Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Duty. Show all posts
Showing posts with label Duty. Show all posts

Friday, February 18, 2022

Measuring Impartial Beneficence: A Kantian Perspective on the Oxford Utilitarianism Scale

Mihailov, E. (2022). 


To capture genuine utilitarian tendencies, (Kahane et al., Psychological Review 125:131, 2018) developed the Oxford Utilitarianism Scale (OUS) based on two subscales, which measure the commitment to impartial beneficence and the willingness to cause harm for the greater good. In this article, I argue that the impartial beneficence subscale, which breaks ground with previous research on utilitarian moral psychology, does not distinctively measure utilitarian moral judgment. I argue that Kantian ethics captures the all-encompassing impartial concern for the well-being of all human beings. The Oxford Utilitarianism Scale draws, in fact, a point of division that places Kantian and utilitarian theories on the same track. I suggest that the impartial beneficence subscale needs to be significantly revised in order to capture distinctively utilitarian judgments. Additionally, I propose that psychological research should focus on exploring multiple sources of the phenomenon of impartial beneficence without categorizing it as exclusively utilitarian.


The narrow focus of psychological research on sacrificial harm contributes to a Machiavellian picture of utilitarianism. By developing the Oxford Utilitarianism Scale, Kahane and his colleagues have shown how important it is for the study of moral judgment to include the inspiring ideal of impartial concern. However, this significant contribution goes beyond the utilitarian/deontological divide. We learn to divide moral theories depending on whether they are, at the root, either Kantian or utilitarian. Kant famously denounced lying, even if it would save someone’s life, whereas utilitarianism accepts transgression of moral rules if it maximizes the greater good. However, in regard to promoting the ideal of impartial beneficence, Kantian ethics and utilitarianism overlap because both theories contributed to the Enlightenment project of moral reform. In Kantian ethics, the very concepts of duty and moral community are interpreted in radically impartial and cosmopolitan terms. Thus, a fruitful area for future research opens on exploring the diverse psychological sources of impartial beneficence.

Tuesday, April 13, 2021

Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid‐19

A. Anzaldua & J. Halpern
Hastings Report
Jan-Feb 2021 22-27.


The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.


The Dynamics of Clinical Empathy

Clinical empathy, a specific form of empathy that has therapeutic impact in the medical setting and is professionally sustainable, was first conceptualized by one of us, Jodi Halpern, as emotionally engaged curiosity. Her work challenged the expectation that physicians should limit themselves to detached cognitive empathy, showing how affective resonance, when redirected into curiosity about the patient, is essential for therapeutic impact. Halpern's interactive model of affective and cognitive empathy has been supported by empirical research, including findings regarding improved diagnosis, treatment adherence, and coping as well as studies of specific diseases (for example, about improved diabetes outcomes), though more research is needed to precisely identify the specific ways that affective resonance and cognitive curiosity contribute to meeting specific clinical needs. This model is also supported by neuroscientific findings showing how affective attunement improves cognitive empathy.

Models of compassion in medical care add valuable practices of mindfulness but do not emphasize an individualized appreciation of each patient's predicament. We thus work with Halpern's model, which emphasizes using emotional resonance to inform imagining the world from each patient's perspective. Halpern defines the cognitive aim of imagining each patient's perspective as “curiosity” because the practice of clinical empathy as engaged curiosity is founded on the recognition that each patient brings their own distinct world, with a unique set of values and needs that the physician cannot presume to know. This is a subtle but vital point. 

Friday, July 3, 2020

American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:
  1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
  2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
  3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
  4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
  5. Monitoring the implementation of tasks 1-4.

Thursday, May 21, 2020

The Difference Ethical Leadership Can Make in a Pandemic

Caterina Bulgarlla
Originally posted May 2, 2020

Here is an excerpt:

Since the personal costs of social isolation also depend on the behavior of others, the growing clamors to reopen the economy create a twofold risk. On the one hand, a rushed reopening may lead to new contagion; on the other, it may blunt the progress that has already been made toward mitigation. Not only can more people get sick, but many others—especially, lower-risk groups like the young—may start reevaluating whether it makes sense to sacrifice themselves in the absence of a shared strategy toward controlling the spread.

