A standard view in ethics is that ethical issues concern a different range of human concerns than does politics. This essay goes beyond the long-standing dispute about the extent to which applied ethics needs a commitment to ethical theory. It argues that regardless of the outcome of that dispute, applied ethics, because it presumes something about the nature of authority, rests upon and is implicated in political theory. After internalist and externalist accounts of applied ethics are described, “mixed” approaches are (...) considered that contain inevitable political dimensions. A feminist alternative, Walker’s metaethic of responsibility, shows that authority is best understood as relational and that situations of unequal power are therefore often the places where applied ethics arises. Furthermore, in a democratic society, commitments to democracy should shape the account of authority, and, thus, the nature of applied ethics as well. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

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. (shrink)

The interdisciplinary debate about the nature of expertise often conflates having expertise with either the individual possession of competences or a certain role ascription. In contrast to this, the paper attempts to demonstrate how different dimensions of expertise ascription are inextricably interwoven. As a result, a balanced account of expertise will be proposed that more accurately determines the closer relationship between the expert’s dispositions, their manifestations and the expert’s function. This finally results in an advanced understanding of expertise that views (...) someone as an expert only if she is undefeatedly disposed to fulfill a contextually salient service function adequately at the moment of assessment. (shrink)

Anti-aging medicine has emerged in the past two decades as both a medical practice and scientific objective largely aimed at intervening into the process of aging itself rather than its “associated” diseases. This has provoked a both excitement and concern in bioethical deliberations on the meaning and potential impact of an effective intervention. In this article, I examine the different ways in which bioethicists, other social scientists, and anti-aging proponents frame anti-aging goals, in particular, the construction of immortality as its (...) implicit and explicit aim. This research is based upon over 9 years of anthropological, ethnographic interview- and observation-based research in the field and draws substantially from the US President’s Council on Bioethics’ deliberations on this topic as well as from interview data and other publications/discussion on anti-aging medicine. I argue that while the framework of life and death provide the primary structure for many bioethical and social science critiques of anti-aging medicine, many if not most anti-aging practitioners, researchers, and advocates employ the alternative structure of health and pain to orient their work. These divergent orientations of life/death and health/pain beget competing conversations around anti-aging medicine; including voices from the front lines of anti-aging practice complicate bioethical critiques and ultimately beg different questions. Positioning the painful, physiological decline of aging as the ultimate adversary rather than death challenges traditional models of biomedical intervention based on “nature” and “disease” constructions. (shrink)

A referral was made to our Cardiac Transplant Program for a patient who was in the New Jersey Prison System. The Medical Director of the New Jersey Department of Corrections called regarding a 39-year-old inmate who was being treated in a New Jersey hospital that has a unit for prisoners from a nearby cor- rectional facility. The referring physician described the patient to our Medical Director of heart transplantation as a “murderer” who had been incarcerated since 1987 and sentenced to (...) prison for 30 years without eligibility for parole before completion of his 30-year sentence. The patient was being treated in the CCU of the facility and according to preliminary studies, was suffering from a possible dilated cardiomyopathy. There was evidence of a prior cerebrovascular accident (etiology unknown) with a dense hemiplegia of the left side. The patient was alert but unable to care for himself. There were a number of specific tests necessary to evaluate the patient's candidacy for heart transplantation before actually placing him-on a waiting list. However, the transplant director was uncertain about having the patient brought to our facility for further testing and called some members of the Transplant Selection Committee team to discuss the case. (shrink)

Given the current organ shortage, a prevalent alternative to the altruism-based policy is a market-based solution: pay people for their organs. Receiving much popular and scholarly attention, a salient normative argument against neoliberal pressures is the preservation of human dignity. This article examines how advocates of both the altruistic status quo and market challengers reason and weigh the central normative concept of dignity, meant as inherent worth and/or rank. Key rhetorical strategies, including motivations and broader social visions, of the two (...) positions are analyzed and evaluated, and the separation of morally normative understandings of dignity from market encroachment is defended. (shrink)