporary community contexts – (a) the formation of a new field of community science, or (b) the updating of community psychology research traditions. If community science is to become established as a field related to community psychology, its proponents will need to agree upon conventions of epistemology, foci of interest, methods, and standards by which its work can be judged so that it can be distinguished from other human sciences. These articles provide early sketches for what community science might be. However, as noted in this commentary, we need to heed signs of concern about community psychologys continued relevance in public discourse regarding the analysis of and responses to social problems. While this special issue offers some promising responses to the concern of what the field can contribute, the field would be well served if we broaden our dialogue about a renewal of community psychologys commitment to social justice and the need for its perspectives in the practice of research that seeks to address community-based issues in the early 21st century.     

Assesement of young children

Discusses important issues and problems related to the assessment of young children. A review of the literature identifies major trends in the field of assessment in early childhood education. Authors conclude that with increased emphasis on assessment of young children, there is an increased need to develop teachers' skills in both selection and interpretation of appropriate formal and informal assessment techniques.     

Growing Pains: A Theory of Stress and Moral Conflict

This article outlines a relationship between the crises that create stress in our lives and periods of instability in moral development. Stressful issues, we suggest, are more difficult to resolve during periods of developmental instability. When problems are most stressful we often experience the impact of that stress physiologically. The physiological symptoms of stress, we argue, reflect unresolved problems in primary relationships that occurred during the early (sensorimotor) developmental stages when feelings are experienced physiologically. In this way the physiological symptoms of stress become a metaphoric map for the developmental resolution of moral issues. Thus, stress and its symptoms, rather than becoming debilitating, can be reconstructed as “Growing Pains.”     

The history and future of the office of research integrity: Scientific misconduct and beyond

This paper looks at the issues and controversies that led to creation of the Office of Research Integrity (ORI) and that dominated its agenda in the early years. The successes and failures of ORI are described and new problems identified. This paper then looks ahead to the future, considering what issues will dominate ORI’s agenda and affect the research institutions, individual scientists, and the scientific community in the next several years.     

Nanoethics—A Collaboration Across Disciplines

The field of nanoscience and nanotechnology is expanding rapidly, promising great benefits for society in the form of better medicine, more efficient energy production, new types of materials, etc. Naturally, in order for the science and technology to live up to these promises, it is important to continue scientific research and development, but equally important is the ethical dimension. Giving attention to the social, ethical and legal aspects of the field, among others, will help in developing a fully responsible—and thereby capable—science and technology. Nanoethics has emerged as a field concerned with such ethical issues related to nanoscience and nanotechnology. Even though this field is relatively new, a significant amount of literature has already been published. This paper focuses on three of the major issues which are discussed in the literature of nanoethics, and also points to a certain bias in this literature. Each quite different in nature, these issues are: (1) The naming and (2) the timing of and approach to the field, as well as (3) the issue of safety. As will be seen, these issues are almost exclusively discussed by ethicists, (throughout the article, the term’ethicist’ is used in a broad definition covering philosophers, social and political scientists as well as philosophers of science) thus having no direct influence on the work being carried out by scientists. One can argue, therefore, that this bias creates a distortion of the ethical debate, making it insufficient and misleading. Ultimately, this bias is caused by the lack of communication and collaboration between ethicists on the one hand, and nanoscientists on the other. Thus, an argument is made for the different disciplines to begin collaborating, so as to more effectively and responsibly develop the field of nanoscience.     

No Means Yes? Perpetuating Myths in the Sexological Construction of Women's Desire

The diagnosis and treatment of desire disorders are contentious issues within sexual medicine today. The issue of women's sexual desire (or rather lack of sexual desire) in particular, has highlighted a variety of problems within the current diagnostic framework for sexual dysfunctions. In an effort to rectify some of these problems, the concept of receptivity has been put forward by a number of clinicians with the suggestion that this better reflects women's experiences of desire. It is argued here, however, that he concept of receptivity presents serious problems for women in heterosexual relationships. Rather than helping women, furthering this concept may simply reinforce male sexual demands, curtail women's sexual autonomy, and promote coercive sex as an acceptable norm. It should therefore not be adopted by therapists.     

Helen Flanders Dunbar: Physician,medievalist, enigma

Helen Flanders Dunbar was a psychiatrist, an early leader in the field of psychosomatic medicine, and a prophetic proponent of supervised clinical training for clergy. She was a prolific writer educated in theology and medieval studies as well as medicine. Yet she remains largely an enigma despite her achievements. This article explores Dunbar's life and attempts an explanation of why her person and ideas are not widely recognized today.     

Philosophy of medicine in Austria

It seems impossible to completely cover the field indicated by the title of this report because of the many contributions of individual physicians and non-physicians to problems of the philosophy of medicine in Austria, and to their solution. The main trends are rooted in historic developments and in the current problems of medicine and health care, which are similar world-wide. In Austria famous names like empress Maria Theresia or the physician Ignaz Semmelweis have to be mentioned in connection with the development of the ideas of a philosophy of medicine. In recent times again influential and well-known persons in related fields of medicine and health care are Austrians. However, the main line of new developments goes mostly unseen by the public: activities in medical ethics with the goal to humanize health care, carried on by groups of young physicians, biomedical engineers and students.     

EDMUND D. PELLEGRINO's PHILOSOPHY OF FAMILY PRACTICE

Family medicine has grown as a specialty from its early days of general practice. It was established as a Board Certified specialty in 1969. This growth and maturation can be traced in the philosophy of family medicine as articulated by Edmund D. Pellegrino, M.D. Long before it was popular to do so, Pellegrino supported the development of family medicine. In this essay I examine the development of Pellegrino's philosophical thought about family practice, and contrast it to other thinkers like Ian McWhinney, Kerr White, Walter Spitzer, Donald Ransom, and Hebert Vandervoort. The arguments focus on whether the goals of family medicine and family practice (possibly two distinct entities) can be articulated, especially considering the definitional problems of “family” and “community.” I conclude by echoing Pellegrino's hope that family medicine can contribute a fresh alternative to isolated, individualistic and technological thinking in medicine.