The purpose of the research. The main purpose of the study is to find out the experience of researching and solving the problem of professional burnout for physicians including family ones in the United States, by analyzing recent surveys and scientific papers of American and European scientists. Methodology. While working on the article, general scientific theoretical methods were used to accom-plish the tasks and achieve the purpose of the research. The methodological basis of the research was the structural-functional method, which (...) allowed considering the phenomenon of professional burnout as a whole with separate elements and their dependencies. Using a historical method, a brief overview of the research development by US scientists on the problem of professional burnout of physicians with a focus on key events that occurred at each of the stages highlighted in the scientific papers. A comparative method was used to compare the results of surveys of different years and topics, data presented in the proceedings of the scientists, and research approaches. Methods of systematization and generalization were used to formulate the paper’s conclusions, in particular, to highlight the essential features of the American research experience and practical problem solution of professional burnout of physicians. Results. It has been found that the professional burnout of physicians has been a matter of concern for the government, professional medical associations, and the general public for physicians of various US specialties for a long time. Although burnout affects physicians of all disciplines, it has been discovered that, among family physicians, this phenomenon exceeds the average level, especially compared to the general economically active population of the United States. Two approaches to identifying and reducing the risk of occupational burnout in the United States have been identified and characterized: the first approach covers measures aimed directly at a physician, that is, a specific individual, and the second, involves measures aimed at an organization, that is, a medical institution. It has been found that Ameri-can scientists have concluded that organizational measures are more effective, but the first approach should be applied as a first step in overcoming professional burnout. Practical meaning. The results of the research are applicable for further scientific exploration and practical problem solution of professional burnout of physicians, including family ones, in Ukraine. Prospects for further research. Meth-odology of surveys of physicians of various specialties on burnout, depresdepression and professional satisfac-tion. Factors of professional burnout for family physicians in Ukraine. (shrink)

The purpose of the research. The main purpose of the study is to find out the experience of researching and solving the problem of professional burnout for physicians including family ones in the United States, by analyzing recent surveys and scientific papers of American and European scientists. Methodology. While working on the article, general scientific theoretical methods were used to accom-plish the tasks and achieve the purpose of the research. The methodological basis of the research was the structural-functional method, which (...) allowed considering the phenomenon of professional burnout as a whole with separate elements and their dependencies. Using a historical method, a brief overview of the research development by US scientists on the problem of professional burnout of physicians with a focus on key events that occurred at each of the stages highlighted in the scientific papers. A comparative method was used to compare the results of surveys of different years and topics, data presented in the proceedings of the scientists, and research approaches. Methods of systematization and generalization were used to formulate the paper’s conclusions, in particular, to highlight the essential features of the American research experience and practical problem solution of professional burnout of physicians. Results. It has been found that the professional burnout of physicians has been a matter of concern for the government, professional medical associations, and the general public for physicians of various US specialties for a long time. Although burnout affects physicians of all disciplines, it has been discovered that, among family physicians, this phenomenon exceeds the average level, especially compared to the general economically active population of the United States. Two approaches to identifying and reducing the risk of occupational burnout in the United States have been identified and characterized: the first approach covers measures aimed directly at a physician, that is, a specific individual, and the second, involves measures aimed at an organization, that is, a medical institution. It has been found that Ameri-can scientists have concluded that organizational measures are more effective, but the first approach should be applied as a first step in overcoming professional burnout. Practical meaning. The results of the research are applicable for further scientific exploration and practical problem solution of professional burnout of physicians, including family ones, in Ukraine. Prospects for further research. Meth-odology of surveys of physicians of various specialties on burnout, depression and professional satisfac-tion. Factors of professional burnout for family physicians in Ukraine. (shrink)

In this issue, Ahmadi1 reports on the practice of hymenoplasty—a surgical intervention meant to restore a presumed physical marker of virginity prior to a woman's marriage. As Mehri and Sills2 have stated, these women ‘want to ensure that blood is spilled on their wedding night sheets.’ Although Ahmadi's research was carried out in Iran specifically, this surgery is becoming increasingly popular in a number of Western countries as well, especially among Muslim populations.3 What are the ethics of hymen restoration?Consider the (...) role of the physician. Two of the doctors interviewed by Ahmadi reported being in ‘a perpetual state of guilt because of the surgery's inherent aim at deceiving the groom’ and noted their ‘personal conflict’ at being involved in this deception. Yet: "None of the doctors believed that the surgery was unethical, arguing that the girl could be ‘abused’ and ‘can even die’ if she is discovered not … ". (shrink)

