Physicians,entrepreneurism and the problem of conflict of interest

This paper examines the ethical issues of conflict of interest raised by the burgeoning development of physician involvement in for-profit entrepreneurial activities outside their practice. After documenting the nature and extent of these activities, and their potential for conflicts of interest, the paper assesses the major arguments for and against physicians' referral of patients to facilities they own or in which they invest. The paper concludes that an outright ban on such activity seems ethically warranted.     

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.     

The moral basis of liberal education

The moral right to liberal education involves issues of distribution and of content. The former issue bears on the distribution of educational resources. The latter issue bears on the issue of multiculturalism. Both issues are discussed from the standpoint of equal rights.Presented as the first Distinguished Lecture to the Association for Philosophy of Education at its meeting in New York, 28 December 1991.     

A Third Principle of Justice

In this paper I argue that in order to secure the commitment of believers in reasonable comprehensive doctrines to political liberalism a third principle of justice needs to be adopted in the Original Position. Rawls acknowledges that neutral legislation by the liberal state may negatively affect some reasonable comprehensive doctrines, and I offer a third principle of justice to help alleviate this problem. This principle, which I believe is in keeping with the United States constitutional history especially where church-state relations are concerned, maintains that a constitutional regime should, insofar as possible, avoid adopting rules with harmful effects upon those comprehensive doctrines which satisfy the conditions of reasonable pluralism.     

Should a criminal receive a heart transplant? Medical Justice vs. Societal Justice

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled to at least a “decent minimum” level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of “rudimentary decent minimum” granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants.     

Self-control in pigeons under the Mischel paradigm

Walter Mischel studied self-control in preschool children in the following manner: if the child waited for an interval to end, he or she received the more preferred of two reinforcers; if the child responded to terminate the interval by ringing a bell, the less preferred reinforcer was given. We used an analogous procedure to study self-control in pigeons: if the bird waited for a trial to end, it received the more preferred reinforcer; if the bird terminated the trial by pecking a key, the less preferred reinforcer was given. We explored the effects on self-control of a number of variables analogous to those studied by Mischel and co-workers, e.g., presence versus absence of reinforcers, of alternative responses, and of stimuli during the wait interval; prior experience of the subjects; and test paradigm. The results obtained with pigeons paralleled the results obtained by Mischel with human children.     

Catholic Feminist Ethics Reconsidered

Taking Catholic sexual ethics and liberal feminist ethics as points of departure, this essay argues that both frameworks are ill‐prepared to deal with the moral problems raised by sex trafficking: while Catholic sexual ethics is grounded in a normative understanding of sexuality, liberal feminist ethics argues for women's sexual autonomy, resting upon freedom of action and consent. From a perspective that attends both to the phenomenological interpretation of embodied selves and the Kantian normative interpretation of dignity, it becomes possible to critique both the Catholic and the liberal feminist frameworks of ethics. I argue that Catholic sexual ethics requires a reconceptualization as social ethics in order to meet the challenges of our present time, but that the shift is possible without giving up the moral imperatives of both Catholic and feminist ethics to protect human dignity and women's rights.     

Changing the Criminal Justice System Response to Sexual Assault: An Empirical Study of a Participatory Action Research Project

In jurisdictions throughout the United States, thousands of sexual assault kits (SAKs; also known as a “rape kits”) have not been submitted by the police for forensic DNA testing. DNA evidence may be helpful to sexual assault investigations and prosecutions by identifying perpetrators, revealing serial offenders through DNA matches across cases, and exonerating those who have been wrongly accused. This paper describes a longitudinal action research project conducted in Detroit, Michigan after that city discovered approximately 11,000 untested sexual assault kits in a police department storage facility. We conducted a root cause analysis to examine individual, organizational, community, and societal factors that contributed to the development of the rape kit backlog in Detroit. Based on those findings, we implemented and evaluated structural changes to increase staffing, promote kit testing, and retrain police and prosecutors so that cases could be reopened for investigation and prosecution. As we conducted this work, we also studied how this action research project impacted the Detroit criminal justice system. Participating in this project changed stakeholders’ attitudes about the utility of research to address community problems, the usefulness of DNA evidence in sexual assault cases, and the impact of trauma on survivors. The results led to new protocols for SAK testing and police investigations, and new state legislation mandating SAK forensic DNA testing.