Accidental Communities: Race,Emergency Medicine,and the Problem of PolyHeme®

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a “community” within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between “autonomy” and “community.” The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part II examines a clinical trial for the blood substitute PolyHeme^® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of “community.” The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment.     

Physicians' Silent Decisions: Because Patient Autonomy Does Not Always Come First

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions—not all—are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

Rethinking Research Ethics

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.     

Males' Reactions to Participating in Research on Dating Violence Victimization and Childhood Abuse

Childhood abuse and dating violence victimization are prevalent and devastating problems. Although there has been an abundance of research on these topics in recent years, researchers and institutional review boards often struggle with determining whether asking respondents questions on previous violence will result in increased emotional distress or other negative research outcomes. Empirical data are therefore needed that examine the research reactions of individuals who participate in research on childhood abuse and dating violence. This study examined this topic among a sample of male college students (N?=?193). Results showed that victims of childhood sexual abuse had more negative emotional reactions and victims of physical dating violence had more negative perceived drawbacks to research participation than nonvictims. However, victims and nonvictims did not differ on positive research reactions. These findings suggest that there are few differences between victims and nonvictims on research reactions.     

An Historical Overview of Basic Approaches and Issues in Ethical and Moral Philosophy and Principles

Summary

This article provides a condensed history of ethics development for the purpose of exposing psychologists and other mental health professionals to ethical and moral bases upon which modern psychological ethics are founded. In addition, it focuses on contemporary theories, with an emphasis on professional ethics.     

Silence is golden? Characteristics and experiences of self-reported whistleblowers

This study investigates the characteristics of whistleblowers, the prevalence and nature of whistleblowing, and the occurrence of retaliation after whistleblowing using a randomly selected and representative sample of Norwegian employees. The results showed that 12 per cent self-reported as whistleblowers according to an operational definition. Being a leader, or a union or personnel safety representative was significantly related to whistleblowing. The most frequently reported wrongdoing was harassment conducted by a single colleague. Wrongdoer(s) received mixed responses, from no reaction to reprimand. Even though most whistleblowers were not sanctioned, they reported less job satisfaction and more workplace bullying than did nonwhistleblowers. Only a few were rewarded. For the most part, wrongdoing was stopped or reduced. However, whistleblowing was only partially effective, because whistleblowers reported lack of feedback about the result of their report. Results also showed that the status of the wrongdoer was related to the reaction he or she received afterwards, as were the type of wrongdoing and the effect on the wrongdoing, and the type of wrongdoing and the effect on the wrongdoer(s). Potential explanations for the results, such as the type of sample and power distance, are discussed. Practical implications of the study are also addressed, such as the importance of providing feedback to whistleblowers.     

Teaching Oppressive Texts

Scholars have identified the many stories in the Bible that are oppressive to women or other minoritized groups. It is remarkable how common it is that North American undergraduate students remain blind to the oppression that is depicted and that is too often the result of commonly accepted interpretations of these texts. Three brief essays collected here, originally presented as part of a panel at the Society of Biblical Literature annual meeting (Atlanta, 2010), present various teaching strategies for exposing the oppressive elements in the biblical text and showing how the oppression operates (an aspect of ideological criticism). What are good strategies for communicating these hard points to students in a way they can hear them and work with them? Why is this important to do?     

From world hunger to food sovereignty: food ethics and human development

The role of Amartya Sen's early work on famine notwithstanding, food security is generally seen as but one capability among many for scholars writing in development ethics. The early literature on the ethics of hunger is summarized to show how Sen's Poverty and Famines was written in response to debates of past decades, and a brief discussion of food security as a capability follows. However, Sen's characterization of smallholder food security also supports the development of agency in both a political and an economic sense. Economic agency is discussed and tied to longstanding literatures on the moral significance of farming within political economy. Finally, while the newly emergent literature on food sovereignty includes many themes, it is shown to be re-articulating arguments that stress smallholder's economic agency as a development goal. This pattern of argument thus provides a way to reconcile at least some of the claims being advanced under the banner of food sovereignty with the human development approach, while also restoring food ethics to a more central place in the overall discourse of development ethics.