The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors indicate different circumstances (...) as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice. (shrink)

Comment on "The ethical 'elephant' in the death penalty 'room'". Arguments in defense of the death penalty typically fall into one of two groups. Consequentialist arguments point out beneficial aspects of capital punishment, normally focusing on deterrence, while non-consequentialist arguments seek to justify execution independently of its effects, for example, by appealing to the concept of retribution. Michael Keane's target article "The ethical 'elephant' in the death penalty 'room'" should, we believe, be read as an interesting new consequentialist defense of (...) physician involvement in capital punishment. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In this paper, I defend (...) the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

Physicians in Islamic countries might be requested to participate in the Islamic legal code of qiṣāṣ, in which the victim or family has the right to an eye-for-an-eye retaliation. Qiṣāṣ is only used as a punishment in the case of murder or intentional physical injury. In situations such as throwing acid, the national legal system of some Islamic countries asks for assistance from physicians, because the punishment should be identical to the crime. The perpetrator could not be punished without a (...) physician’s participation, because there is no way to guarantee that the sentence would be carried out without inflicting more injury than the initial victim had suffered. By examining two cases of acid throwing, this paper discusses issues related to physicians’ participation in qiṣāṣ from the perspective of medical ethics and Islamic Shari’a law. From the standpoint of medical ethics, physicians’ participation in qiṣāṣ is not appropriate. First, qiṣāṣ is in sharp contrast to the Hippocratic Oath and other codes of medical ethics. Second, by physicians’ participation in qiṣāṣ, medical practices are being used improperly to carry out government mandates. Third, physician participation in activities that cause intentional harm to people destroys the trust between patients and physicians and may adversely affect the patient–physician relationship more generally. From the standpoint of Shari’a, there is no consensus among Muslim scholars whether qiṣāṣ should be performed on every occasion. We argue that disallowing physician involvement in qiṣāṣ is necessary from the perspectives of both medical ethics and Shari’a law. (shrink)

Concern about the ethics of clinical drug trials research on patients and healthy volunteers has been the subject of significant ethical analysis and policy development—protocols are reviewed by Research Ethics Committees and subjects are protected by informed consent procedures. More recently attention has begun to be focused on DNA banking for clinical and pharmacogenetics research. It is, however, surprising how little attention has been paid to the commercial nature of such research, or the unique issues that present when subjects are (...) asked to consent to the storage of biological samples. Our contention is that in the context of pharmacogenetic add-on studies to clinical drug trials, the doctrine of informed consent fails to cover the broader range of social and ethical issues. Applying a sociological perspective, we foreground issues of patient/subject participation or ‘work’, the ambiguity of research subject altruism, and the divided loyalties facing many physicians conducting clinical research. By demonstrating the complexity of patient and physician involvement in clinical drug trials, we argue for more comprehensive ethical review and oversight that moves beyond reliance on informed consent to incorporate understandings of the social, political and cultural elements that underpin the diversity of ethical issues arising in the research context. (shrink)

Analyses of factual causation face perennial problems, including preemption, overdetermination, and omissions. Arguably, the thorniest, are cases of omissive overdetermination, involving two independent omissions, each sufficient for the harm, and neither, independently, making a difference. A famous example is Saunders, where pedestrian was hit by a driver of a rental car who never pressed on the (unbeknownst to the driver) defective (and, negligently, never inspected) brakes. Causal intuitions in such cases are messy, reflected in disagreement about which omission mattered. What (...) these analyses mistakenly take for granted, is that at issue is the 'efficacy' of each omission. I argue, on the contrary, the puzzle of omissive overdetermination favors taking the act/omission distinction seriously. Factual causation, properly understood precludes omissions (i.e. omissions are not causal). Of course, the law also attaches liability to omissions, but this works differently from liability for real causes (e.g. omissions have a duty requirement, they also respond differentially to difference-making considerations). The manner in which liability attaches for omissions differs from that of straightforward causal liability, and is entirely dependent on the underlying causal structure. Attention to that structure (e.g. that the driver's hitting the pedestrian with his car is what actually caused the injury) sheds light on which omissions matter (e.g. driver's failure to press on the brakes) and why (because that failure removes a defense the driver would have to liability for the accident he caused). Other cases, where the parties' connection is entirely omissive (e.g. two physicians fail to detect independently lethal conditions), come out differently (tracking moralized elements). The analysis offered makes better sense of both why omissive determination cases are puzzling and how to resolve them. (shrink)