Self-sacrifice becomes less of a hard choice when everybody does his/her part. In the presence of a genuinely shared effort, not only are the costs of isolation more fairly spread, but it’s easier to appreciate that one’s personal interest is aligned with everyone else’s. Furthermore, if people consistently cooperate and shelter-in-place, progress toward mitigation is more likely to unfold in a steady and linear fashion, potentially creating a positive-feedback loop for all to see.

Ultimately, whether people cooperate or not has more to do with how they weigh the costs and benefits of cooperation than the objective value of those costs and benefits. Uncertainty—such as the uncertainty of whether one’s personal sacrifices truly matter—may lead people to view cooperation as a more costly choice, but trust may increase its value. Similarly, if the choice to cooperate is framed in terms of what one can gain—such as in “stay home to avoid getting sick”—rather than in terms of how every contribution is critical for the common good, people may act more selfishly.

For example, some may start pitting the risk of getting sick against the risk of economic loss and choose to risk infection. In contrast, if people are forced to evaluate whether they bear responsibility for the life of others, they may feel compelled to cooperate. When it comes to these types of dilemmas, cooperation is less likely to manifest if the decisions to be made are framed in business terms rather than in ethical ones.

The info is here.

Monday, May 11, 2020

Why some nurses have quit during the coronavirus pandemic

Safia Samee Ali
Originally posted 10 May 20

Here is an excerpt:

“It was an extremely difficult decision, but as a mother and wife, the health of my family will always come first. In the end, I could not accept that I could be responsible for causing one of my family members to become severely ill or possibly die.”

As COVID-19 has infected more than one million Americans, nurses working on the front lines of the pandemic with little protective support have made the gut-wrenching decision to step away from their jobs, saying they were ill-equipped and unable to fight the disease and feared not only for their own safety but also for that of their families.

Many of these nurses, who have faced backlash for quitting, say new CDC protocols have made them feel expendable and have not kept their safety in mind, leaving them no choice but to walk away from a job they loved.

'We're not cannon fodder, we’re human beings'

As the nation took stock of its dwindling medical supplies in the early days of the pandemic, CDC guidance regarding personal protective equipment quickly took a back seat.

N95 masks, which had previously been the acceptable standard of protective care for both patients and medical personnel, were depleting so commercial grade masks, surgical masks, and in the most extreme cases homemade masks such as scarves and bandanas were all sanctioned by the CDC -- which did not return a request for comment -- to counter the lacking resources.

The info is here.

Saturday, March 28, 2020

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Ariana Eunjung Cha
The Washington Post
Originally posted 25 March 20

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

The info is here.

Thursday, March 26, 2020

Respirators, our rights, right and wrong: Medical ethics in an age of coronavirus

Dan Sulmasy
Being human in helping others.nydailynews.com
Originally posted 22 March 20

The coronavirus pandemic is upon us. This novel virus has disrupted lives, killed people, and wreaked havoc with our economy. COVID-19 has also raised novel ethical questions and generated ethical duties for the public, health professionals and the government. Just as our health system has been caught off guard, so have our ethics.

The general principles that guide care for individual patients are the duty to help the sick and respect their autonomy. The general principles that guide public health ethics are concern for the common good and justice. In the current crisis, these principles all come into play. We are in this together. Even if the personal risk for an individual is not great, the risk to the common good is immense. But the measures taken to mitigate the effects of the virus must be just and fair.

The duties for the general public are not arbitrary. They might seem mundane, but they are important and ought to be considered truly ethical duties. Obey the rules: We owe this to each other. Wash your hands. Keep six feet away from strangers. Don’t shake hands with, kiss or hug strangers or acquaintances. Disinfect surfaces where the coronavirus might linger. Self-quarantine if you become sick. Call or email your doctor through an encrypted system or telemedicine connection.

Unless you are experiencing life-threatening distress, don’t rush to the emergency room where you could infect people having heart attacks or complications of cancer. Don’t hoard food, disinfectant wipes, or toilet paper. Don’t spread false and alarming rumors on social media.

Saturday, March 21, 2020

Moral Courage in the Coronavirus: A Guide for Medical Providers and Institutions

Holly Tabor & Alyssa Burgard
Just Security
Originally published 18 March 20

Times of crisis generate extreme moral dilemmas: situations we can’t begin to imagine, unthinkable choices emerging between options that all seem bad, each with harms and negative outcomes. During the COVID-19 pandemic, these moral dilemmas are experienced across the healthcare landscape — from bedside encounters to executive suites of hospitals and health systems. Who gets put on a ventilator? Who transitions to comfort care? What does end of life care look like when high flow oxygen can’t be used because of viral spread? Who gets a hospital bed? How do we choose which sick person, with or without COVID-19, gets treated? Which patients should be enrolled in research? How do we support patients when their families cannot visit them? We will turn away people who, in any other circumstance in a U.S. medical facility, we would have been obliged to treat. We will second guess these decisions, and perhaps be haunted by them forever. We only know one thing for sure: people will suffer and die regardless of which decisions we make.

