This article argues that strong versions of the situationist critique of virtue ethics are empirically and conceptually unfounded, as well as that, even if one accepts that the predictive power of character may be limited, this is not a fatal problem for early Confucian virtue ethics. Early Confucianism has explicit strategies for strengthening and expanding character traits over time, as well as for managing a variety of situational forces. The article concludes by suggesting that Confucian virtue ethics represents a more (...) empirically responsible model of ethics than those currently dominant in Western philosophy. (shrink)

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 17-18, November 2011.

Virtue ethics is perhaps the most important development within late twentieth-century moral philosophy. Rosalind Hursthouse, who has made notable contributions to this development, here presents a full exposition and defense of her neo-Aristotelian version of virtue ethics. She shows how virtue ethics can provide guidance for action, illuminate moral dilemmas, and bring out the moral significance of the emotions.

Although clinical ethics scholarship and practice has largely avoided assuming an activist stance, the many health care crises of the last eighteen months motivated a distinct change: On listserves, in blog postings, and in published essays, activist language has permeated conversations over such issues as the impact of triage policies on persons with disabilities and of color, and how the health care system has historically failed African Americans. In this paper, I defend this turn, arguing that clinical ethicists should embrace (...) activism—generally, and with particular emphasis on institutional, mesolevel concerns. Ethicists are often uniquely situated to understand the structural factors that regularly motivate clinical ethics cases, and they are often in a privileged position to be effective change agents. In making this case, I also stress the need not to overstep one's skills and to be acutely cognizant of the political risks associated with such work. (shrink)

Clinical ethics consultants should show bold moral courage in discharging their duties to patients, families, and healthcare providers. Given the corrosive impact on trust, and on the appropriate d...

We argue against Christopher Meyers’s call for clinical ethicists to participate in deceiving patients, surrogate decision-makers, or family members. While we acknowledge that some forms of deception may be ethically appropriate in highly circumscribed situations, the type of case Meyers describes as involving justifiable deception differs in at least two important ways. First, Meyers fails to distinguish acts of deception based on the critical feature of who is being deceived—patient, surrogate, or family member—and the overarching duty to respect the autonomy (...) of relevant decision-makers to make rationally-informed decisions. Second, Meyers’s analysis relies on an assessment of harm, a value-laden concept which health care professionals and ethicists should not presumptively assess without considering how the patient, surrogate, or family might assess specific harms. (shrink)

Anyone who is not a deontological absolutist regarding truthfulness will readily agree with Christopher Meyers’s thesis that there are cases in which...

In “Deception and the Clinical Ethicist,” Christopher Meyers argues that clinical ethicists sometimes ought to actively help deceive patients or their families, all...

Meyers argues that clinical ethicists should sometimes be active participants in the deception of patients and families, whether that involves lies of omission or commission. I shall...

Lying to one’s patients is wrong. So obvious as to border on a platitude, this truism is one that bioethicists have heartily endorsed for several decades. Deception, the standard line holds, underc...

The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event—especially subjective self-appraised symptoms—can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (another (...) version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 13-14, November 2011.

Most bioethicists and professional medical societies condemn the practice of ?slow codes.? The American College of Physicians ethics manual states, ?Because it is deceptive, physicians or nurses should not perform half-hearted resuscitation efforts (?slow codes?).? A leading textbook calls slow codes ?dishonest, crass dissimulation, and unethical.? A medical sociologist describes them as ?deplorable, dishonest and inconsistent with established ethical principles.? Nevertheless, we believe that slow codes may be appropriate and ethically defensible in situations in which cardiopulmonary resuscitation (CPR) is likely (...) to be ineffective, the family decision makers understand and accept that death is inevitable, and those family members cannot bring themselves to consent or even assent to a do-not-resuscitate (DNR) order. In such cases, we argue, physicians may best serve both the patient and the family by having a carefully ambiguous discussion about end-of-life options and then providing resuscitation efforts that are less vigorous or prolonged than usual. (shrink)

