Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force

Abstract

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient’s ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.     

Sexual Assault in Intimate Relationships: Introduction to Special Issue

ABSTRACT

The 13 articles in this special issue draw from the experience of women and men in Australia, Canada, Denmark, India, Micronesia, Sierra Leone, Tanzania, Vietnam, and the US to shed light on the complex problem of accounting for Intimate Partner Sexual Violence (IPSV) in a globalizing world. As a collection, the articles draw from qualitative methodologies in social science and humanities privileging local narratives drawn through interviews, focus groups, participant observation and historical surveys. This special issue presents articles from multiple disciplinary vantage points that seek to bring to the fore insight drawn from the close reading of sexual violence in varied global cultural contexts. The collection of articles challenges the idea that there is a universal way to understand and measure IPSV. Together the articles demonstrate key elements of the disconnect between local understandings and the assumed universality of concepts that undergird most sexual violence research. Congruent with our previous work, the challenge of the work in the cross-cultural perspective taken by this special issue lies in the acknowledgement that the ways we account for and define sexual violence in intimate (dating, cohabiting and marital) relationships is culturally-situated and must be contextualized as such. This cross-cultural perspective values the conceptual insight that can be drawn from cultural difference and pushes against a homogenization of notions of sexual violence in studies within global societies as well as those that work to compare them.     

Cognitive Transformation,Dementia, and the Moral Weight of Advance Directives

Abstract

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients.     

Moral judgments and ethical constructs in clinical psychology doctoral students

ABSTRACT

This cross-sectional study compared the moral reasoning of first-year and third-year doctoral students in clinical psychology. Nineteen first-year and 20 third-year students were recruited from 17 doctoral training programs in the UK. Most adopted a sophisticated approach to moral judgments, as assessed by the Defining Issues Test, although, surprisingly, more experienced students had significantly less sophisticated schemata. In their moral judgments, less experienced students relied more heavily on their personal, and more experienced students on their professional, constructs, as assessed by repertory grid technique. Integration between personal and professional constructs was higher in more experienced students.     

Obesity,Sexuality, and Psychological Treatment for Women

Obesity as a psychological and physical disorder that affects women is discussed and evaluated. Dilemmas for women that are obese are synthesized and implications for therapists counseling obese women are discussed.     

Narrating Rape: An Ethnographic Case-Study of Non-Consensual Sexual Debut in Tanzania

ABSTRACT

This article explores the issue of (female) sexual consent in a non-western context by examining narratives of the non-consensual sexual debut in Tanzania within the institutional and cultural tolerance for intimate violence, and the role of the state and media in condoning “proper” gender roles. None of the young women interviewed during a year of ethnographic fieldwork on a college campus were willing to identify this activity as “rape,” though they frequently detailed the ways that aspirations for “respectability” created conditions of vulnerability to ongoing exploitative sexual relationships with older men in positions of authority whom they once trusted. In the socio-sexual premarital landscape of school girls, sex is never given away for free, but may be dispensed with reasonable expectation of return. In an effort to contextualize sexual intimacy and avoid careless use of labels like “prostitution,” feminist public health researchers began to frame sexual encounters in transactional terms. Although not entirely unproblematic, the less stigmatizing terminology reveals more nuanced intimate economies among men and women which include structurally and culturally-derived elements of deprivation, agency, and instrumentality. This article pays careful attention to the narrative of one young women who describes a socio-sexual premarital landscape which almost universally positions male partners as culturally-empowered to proceed with aggressive, even violent, advances toward young women they wish to have sex with, “date,” or marry. Within this context, this article then teases out emerging discourses about structural conditions that reinforce violence.     

Understanding Intimate Partner Sexual Assaults: Findings from Sexual Assault Kits

ABSTRACT

In 2013, Cuyahoga County, Ohio, began DNA testing and investigating nearly 5000 previously unsubmitted sexual assault kits (SAKs) from 1993 through 2009. We examined case files from a sample of SAKs that were tested but not previously adjudicated (n = 429). More than 10% (n = 45) involved victims who reported to police that a former or current intimate partner sexually assaulted them. This article integrates the available data on the offenders, the victims, the initial investigation, and the specifics of the assaults to provide a more complete understanding of intimate partner sexual assault (IPSA). More than one-third of the IPSA offenders were serial sex offenders; that is, the offenders sexually assaulted an intimate partner and another person(s). Comparing IPSAs to all other sexual assaults, IPSAs more frequently involved bodily force, less frequently involved a weapon, and IPSA investigations were more frequently closed because (1) the victims stated they lied or the police doubted the victims and (2) the victims declined to prosecute. The most common sequencing of events was a demand for sex by the offender followed by a verbal refusal by the victim and the use of bodily force in the sexual assault. The findings, however, indicate a great deal of variation in the sequencing of events surrounding the sexual assault, with over 25% involving no physical confrontation before or after the sexual assault and no demands for sex. Unsubmitted SAK data provide a unique window into understanding the understudied and underreported issue of IPSA.