Hume on Miracles: Would It Take a Miracle to Believe in a Miracle?

Given Hume's theory of belief and belief production it is no small task to explain how it is possible for a belief in a miracle to be produced. I argue that belief in a miracle cannot be produced through Hume's standard causal mechanisms and that although education, passion, and testimony initially seem to be promising mechanisms for producing belief in a miracle, none of these is able to produce the belief in a miracle. I conclude by explaining how this poses a problem for Hume's theory of belief and I briefly investigate the alternatives available for solving this problem.     

Moralist,technician, sophist,teacher/learner: Reflections on the ethicist in the clinical setting

The ethicist's role in the clinical context is not presently well defined. Ethicists can be thought of as moralists, technicians, Sophists, or as teachers and learners. Each of these roles is examined in turn. An argument is made for the ethicist as a teacher who must also learn a great deal about the clinical setting in order to encourage an effective critical examination of basic values. Four specific tasks of this teaching role are discussed: describing moral experience, eliciting assumptions, considering multiple alternatives and justifying choices.     

Potential roles of the medical ethicist in the clinical setting

The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of consultant and patient advocate.     

Conjoint Couple's Treatment for Intimate Partner Violence

Abstract

Despite lingering concerns in the field about the wisdom of seeing couples conjointly when there has been Intimate Partner Violence (IPV), the research literature and clinical practice experience both indicate that this approach can be safe and effective for at least some couples. In this paper, we briefly review the existing outcome research on Couple's treatment for IPV and then suggest best clinical practices for this work. Best practices, in our view, include seeing Couple's treatment of IPV as a clinical specialty necessitating specific training, working as part of a coordinated community response to IPV, modification of the structure of therapy to increase safety, as well as careful screening of couples and on-going assessment of the propriety of conjoint treatment.     

Why physicians should not do ethics consults

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.     

Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk

Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.     

Consciousness, the Vegetative State, and the Intrinsic Value of Life

Using the controversy surrounding the views of the Princeton University ethicist Peter Singer as a foil, the authors address the commonly held view that the appropriate time to terminate the life of a human being is when the individual has lost consciousness and there is no hope that he or she will regain it. They make an admittedly dubious case for the vegetative state, with which loss of consciousness is commonly equated, in order to clear the way for a more defensible basis for the termination of a human life, that of the person’s own personal, even if idiosyncratic view of when his or her life is no longer worth living.     

A secular chaplaincy

This essay reviews Richard Zaner'sTroubled Voices, a philosopher's reflection on his work as a clinical ethicist at a major medical center. Through stories of sickness and illness and the dilemmas posed by infirmity, Zaner considers principal issues in clinical ethics and the philosopher's place at the bedside. director of medical ethics at The New York Hospital.     

Intellectual humility predicts COVID-19 preventive practices through greater adoption of data-driven information and feelings of responsibility

Preventive health practices have been crucial to mitigating viral spread during the COVID-19 pandemic. In two studies, we examined whether intellectual humility—openness to one's existing knowledge being inaccurate—related to greater engagement in preventive health practices (social distancing, handwashing, mask-wearing). In Study 1, we found that intellectually humble people were more likely to engage in COVID-19 preventive practices. Additionally, this link was driven by intellectually humble people's tendency to adopt information from data-driven sources (e.g., medical experts) and greater feelings of responsibility over the outcomes of COVID-19. In Study 2, we found support for these relationships over time (2 weeks). Additionally, Study 2 showed that the link between intellectual humility and preventive practices was driven by a greater tendency to adopt data-driven information when encountering it, rather than actively seeking out such information. These findings reveal the promising role of intellectual humility in making well-informed decisions during public health crises.     

In the Wake of Violence: Enacting and Witnessing Hope Among People

In the territory of violence and despair, hope is rare. Recent work on hope has shifted attention from hope as a feeling to hope as a practice that people can do together. This case report of a family exposed to domestic violence highlights the role played by a South African police officer in the mother's actions to separate from the context of violence. As a witness to the violence, the police officer acted from an ethic of justice and an ethic of compassion. Outsider witnessing of a counseling session resulted in the recruiting of a community of acknowledgement for the mother, the police officer, and an Assistant Commissioner of Police. Listening carefully and doing hope together gave rise to alliances against practices of violence. As a step of accountability, the authors used reflexive practices to question their responses and to avoid colonizing practices.     

Rainbows in the society: A measure of hope for society

The aim of this study was to develop and validate a measure of social hope. Previous studies have extensively reported on personal hope and its outcomes. Although a few studies have suggested the concept of collective or social hope, there is no instrument to assess the construct. In this study, we created a 5‐item scale, drawing on Snyder's hope theory, and collected two sets of survey data online. Analysis of these data sets revealed that the new scale was structurally unidimensional and internally consistent. In association with Snyder's State Hope Scale, the Social Hope Scale showed convergent and discriminant validity. The social hope construct also exhibited theoretically meaningful relationships with political efficacy and self‐construal (concurrent validity). Finally, social hope was higher for those who had participated in certain types of social activism than it was for those who had not (predictive validity). These results suggest that the Social Hope Scale is a reliable and valid self‐report measure of hopeful thinking for society.     