How should we confront these intense challenges? Many institutions are doing what they can to provide guidance. But “guidelines” by design are intended to provide broad parameters to aid in decision making, and therefore rarely address the exact situations clinicians face. Certainly no guidelines can reduce the pain of having to actually carry out recommendations that affect an individual patient.  For other decisions, front line providers will have no guidance at all, or will have ill-informed, or even potentially harmful guidance. In perhaps the worst case scenario, they may even be encouraged to keep quiet about their concerns or observations rather than raise them to others’ attention.

As bioethicists, we know that moral dilemmas require personal moral courage, that is, the ability to take action for moral reasons, despite the risk of adverse consequences. We have already seen several stark examples of moral courage from doctors, nurses, and researchers in this outbreak. In late December in Wuhan, China, a 34 year-old ophthalmologist, Dr. Li Wenliang, raised the alarm in a chat group of doctors about a new virus he was seeing. He was subsequently punished by the Chinese government. He continued to share his story via social media, even from his hospital bed, and was repeatedly censored. Dr. Wenliang died of the virus on February 7.

The info is here.

Wednesday, November 27, 2019

The Moral Injury of Pardoning War Crimes

The Editorial Board
The New York Times
Originally posted 22 Nov 19

Here is an excerpt:

That Mr. Trump would pardon men accused or convicted of war crimes should come as little surprise, given that he campaigned on promises to torture the nation’s enemies and kill their families. Mr. Trump in May became the first modern president to pardon a person convicted of war crimes, when he pardoned Michael Behenna, a former Army lieutenant, who had been convicted of killing a prisoner in Iraq.

The president may think he’s supporting men and women in uniform. “When our soldiers have to fight for our country, I want to give them the confidence to fight,” he said in a statement issued by the White House. “We train our boys to be killing machines, then prosecute them when they kill!” he said on Twitter last month.

Whatever the reason, absolving people who commit war crimes does great harm to society in general, and the men and women who served honorably — as far more than “killing machines” — in the wars since the Sept. 11 terrorist attacks in particular.

A nation has to know that military action being taken in its name follows morally defensible rules — that soldiers do not, for instance, kill unarmed civilians or prisoners.

To excuse men who have so flagrantly violated those rules — to treat them as heroes, even — is to cast the idea of just war to the winds. It puts the nation and veterans at risk of moral injury, the shattering of a moral compass.

One of the loudest groups pushing for Mr. Trump’s pardons was United American Patriots, a nonprofit organization that supports numerous soldiers accused of crimes, including Mr. Lorance, Mr. Behenna and Major Golsteyn. Last month, Chief Gallagher sued two of his former lawyers and United American Patriots, alleging that his lawyers tried to delay the case to increase fund-raising for the organization.

Supporters of the pardoned men say the military justice system comes down too hard and too often on honorable soldiers fighting through the fog of war. That wouldn’t explain why United American Patriots has made a cause célèbre of Robert Bales, who pleaded guilty to slaughtering 16 Afghan civilians in their homes during a one-man nighttime rampage in 2012.

The info is here.

Sunday, November 3, 2019

The Sex Premium in Religiously Motivated Moral Judgment

Image result for sexual behavior moralityLiana Hone, Thomas McCauley, Eric Pedersen,
Evan Carter, and Michael McCullough
PsyArXiv Preprints


Religion encourages people to reason about moral issues deontologically rather than on the basis of the perceived consequences of specific actions. However, recent theorizing suggests that religious people’s moral convictions are actually quite strategic (albeit unconsciously so), designed to make their worlds more amenable to their favored approaches to solving life’s basic challenges. In six experiments, we find that religious cognition places a “sex premium” on moral judgments, causing people to judge violations of conventional sexual morality as particularly objectionable. The sex premium is especially strong among highly religious people, and applies to both legal and illegal acts. Religion’s influence on moral reasoning, even if deontological, emphasizes conventional sexual norms, and may reflect the strategic projects to which religion has been applied throughout history.