One of the most influential recent developments in supposedly radical philosophy is ‘posthumanism’. This can be seen as the successor to ‘deconstructive postmodernism’. In each case, the claim of its proponents has been that cultures are oppressive by virtue of their elitism, and this elitism, fostered by the humanities, is being challenged. In each case, however, these philosophical ideas have served ruling elites by crippling opposition to their efforts to impose markets, concentrate wealth and power and treat everyone and everything (...) as mere instruments in a way that is not only undermining democracy and threatening economic, social and political stability through growing inequality, but is crippling efforts to deal with the global ecological crisis. Philosophers, Nietzsche claimed, are physicians of culture. Why should people claiming to be philosophers, or at least aligned with philosophers, subvert their own calling? In this paper I will suggest that with the expansion of education and the rise of neoliberalism, those involved in education and research, particularly in the humanities and social sciences, have been proletarianized, and most have accepted this proletarianization. They have been reduced to a fraction of the proletariat - wage-slaves without economic security and therefore dependent on the will of others on whom they are dependent. They are not ordinary wage-slaves, however, but wage-house-slaves, having salaries rather than wages. If, as Marx argued, social being determines consciousness, posthumanism can be understood as the expression of ressentiment of these house-slaves at their condition while simultaneously serving to affirm their superiority to field-slaves while serving their masters. Their work is supported because it provides ideological cover for their masters, the new transnational managerial class or corporatocracy as they expand their power through information technology, while absolving this corporatocracy from responsibility for the consequences of their growing power. In making this claim I will argue that the real target of deconstructionists and posthumanists, although this is now seldom appreciated, has been the humanism of the New Left, a revival of the Radical Enlightenment inspired by Renaissance civic humanism and the German Renaissance. (shrink)

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)

The pelvic exam is used to assess the health of female reproductive organs and so involves digital penetration by a physician. However, it is common practice for medical students to acquire experience in administering pelvic exams by performing them on unconscious patients without prior authorization. In this article, we argue that such unauthorized pelvic exams (UPEs) are sexual assault. Our argument is simple: in any other circumstance, unauthorized digital penetration amounts to sexual assault. Since there are no morally significant (...) differences between UPEs and other instances of digital penetration, UPEs are sexual assault. So, insofar as one is against sexual assault, one should be against UPEs. (shrink)

Torture is unethical and usually counterproductive. It is prohibited by international and national laws. Yet it persists: according to Amnesty International, torture is widespread in more than a third of countries. Physicians and other medical professionals are frequently asked to assist with torture. -/- Medical complicity in torture, like other forms of involvement, is prohibited both by international law and by codes of professional ethics. However, when the victims of torture are also patients in need of treatment, doctors can (...) find themselves torn. To accede to the requests of the torturers may entail assisting or condoning terrible acts. But to refuse care to someone in medical need may seem like abandoning a patient and thereby fail to exhibit the beneficence expected of physicians. -/- In this paper, we argue that this dilemma is real and that sometimes the right thing for a doctor to do, overall, is to be complicit in torture. Though complicity in a wrongful act is itself prima facie wrongful, this judgment may be outweighed by other factors. We propose three criteria for analyzing how those factors apply to particular cases of medical complicity in torture. (shrink)

In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for (...) the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues. (shrink)

abstract Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be administered in an (...) honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment. While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive. (shrink)

This paper investigates the relationship between some corpuscularian and Aristotelian strands that run through the thought of the sixteenth-century philosopher and physician Julius Caesar Scaliger. Scaliger often uses the concepts of corpuscles, pores, and vacuum. At the same time, he also describes mixture as involving the fusion of particles into a continuous body. The paper explores how Scaliger’s combination of corpuscularian and non-corpuscularian views is shaped, in substantial aspects, by his response to the views on corpuscles and the vacuum (...) in the work of his contemporary, Girolamo Fracastoro. Fracastoro frequently appears in Scaliger’s work as an opponent against whom numerous objections are directed. However, if one follows up Scaliger’s references, it soon becomes clear that Scaliger also shares some of Fracastoro’s views. Like Scaliger, Fracastoro suggests corpuscularian explanations of phenomena such as water rising in lime while at the same time ascribing some non-corpuscularian properties to his natural minima. Like Scaliger, Fracastoro maintains that there is no vacuum devoid of bodies since places cannot exist independently of bodies (although their opinions diverge regarding how exactly the relevant dependency relation might be explicated). Finally, like Scaliger, Fracastoro connects a continuum view of mixture with a theory of natural minima. (shrink)