How to Be Helpful to Multiple People at Once

When someone hosts a party, when governments choose an aid program, or when assistive robots decide what meal to serve to a family, decision-makers must determine how to help even when their recipients have very different preferences. Which combination of people’s desires should a decision-maker serve? To provide a potential answer, we turned to psychology: What do people think is best when multiple people have different utilities over options? We developed a quantitative model of what people consider desirable behavior, characterizing participants’ preferences by inferring which combination of “metrics” (maximax, maxsum, maximin, or inequality aversion [IA]) best explained participants’ decisions in a drink-choosing task. We found that participants’ behavior was best described by the maximin metric, describing the desire to maximize the happiness of the worst-off person, though participant behavior was also consistent with maximizing group utility (the maxsum metric) and the IA metric to a lesser extent. Participant behavior was consistent across variation in the agents involved and  tended to become more maxsum-oriented when participants were told they were players in the task (Experiment 1). In later experiments, participants maintained maximin behavior across multi-step tasks rather than shortsightedly focusing on the individual steps therein (Experiment 2, Experiment 3). By repeatedly asking participants what choices they would hope for in an optimal, just decision-maker, and carefully disambiguating which quantitative metrics describe these nuanced choices, we help constrain the space of what behavior we desire in leaders, artificial intelligence systems helping decision-makers, and the assistive robots and decision-makers of the future.     

Consensus, clinical decision making, and unsettled cases

The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted-a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option.     

How Christian ethics became medical ethics: the case of Paul Ramsey.

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.     

Religious Ethics and the Spirit of Undomesticated Dissent

The field of religious ethics contributes to practices of resistance and hope in broader society. In advancing my claim that religious ethics contributes to practices of resistance and hope today, I first tell a story about the changing demographics in the field of religious ethics and why this demographic shift is important. I next focus on womanist religious scholarship as an exemplary discourse in religious ethics and how it has contributed to practices of resistance and hope in the academy and within contemporary society. While a few scholars in JRE over the last 50 years have cited and engaged womanist ethicists like Katie Cannon and Emilie Townes, I want to offer a more explicit argument on how the womanist idea has contributed to practices of resistance and hope. I maintain that womanist religious scholarship embodies the practice of undomesticated dissent and that such dissent might be understood as a contribution to larger humanistic inquiry within the academy. Finally, I briefly consider an objection to my argument through engaging Stanley Fish's claim that the purposes and ends of institutions of higher education should not be oriented toward activism.     

Hope Against Hope in Cancer at the End of Life

Hope has many facets to it in the context of cancer. This article outlines an instrumental case study for a patient with aggressive lymphoma who rapidly deteriorated to the point of dying. How her and her family’s hope was managed is outlined here from various perspectives. Interviews were carried out with the patient’s family, medical consultant-in-charge (attending physician) and nurses caring for her at the end of life. The findings outline the transition from hope for cure to hope for a good death and the role that the patient and family’s Christian hope played in this. Religiosity and spirituality of hope in terms of Christian hope is explored from the theological perspective. Practical aspects of care in the face of changing hope are discussed. Conclusions are drawn about reframing hope in a changing clinical situation with reference to theories of hope. The importance of acknowledging hope, coping, spirituality and religiosity, especially at end of life, is emphasised.     

Love Will Do the Thing That's Right: Commentary on Paper by Stuart A. Pizer,Ph.D., A.B.P.P.

In this paper, hope is explored as a motivating force in analysis. To see the patient's and the analyst's hopes in terms of changes they expect the treatment to accomplish emphasizes the cognitive aspect of hope. While touching on these cognitive expectations, this paper focuses on the emotional, rather than the cognitive, function of hope in treatment. It addresses the question of how hope can inspire analytic participants to have the strength and stamina that analysis requires.     

Response to Michael Sells

In an era when lies and misrepresentations about historical events easily become firmly rooted, Michael Sells's discussion illustrates the importance of careful historical research as a moral enterprise. In addition to the skills of the historian, however, there is also room in this enterprise for those of the ethicist. In particular, I warn against confusing the truth or falsity of claims about one narrow historical period with larger questions about the moral meaning and significance of those claims. Illustrating this, I argue one cannot assess the legitimacy of competing nationhood claims solely on the basis of the deeds of specific actors. Nor should the actions of a single individual like the Grand Mufti of Jerusalem be converted into a totalizing claim about the rights of the Palestinian people.     

Women on the Couch: Genital Stimulation and the Birth of Psychoanalysis

Following Freud's emphasis on his rejection of hypnosis as leading up to the development of psychoanalysis, there has been little mention in the psychoanalytic literature of the larger context of the somatic medical treatment of hysteria within which Freud treated his hysterical patients, and which Freud himself practiced. We contend that Freud's emphasis obscured his association with massage, electrotherapy, and the procedure of genital stimulation practiced by his medical colleagues in the treatment of hysteria. We show that the history of genital stimulation—including its obfuscation, desexualization, medicalization, and co-option from traditional women healers by an exclusively male medical establishment—provides us with the background for a more sophisticated understanding of the context in which Freud developed his theories. Specifically, we examine the contribution of this understanding to Freud's theoretical emphases on autonomy and individuality, abstinence and the renunciation of gratification, penis envy, clitoral versus vaginal orgasm, mature genital sexuality, and the “repudiation of femininity” as the “bedrock” of psychoanalysis. We demonstrate that Freud's position as a Jew in an anti-Semitic milieu fueled his efforts to distance his psychoanalytic method from the more prurient practices of his day, including one his society associated with Jewish doctors and patients.