Can phronesis save the life of medical ethics?

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek.     

Anesthesiological ethics: can informed consent be implied?

Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are "captain of the ship" in the operating theater (leaving anesthesiologists in a subservient role). We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon's preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia.     

Moral attentiveness: who pays attention to the moral aspects of life?

This research draws from social cognitive theory to develop a construct known as moral attentiveness, the extent to which an individual chronically perceives and considers morality and moral elements in his or her experiences, and proposes that moral attentiveness affects a variety of behaviors. A series of 5 studies with undergraduates, MBA students, and managers were conducted to create and validate a reliable multidimensional scale and to provide evidence that moral attentiveness is associated with (a) the recall and reporting of self- and others' morality-related behaviors, (b) moral awareness, and (c) moral behavior. Results of the studies suggest that moral attentiveness has a significant effect on how individuals understand and act in their moral worlds. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

What can we learn by looking for the first code of professional ethics?

The first code of professional ethics must: (1)be a code of ethics; (2) apply to members of a profession; (3) apply to allmembers of that profession; and (4) apply only to members of that profession. The value of these criteria depends on how we define “code”, “ethics”, and “profession”, terms the literature on professions has defined in many ways. This paper applies one set of definitions of “code”, “ethics”, and “profession” to a part of what we now know of the history of professions, there by illustrating how the choice of definition can alter substantially both our answer to the question of which came first and (more importantly) our understanding of professional codes (and the professions that adopt them). Because most who write on codes of professional ethics seem to take for granted that physicians produced the first professional code, whether the Hippocratic Oath, Percival’s Medical Ethics, the 1847 Code of Ethicsof the American Medical Association (AMA), or some other document, I focus my discussion on these codes. This revised version was published online in June 2006 with corrections to the Cover Date.     

An ethics of suffering: does it solve the problems we want to solve?: commentary

Erich H. Loewy proposes to elevate the moral obligation to prevent and relieve suffering to the level of a prima facie moral duty by delineating which beings are of primary moral worth and which are of secondary moral worth. Sentient beings have a capacity to suffer and are therefore of primary moral worth. Beings that are insentient cannot suffer; therefore such beings are only of secondary moral worth. Objects of secondary moral worth include patients in a persistent vegetative state (PVS) and brain-dead patients. This proposal, he says, would solve a number of problems in clinical bioethics. First, it would help to clarify our moral duties at the bedside. And secondly, by creating a hierarchy of moral values, it helps to differentiate which patients are owed our primary allegiance and resources. Despite his extensive and painstaking proof, I believe several questions remain about the use of the "capacity of sentient beings to suffer" as a basis for a universal grounding in ethics.     

What is the question you need to answer? How consultation can prevent professional systems immobilizing families

Consultation to an outside agency is an important part of the work of departments of child and adolescent psychiatry. This article describes and illustrates one particular approach to such consultations based on the principles of structural family therapy. It is premised on the belief that outside agencies have the capacity to arrive at a decision which is in the best interest of their clients. To do this the agency needs to define what is the question they need an answer in order to make a decision regarding their client. The consultants' role is to clarify what decision the consul tee agency needs to make by following up the question, What is the question you need to answer? How this question is followed up is discussed.     

Virtue ethics and modern society—A response to the thesis of the modern predicament of virtue ethics

The revival of modern Western virtue ethics presents the question of whether or not virtue ethics is appropriate for modern society. Ethicists believe that virtue ethics came from traditional society, to which it conforms so well. The appearance of the market economy and a utilitarian spirit, together with society’s diversification, is a sign that modern society has arrived. This also indicates a transformation in the moral spirit. But modern society has not made virtues less important, and even as modern life has become more diversified, rule-following ethics have taken on even greater importance. Modern ethical life is still the ethical life of individuals whose self-identity contains the identity of moral spirit, and virtues have a very important influence on the self-identical moral characters. Furthermore, modern society, which is centered around utilitarianism, makes it apparent that rules themselves are far from being adequate and virtues are important. Virtues are a moral resource for modern people to resist modern evils.     

Failure to Mentalize: Defect or Defense?

ABSTRACT

The author reviews current thinking on the phenomena of failure to mentalize and provides an alternative to the structural defect point of view. Also included are some clinical implications of this alternative viewpoint.     

The art of ethics as the art of wise life in the concept of Józef Tischner

Studies in East European Thought - The article examines Tischner’s views on the meaning of ethics in human life. Tischner opposes positions that treat ethics as a set of recommendations...     

Listening or telling? Thoughts on responsiblity in clinical ethics consultation

This article reviews the historical and current controversies about the nature of clinical ethics consultation, as a way to focus on the place and responsibility of ethics consultants within the context of clinical conversation — interpreted as a form of dialogue. These matters are approached through a particularly compelling instance of the controversy that involves several major figures in the field. The analysis serves to highlight very significant questions of the nature and constraints of clinical situations, and the moral responsibility and legal accountability that are especially important for clinical ethics consultants.     

Is it wrong to impose the harms of human life? A reply to Benatar

Might it be morally wrong to procreate? David Benatar answers affirmatively in Better Never to Have Been, arguing that coming into existence is always a great harm. I counter this view in several ways. First, I argue against Benatar’s asserted asymmetry between harm and benefit—which would support the claim that any amount of harm in a human life would make it not worth starting—while questioning the significance of his distinction between a life worth starting and one worth continuing. I further contend that his understanding of hedonism and desire-fulfillment theories distorts their implications for the quality of human life; as for objective-list theories, I rebut his critique of their human-centered basis of evaluation. Notwithstanding this multi-tiered challenge to Benatar’s reasoning, I conclude with praise for his work and the intellectual virtues it embodies.