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative approach (...) to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs. (shrink)

Dreaming is a communicative activity between the most sensitive archive of the enregistered experience of life on the earth, the brain, and the most plastic medium for the discovery and practice of meaning, the mind or culture. Both love and war have been made on the basis of dreams, not to mention scientific discoveries. In ancient Greece dreams were medicinal parts of curative sleeping or "incubation" rites in the temple of Aesculapius, and many psychoanalytic physicians today still consider dreams as (...) possessing therapeutic potential. The ethnographic literature gives ample testimony to the great significance accorded to dreams by all of the world cultures. Dreams form a rich store of ethnographic evidence, and their indigenous interpretations can often illuminate the central issues and conflicts of a people otherwise hidden from obvious view. Given these facts, plus the physiological facts that the dream process itself involves deeply-rooted material brain functions, and that rapid eye movement, or REM, sleep, which is the key indicator of human dreaming, is shared by all mammals, it remains strange how little attention is given to dreaming as a formative aspect of human evolution and culture. -/- This essay addresses dreaming as a formative aspect of human evolution and culture by viewing dreaming as a borderland between biology and culture, a thoroughly social, yet private experience. Dreaming not only highlights the "cultic" roots of culture—the spontaneous impulse to meaning—but also illustrates one of the ways in which the technics of the biosocial human body itself form the primary source of culture. I show why dreaming, although private, is a thoroughly cultural, biological, communicative activity. -/- Culture and biology are often treated by social scientists as though they were oil and water, not to be mixed. I should inform the culture theorist at the start that I am fully aware of the assumed nature-culture dichotomy, and that I reject it. I do so not because I am a sociobiologist, quite the contrary, rather because I am a semiotician, and my studies of signs have led me toward a critical reconstruction of the concepts of nature and culture. In what follows I beg the reader's patience, since I will draw from diverse materials and project some speculative hypotheses in places in order to make my argument. -/- . (shrink)

The IPAP Schizophrenia Algorithm was originally designed in the form of a flow chart to help physicians optimise the treatment of schizophrenic patients. We examined the current version from the perspective of recent work on terminologies and ontologies thereby drawing on the resources of Basic Formal Ontology, and this with the objective to make the algorithm appropriate for Semantic Web applications. We found that Basic Formal Ontology is a rich enough theory to represent all the entities involved and that applying (...) the theory to the IPAP schizophrenia algorithm results in a representation that can be used by software agents to perform monitoring and control in a referent tracking environment. (shrink)

A remarkable event occurred at the December 3, 2004, meeting of the U. S. President’s Council on Bioethics. Council member William Hurlbut, a physician and Consulting Professor in the Program in Human Biology at Stanford University, formally unveiled a proposal that he claimed would solve the ethical problems surrounding the extraction of stem cells from human embryos. The proposal would involve the creation of genetically defective embryos that “never rise to the level of integrated organismal existence essential to be (...) designated human life with potential,” and therefore could be used as morally acceptable sources of stem cells for research and therapy. The aim of this essay is to show that Hurlbut’s proposal does not solve the ethical problems associated with human embryonic stem cell research. Two major reasons are presented. First, the proposal, which involves modification of a somatic cell nucleus, suffers from an ethical problem that is common to all types of human genetic engineering: since the procedure is not foolproof, there will be failures. In the case of the procedure Hurlbut proposes, some normal (albeit cloned) embryos will be produced. Second, the embryo engineered in the manner described is, at least in the early stages of its development, fully human despite its genetic defect. This essay also will show how a reasonable person might mistakenly view the proposal as legitimate if he or she makes the error of conflating genetic determinism with Aristotelian teleology. Finally, it will argue that ethical clarity can be achieved by seeing the embryo as a holistic entity possessing emergent properties that cannot simply be spelled out by genes. (shrink)

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the MEDLINE, (...) Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: the value that patients give to healthcare professionals' communication skills; the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status. (shrink)

