SIRA conference of philosophy of medicine in Crakow, August 2000, offered the opportunity to visit Auschwitz—an offer reluctantly accepted by the author who had two decades ago, spent some months in Israel, cried at Dachau, treated many holocaust survivors, and counts among close friends and colleagues persons profoundly affected by Auschwitz and associated activities. Surely, the visit would be simply a mark of respect, and an episode of further personal grieving maybe, but not enlightenment. This was not the case.The lasting (...) impression has been that of the dangers of efficiency as a value in itself, the inadequacy of outcome measures if the array is incomplete, and the need for clear articulation not only of goals, but …. (shrink)

SIRThere is nothing wrong with Dr Gillon's suggestion to doctors that they ask Jehovah's Witness patients why they refuse a blood transfusions and present alternative viewpoints. ….

Despite tendencies to compete for a prime place in moral theory, neither virtue ethics nor the four principles approach should claim to be superior to, or logically prior to, the other. Together they provide a more adequate account of the moral life than either can offer on its own. The virtues of principlism are clarity, simplicity and (to some extent) universality. These are well illustrated by Ranaan Gillon’s masterly analysis of the cases he has provided. But the vices of this (...) approach are the converse of its virtues: neglect of emotional and personal factors, oversimplification of the issues, and excessive claims to universality. Virtue ethics offers a complementary approach, providing insights into moral character, offering a blend of reason and emotion, and paying attention to the context of decisions. The cases provided can be more adequately understood if we combine the approaches. Both should foster the virtues of humility and magnanimity. (shrink)

SIRI read with interest the recent articles by “Lee Elder”1 and O Muramoto,2 along with the accompanying editorial3 about the treatment of ….

The neglect of psycho-spiritual needs of patients as they traverse the modern healthcare system has been a featured theme in medical literature over the past decade. This literature, which often highlights in-patient palliative care, as well as acute and critical care settings, influences practice guidelines and protocols of doctors and nurses. In this essay, I review some of the pertinent issues raised in the literature and examine the validity of placing an ethical perspective on this issue. I also compare Islamic (...) theocentric perspectives with secular, non-theistic perspectives on restoring psycho-spiritual care for patients. I then develop a framework for pastoral intervention based on aspects of the Islamic tradition and elaborate this framework by addressing clinical contexts and cases. The essay is an exposition based upon a review of the modern medical literature, an analysis of some of the traditional Islamic written sources, and the observations of the investigator, a practicing physician and an American Muslim. (shrink)

The “therapeutic misconception” describes a process whereby research volunteers misinterpret the intentions of researchers and the nature of clinical research. This misinterpretation leads research volunteers to falsely attribute a therapeutic potential to clinical research, and compromises informed decision making, therefore compromising the ethical integrity of a clinical experiment. We review recent evidence from the neurobiology of social cognition to provide a novel framework for thinking about the therapeutic misconception. We argue that the neurobiology of social cognition should be considered in (...) any ethical analysis of how people make decisions about participating in clinical trials. The neurobiology of social cognition also suggests how the complicated dynamics of the doctor-patient relationship may unavoidably interfere with the process of obtaining informed consent. Following this argument we suggest new ways to prevent or at least mitigate the therapeutic misconception. (shrink)