Does it signify morally whether a deception is achieved by a lie or some other way? David Bakhurst has challenged my view that it can signify. Here I counter his criticisms--firstly, by clarifying the terminology: What counts as a lie? Secondly, by exploring further what makes lying wrong. Bakhurst maintains that lying is wrong in that it infringes autonomy--and other deceiving stratagems, he says, do so equally. I maintain that lying is wrong in that it endangers trust--and other types of (...) deceiving stratagems do not do so equally. Lying to patients, I contend, is an abuse of their trust. Other forms of their intentional deception need not be so, although, in our autonomy-minded culture, they are likely to be so. (shrink)

Sustaining hope in patients is an important element of health care, allowing improvement in patient welfare and quality of life. However in the palliative care context, with patients who are terminally ill, it might seem that in order to maintain hope the palliative care practitioner would sometimes have to deceive the patient about the full nature or prospects of their condition by providing a ‘false hope’. This possibility creates an ethical tension in palliative practice, where the beneficent desire to improve (...) patient welfare through sustaining hope appears to be in conflict with an autonomy-based requirement not to deceive patients about their condition. In order to resolve this ethical tension, we provide an analysis of the concept of hope and argue that there is at least one conception – the ‘absolute’ conception of hope – which when properly understood allows practitioners to foster hope in terminally-ill patients while avoiding any need to deceive them about their condition. Practitioners therefore do not need to shy away from using the language of hope in the palliative setting, as on this understanding of hope it can be used in a way that both promotes patient welfare and respects patient autonomy. (shrink)

The target article by Christopher Meyers concerning justification of deception for clinical ethicists is both well-reasoned and plausible. Clearly grounded in utilitarian considerations, its...

Christopher Meyers attempts a utilitarian defense of the deception of patients when the purported harms of truthful disclosure outweigh its benefits. He suggests that honesty i...

Not only is deception commonplace in medical encounters, according to Christopher Meyers (2021), but the clinical ethicist might have moral obligations to support and even enact deception. Descriptively Meyers is right that there are “opportunistic, self-interested and benevolent reasons” for deception through omission and commission in clinical medicine. But it is possible to retain this premise while rejecting the normative conclusion that the clinical ethicist “should sometimes be an active participant in the deception of patients and families.” One reason to (...) reject the normative conclusion is its incompatibility with providing trauma informed ethics consultation (TIEC). In the TIEC framework I developed with Uchenna Anani, we defend the integration of trauma informed care (TIC) into ethics consultation (Lanphier and Anani 2021). While ethicists narrowly attend to the question and scope of the ethics consults made to them, doing so in alignment with trauma informed principles is tantamount to providing good ethics consultation. According to Meyers, the clinical ethicist is an “advocate for the best ethical choices.” The best ethical choices are also trauma informed ones. (shrink)

Rosalind Hursthouse has written an excellent book, in which she develops a neo-Aristotelian virtue ethics that she sees as avoiding some of the major criticisms leveled against virtue ethics in general, and against Aristotle's brand of virtue ethics in particular.

Clinical ethical consultants are subject to an unavoidable conflict of interest. Their work requires that they be independent, but incentives attached to their role chip relentlessly at independence. This that they be independent, is a problem without any solution, but it can at least be ameliorated through careful management.

In “Deception and the Clinical Ethicist,” Christopher Meyers defends that view that deception practiced by clinical ethicists is legitimate if it satisfies a series of justifying conditions (Meyers...

The opening sentence of Christopher Meyers’ Target Article is “Lying to one’s patient is wrong”. The author continues, “This truism is one that bioethicists have heartedly endorsed fo...

I trust my lawyer more than I trust my doctor.—Shana Alexander, 1992 [The audience laughed.]1The Hippocratic Oath makes the physician invoke external supervision of her adherence to what she affirm...

Anne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision‐making. The bottom line is that, even if an undisclosed placebo might be marginally more effective for a particular patient in the short term, over the long haul the integrity of the patient‐physician relationship relies (...) on doctors being honest with their patients. Even when it comes to placebos, honesty remains the best policy. (shrink)