From the Discussion

How does the sex premium in religiously motivated moral judgment arise during development? We see three plausible pathways. First, society’s vectors for religious cultural learning may simply devote more attention to sex and reproduction than to prosociality when they seek to influence others’ moral stances. Conservative preachers, for instance, devote more time to issues of sexual purity than do liberal preachers, and religious parents discuss the morality of sex with their children more frequently than do less religious parents, even though they discuss sex with their children less frequently overall. Second, strong emotions facilitate cultural learning by improving attention, memory, and motivation, and few human experiences generate stronger emotions than do sex and reproduction. If the emotions that regulate sexual attraction, arousal, and avoidance (e.g., sexual disgust) are stronger than those that regulate prosocial behavior (e.g., empathy; moralistic anger), then the sex premium documented here may emerge from the fact that religiously motivated sexual moralists can create more powerful cultural learning experiences than prosocial moralists can.  Finally, given the extreme importance of sex and reproduction to fitness, the children of religiously adherent adults may observe that violations of local sexual standards to evoke greater moral outrage and condemnation from third parties than do violations of local standards for prosocial behavior.

The research is here.

Tuesday, October 15, 2019

Why not common morality?

Rhodes R 
Journal of Medical Ethics 
Published Online First: 11 September 2019. 
doi: 10.1136/medethics-2019-105621


This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

Thursday, September 5, 2019

Allegations of sexual assault, cocaine use among SEAL teams prompt 'culture' review

Image result for navy sealsBarbara Starr
Originally posted August 12, 2019

In the wake of several high-profile scandals, including allegations of sexual assault and cocaine use against Navy SEAL team members, the four-star general in charge of all US special operations has ordered a review of the culture and ethics of the elite units.

"Recent incidents have called our culture and ethics into question and threaten the trust placed in us," Gen. Richard Clarke, head of Special Operations Command, said in a memo to the entire force.
While the memo did not mention specific incidents, it comes after an entire SEAL platoon was recently sent home from Iraq following allegations of sexual assault and drinking alcohol during their down time -- which is against regulations.

Another recent case involved an internal Navy investigation that found members of SEAL Team 10 allegedly abused cocaine and other illicit substances while they were stationed in Virginia last year. The members were subsequently disciplined.


"I don't know yet if we have a culture problem, I do know that we have a good order and discipline problem that must be addressed immediately," Green said.

In early July, a military court decided Navy SEAL team leader Eddie Gallagher, a one-time member of SEAL Team 7, would be demoted in rank and have his pay reduced for posing for a photo with a dead ISIS prisoner while he was serving in Iraq. Another SEAL was sentenced in June for his role in the 2017 death of Army Staff Sgt. Logan Melgar, a Green Beret, in Bamako, Mali.

The info is here.

Friday, March 8, 2019

Seven moral rules found all around the world

University of Oxford
Originally released February 12, 2019

Anthropologists at the University of Oxford have discovered what they believe to be seven universal moral rules.

The rules: help your family, help your group, return favours, be brave, defer to superiors, divide resources fairly, and respect others' property. These were found in a survey of 60 cultures from all around the world.

Previous studies have looked at some of these rules in some places – but none has looked at all of them in a large representative sample of societies. The present study, published in Current Anthropology, is the largest and most comprehensive cross-cultural survey of morals ever conducted.

The team from Oxford's Institute of Cognitive & Evolutionary Anthropology (part of the School of Anthropology & Museum Ethnography) analysed ethnographic accounts of ethics from 60 societies, comprising over 600,000 words from over 600 sources.

Dr. Oliver Scott Curry, lead author and senior researcher at the Institute for Cognitive and Evolutionary Anthropology, said: "The debate between moral universalists and moral relativists has raged for centuries, but now we have some answers. People everywhere face a similar set of social problems, and use a similar set of moral rules to solve them. As predicted, these seven moral rules appear to be universal across cultures. Everyone everywhere shares a common moral code. All agree that cooperating, promoting the common good, is the right thing to do."

The study tested the theory that morality evolved to promote cooperation, and that – because there are many types of cooperation – there are many types of morality. According to this theory of 'morality as cooperation," kin selection explains why we feel a special duty of care for our families, and why we abhor incest. Mutualism explains why we form groups and coalitions (there is strength and safety in numbers), and hence why we value unity, solidarity, and loyalty. Social exchange explains why we trust others, reciprocate favours, feel guilt and gratitude, make amends, and forgive. And conflict resolution explains why we engage in costly displays of prowess such as bravery and generosity, why we defer to our superiors, why we divide disputed resources fairly, and why we recognise prior possession.

