On the importance of being ethnic: coping with the threat of prostate cancer in relation to prostate cancer screening

The relation between coping with a possible prostate cancer diagnosis and screening behavior was examined in men from seven precise ethnic groups. Five coping styles differed in their likelihood of use across ethnic groups and had somewhat different associations with frequency of prostate-specific antigen (PSA) testing. As expected, PSA test frequency differed among men from different ethnic groups and was differentially predicted by coping styles. Analyzing the results using typical groups of White, Black, and Hispanic, rather than precise ethnic groups, obscured these results. Researchers investigating psychological variables in preventive health behaviors must analyze diversity within the framework provided by ethnic specificity. Such an approach will guide the development and provision of interventions that are more sensitive to the characteristics of specific ethnic groups of at risk men.     

Adolescent marijuana use: screening and ethics

Adolescent marijuana use is an issue of concern to the entire community. The emergence of technology that can identify marijuana use poses questions relating to public health issues such as justification and extension of screening. This article discusses the moral issues relating to surveillance of adolescent marijuana use and postulates a justification for clinical screening.     

Thinking critically in medicine and its ethics: relating applied science and applied ethics

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision-making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision-making.     

Beyond medical ethics: New directions for philosophy and medicine

A unique relationship exists between physicians and philosophers — one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages — a sense of how medicine has adapted to the social cultural and ethical needs of each period. This perspective, while emphasizing medicine asscience, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary.     

Grounding medical ethics in philosophy of medicine: problematic and potential

After considering two of Pellegrino’s papers that address the relation between philosophy of medicine and medical ethics, I identify several overarching problems in his account that revolve around his self-described essentialism and the lack of a systematic attempt to relate clinical medicine to biomedicine and public health. I address these from the critical realist position of Bernard Lonergan, who grounds both metaphysics and ethics on the normative structure of human inquiry and seeks to understand historical development, such as we are witnessing in health science and health care, in terms of the dynamic structure of the human good. I conclude that Lonergan’s generalized empirical method and hierarchical account of world order provide a potentially dynamic framework on which to build a more comprehensive philosophy of medicine than one whose foundations rest primarily on a phenomenology of the clinical encounter and the telos of medicine.

     

Discourse on medicine: meditative and calculative approaches to ethics from an international perspective

Heidegger’s two modes of thinking, calculative and meditative, were used as the thematic basis for this qualitative study of physicians from seven countries (Canada, China, India, Ireland, Japan, Korea, & Thailand). Focus groups were conducted in each country with 69 physicians who cared for the elderly. Results suggest that physicians perceived ethical issues primarily through the lens of calculative thinking (76%) with emphasis on economic concerns. Meditative responses represented 24% of the statements and were mostly generated by Canadian physicians whose patients typically were not faced with economic barriers to treatment due to Canada’s universal health care system.     

The role of philosophy and ethics at the edges of medicine

Background

The purpose of this study is to make a philosophical argument against the phenomenological critique of standardization in clinical ethics. We used the context of clinical ethics in Saudi Arabia to demonstrate the importance of credentialing clinical ethicists.

Methods

Philosophical methods of argumentation and conceptual analysis were used.

Results

We found the phenomenological critique of standardization to be flawed because it relies on a series of false dichotomies.

Conclusions

We concluded that the phenomenological framing of the credentialing debate relies upon two extreme views to be navigated between, not chosen among, in the credentialing of clinical ethicists.

     

Social ethics,the philosophy of medicine,and professional responsibility

The social ethics of medicine is the study and ethical analysis of social structures which impact on the provision of health care by physicians. There are many such social structures. Not all these structures are responsive to the influence of physicians as health professionals. But some social structures which impact on health care are prompted by or supported by important preconceptions of medical practice. In this article, three such elements of the philosophy of medicine are examined in terms of the negative impact on health care of the social structures to which they contribute. The responsibilities of the medical profession and of individual physicians to work to change these social structures are then examined in the light of a theory of profession.     

The development of computer ethics: Contributions from business ethics and medical ethics

In this essay, we demonstrate that the field of computer ethics shares many core similarities with two other areas of applied ethics, Academicians writing and teaching in the area of computer ethics, along with practitioners, must address ethical issues that are qualitatively similar in nature to those raised in medicine and business. In addition, as academic disciplines, these three fields also share some similar concerns. For example, all face the difficult challenge of maintaining a credible dialogue with diverse constituents such as academicians of various disciplines, professionals, policymakers, and the general public, Given these similarities, the fields of bioethics and business ethics can serve as useful models for the development of computer ethics. A version of this paper was presented at ETHICOMP98, the Fourth International Conference on Ethical Issues of Information Technology, March 25–27, 1998, Erasmus University, the Netherlands. Kenman Wong, Ph.D., is an Associate Professor of Business Ethics; Gerhard Steinke, Ph.D., is Professor of Management and Information Systems. Both authors are at Seattle Pacific University's School of Business and Economics.     

Technological paternalism: On how medicine has reformed ethics and how technology can refine moral theory

The objective of this article is to investigate ethical aspects of technology through the moral term “paternalism”. The field of investigation is medicine. The reason for this is twofold. Firstly, “paternalism” has gained moral relevance through modern medicine, where physicians have been accused of behaving paternalistic and threatening patients’ autonomy. Secondly, medicine is a brilliant area to scrutinise the evaluative aspects of technology. It is argued that paternalism is a morally relevant term for the ethics of technology, but that its traditional conception is not adequate to address the challenges of modern technology. A modification towards a “technological paternalism” is necessary. That is, “technological paternalism” is a fruitful term in the ethics of technology. Moreover, it is suited to point out the deficiencies of the traditional concept of paternalism and to reform and vitalise the conception of paternalism in ethics in order to handle the challenges of technology.     

Laying medicine open: understanding major turning points in the history of medical ethics

At different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenonmenon of laying medicine open has sometimes resulted in major turning points in the history of medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724-1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician's fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.     

绝对命令伦理学和协调伦理学——四谈工程伦理学

绝对命令伦理学和协调伦理学是两种具有不同性质、不同理论假设和不同特征的伦理学立场和伦理学进路。由于决策在工程活动中占据了中心位置,决策伦理问题在工程伦理学中也占据了中心位置。在工程决策中,必须正确认识和处理工程中伦理因素和非伦理因素的关系,强化工程决策中的伦理意识,正确处理决策伦理和伦理决策的关系,特别是要妥善处理工程决策中涉及伦理要素的“内外双重协调”问题。文章最后分析了协调原则和共同体、共识和共赢的关系。