The information is here.

Saturday, December 15, 2018

What is ‘moral distress’? A narrative synthesis of the literature

Georgina Morley, Jonathan Ives, Caroline Bradbury-Jones, & Fiona Irvine
Nursing Ethics
First Published October 8, 2017 Review Article  


The concept of moral distress (MD) was introduced to nursing by Jameton who defined MD as arising, ‘when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. MD has subsequently gained increasing attention in nursing research, the majority of which conducted in North America but now emerging in South America, Europe, the Middle East and Asia. Studies have highlighted the deleterious effects of MD, with correlations between higher levels of MD, negative perceptions of ethical climate and increased levels of compassion fatigue among nurses. Consensus is that MD can negatively impact patient care, causing nurses to avoid certain clinical situations and ultimately leave the profession. MD is therefore a significant problem within nursing, requiring investigation, understanding, clarification and responses. The growing body of MD research, however, is arguably failing to bring the required clarification but rather has complicated attempts to study it. The increasing number of cited causes and effects of MD means the term has expanded to the point that according to Hanna and McCarthy and Deady, it is becoming an ‘umbrella term’ that lacks conceptual clarity referring unhelpfully to a wide range of phenomena and causes. Without, however, a coherent and consistent conceptual understanding, empirical studies of MD’s prevalence, effects, and possible responses are likely to be confused and contradictory.

A useful starting point is a systematic exploration of existing literature to critically examine definitions and understandings currently available, interrogating their similarities, differences, conceptual strengths and weaknesses. This article presents a narrative synthesis that explored proposed necessary and sufficient conditions for MD, and in doing so, this article also identifies areas of conceptual tension and agreement.

Friday, December 14, 2018

Why Health Professionals Should Speak Out Against False Beliefs on the Internet

Joel T. Wu and Jennifer B. McCormick
AMA J Ethics. 2018;20(11):E1052-1058.
doi: 10.1001/amajethics.2018.1052.


Broad dissemination and consumption of false or misleading health information, amplified by the internet, poses risks to public health and problems for both the health care enterprise and the government. In this article, we review government power for, and constitutional limits on, regulating health-related speech, particularly on the internet. We suggest that government regulation can only partially address false or misleading health information dissemination. Drawing on the American Medical Association’s Code of Medical Ethics, we argue that health care professionals have responsibilities to convey truthful information to patients, peers, and communities. Finally, we suggest that all health care professionals have essential roles in helping patients and fellow citizens obtain reliable, evidence-based health information.

Here is an excerpt:

We would suggest that health care professionals have an ethical obligation to correct false or misleading health information, share truthful health information, and direct people to reliable sources of health information within their communities and spheres of influence. After all, health and well-being are values shared by almost everyone. Principle V of the AMA Principles of Ethics states: “A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated” (italics added). And Principle VII states: “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health” (italics added). Taken together, these principles articulate an ethical obligation to make relevant information available to the public to improve community and public health. In the modern information age, wherein the unconstrained and largely unregulated proliferation of false health information is enabled by the internet and medical knowledge is no longer privileged, these 2 principles have a special weight and relevance.

Thursday, December 6, 2018

Survey Finds Widespread 'Moral Distress' Among Veterinarians

Carey Goldberg
Originally posted October 17, 2018

In some ways, it can be harder to be a doctor of animals than a doctor of humans.

"We are in the really unenviable, and really difficult, position of caring for patients maybe for their entire lives, developing our own relationships with those animals — and then being asked to kill them," says Dr. Lisa Moses, a veterinarian at the Massachusetts Society for the Prevention of Cruelty to Animals-Angell Animal Medical Center and a bioethicist at Harvard Medical School.

She's the lead author of a study published Monday in the Journal of Veterinary Internal Medicine about "moral distress" among veterinarians. The survey of more than 800 vets found that most feel ethical qualms — at least sometimes — about what pet owners ask them to do. And that takes a toll on their mental health.

Dr. Virginia Sinnott-Stutzman is all too familiar with the results. As a senior staff veterinarian in emergency and critical care at Angell, she sees a lot of very sick animals — and quite a few decisions by owners that trouble her.

Sometimes, owners elect to have their pets put to sleep because they can't or won't pay for treatment, she says. Or the opposite, "where we know in our heart of hearts that there is no hope to save the animal, or that the animal is suffering and the owners have a set of beliefs that make them want to keep going."

The info is here.

Tuesday, December 4, 2018

Document ‘informed refusal’ just as you would informed consent

James Scibilia
AAP News
Originally posted October 20, 2018

Here is an excerpt:

The requirements of informed refusal are the same as informed consent. Providers must explain:

  • the proposed treatment or testing;
  • the risks and benefits of refusal;
  • anticipated outcome with and without treatment; and
  • alternative therapies, if available.

Documentation of this discussion, including all four components, in the medical record is critical to mounting a successful defense from a claim that you failed to warn about the consequences of refusing care.

Since state laws vary, it is good practice to check with your malpractice carrier about preferred risk management documentation. Generally, the facts of these discussions should be included and signed by the caretaker. This conversation and documentation should not be delegated to other members of the health care team. At least one state has affirmed through a Supreme Court decision that informed consent must be obtained by the provider performing the procedure and not another team member; it is likely the concept of informed refusal would bear the same requirements.

The info is here.

Tuesday, November 6, 2018

Bringing back professionalism in the practice of law is key

Samuel C. Stretton
The Legal Intelligencer
Originally published October 4, 2018

Here is an excerpt:

All lawyers ought to review the Pennsylvania Rules of Civility. Although these rules do not have disciplinary consequences, they set forth the aspirations all lawyers should achieve in the legal profession. Perhaps lawyers have to understand what it means to be a professional. To have the privilege of being admitted to practice law in a state is a wonderful opportunity. The lawyer being admitted becomes part of the legal profession which has a long and historic presence. The legal profession can take great credit for the evolving law and for the democratic institutions which populate this country. Lawyers through vigorous advocacy and through much involvement in the community and in the political offices have help to create a society by law where fairness and justice are the ideals. Once admitted to practice, each and every lawyer becomes part of this wonderful profession and has a duty to uphold the ideals not only in terms of representing clients as vigorously and as honestly as they can, but also in terms of insuring involvement in the community and in society. Each generation of lawyers help to reinterpret the constitution and make it a living document to adjust to the modern problems of every generation. It is a wonderful and great honor to be part of this profession and perhaps one of the greatest privileges any lawyer can have. This privilege allows a lawyer to participate fully in the third branch of public. This privilege allows a lawyer to become part of the public life of their community and of the country in terms of representation and in terms of legal and judicial changes.

The information is here.

Thursday, May 11, 2017

Is There a Duty to Use Moral Neurointerventions?

Michelle Ciurria
Topoi (2017).


Do we have a duty to use moral neurointerventions to correct deficits in our moral psychology? On their surface, these technologies appear to pose worrisome risks to valuable dimensions of the self, and these risks could conceivably weigh against any prima facie moral duty we have to use these technologies. Focquaert and Schermer (Neuroethics 8(2):139–151, 2015) argue that neurointerventions pose special risks to the self because they operate passively on the subject’s brain, without her active participation, unlike ‘active’ interventions. Some neurointerventions, however, appear to be relatively unproblematic, and some appear to preserve the agent’s sense of self precisely because they operate passively. In this paper, I propose three conditions that need to be met for a medical intervention to be considered low-risk, and I say that these conditions cut across the active/passive divide. A low-risk intervention must: (i) pass pre-clinical and clinical trials, (ii) fare well in post-clinical studies, and (iii) be subject to regulations protecting informed consent. If an intervention passes these tests, its risks do not provide strong countervailing reasons against our prima facie duty to undergo the intervention.

The article is here.

Friday, May 5, 2017

The Duty to be Morally Enhanced

Persson, I. & Savulescu, J.
Topoi (2017)


We have a duty to try to develop and apply safe and cost-effective means to increase the probability that we shall do what we morally ought to do. It is here argued that this includes biomedical means of moral enhancement, that is, pharmaceutical, neurological or genetic means of strengthening the central moral drives of altruism and a sense of justice. Such a strengthening of moral motivation is likely to be necessary today because common-sense morality having its evolutionary origin in small-scale societies with primitive technology will become much more demanding if it is revised to serve the needs of contemporary globalized societies with an advanced technology capable of affecting conditions of life world-wide for centuries to come.

The article is here.