In 2015 the United Kingdom (UK) became the first nation to legalize egg and zygotic nuclear transfer procedures using mitochondrial replacement techniques (MRTs) to prevent the maternal transmission of serious mitochondrial DNA diseases to offspring. These techniques are a form of human germline genetic modification and can happen intentionally if female embryos are selected during the MRT clinical process, either through sperm selection or preimplantation genetic diagnosis (PGD). In the same year, an MRT was performed by a United States (U.S.)-based (...) physician team. This experiment involved a cross-border effort: the MRT procedure per se was carried out in the US, and the embryo transfer in Mexico. The authors examine the ethics of MRTs from the standpoint of genetic relatedness and gender implications, in places that lack adequate laws and regulation regarding assisted reproduction. Then, we briefly examine whether MRTs can be justified as a reproductive option in the US and Mexico, after reassessing their legalization in the UK. We contend that morally inadequate and ineffective regulations regarding egg donation, PGD, and germline genetic modifications jeopardize the ethical acceptability of the implementation of MRTs, suggesting that MRTs are currently difficult to justify in the US and Mexico. In addition to relevant regulation, the initiation and appropriate use of MRTs in a country require a child-centered follow-up policy and more evidence for its safety. (shrink)

The current impasse in the old debate about the morality of euthanasia is mainly due to the fact that the actual source of conflict has not been properly identified—or so I shall argue. I will first analyse the two different issues involved in the debate, which are sometimes confusingly mixed up, namely: (a) what is euthanasia?, and (b) why is euthanasia morally problematic? Considering documents by physicians, philosophers and the Roman Catholic Church, I will show that (a) ‘euthanasia’ is defined (...) by the intention to bring about a patient’s death, and (b) the distinction between what is intentional and what is not does not represent the morally problematic reason against euthanasia. Therefore, although the debate on euthanasia so far has mainly focussed on the distinctions ‘active /passive’ and ‘intentional /unintentional,’ I argue that neither constitutes the genuine source of the controversies. I will clarify what the source of controversies is, and outline the minimal requirement for an argument against euthanasia. (shrink)

In medical settings, machines are in close proximity with human beings: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. Machines in these contexts are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. -/- As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a code of medical ethics? What (...) theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for empathy and emotion detection necessary? What about consciousness? -/- The essays in this collection by researchers from both humanities and science describe various theoretical and experimental approaches to adding medical ethics to a machine, what design features are necessary in order to achieve this, philosophical and practical questions concerning justice, rights, decision-making and responsibility, and accurately modeling essential physician-machine-patient relationships. -/- This collection is the first book to address these 21st-century concerns. (shrink)

This article argues in favor of modifying the medical model of severe psychiatric disturbances that underlies calling them "mental illness." The key reason for this proposal is that numerous specialists other than physicians as well as non-specialists contribute to the process of assisting a person recover from what the author suggests might better be called "extraordinary functional disability." There is little uniformity in existing definitions under state laws, but all involve three types of intervention: civil commitment; civil determination of legal (...) competency; and standing to be subject to criminal law. Physicians typically make relevant determinations in each of these areas; but non-physicians are the principal care-givers once a determination has been made. (shrink)

Dear Editors, -/- I found the content of your editorials to be highly intriguing [1,2]. Scientific journals are witnessing a growing prevalence of publications related to artificial intelligence (AI). Three letters to the editor were recently published in your journal [3-5]. The renowned journal Nature has dedicated approximately 25 publications solely to the subject of ChatGPT. Moreover, a quick search on Pubmed using the term "ChatGPT" yields around 900 articles, with the vast majority originating in 2023. These statistics underscore the (...) substantial interest of the scientific community in this area. -/- AI, especially the ChatGPT tool and the recent Bard, have faced criticism and been portrayed as significant adversaries of science. It is evident that many authors or researchers, who may not be well-versed in writing, can greatly benefit from these tools, as mentioned earlier. Without taking a contrarian stance, one should consider the potential advantages of such technologies for researchers in less privileged regions, where access to new technologies is limited, and local or regional challenges abound [6]. AI cannot be confounded with other technologies, as it specifically focuses on replicating human-like intelligence and decision-making processes, rather than simply automating tasks or improving performance based on data patterns. -/- The translation into English poses challenges due to the dominance of English in worldwide publications, with over 95% of articles being published in this language, and even reaching 98% in some fields. Although this manuscript was partially translated using AI, it can still benefit researchers from non-native English regions. Even simple tasks like text editing can be problematic for researchers in underprivileged areas. AI can play a crucial role in the evolution of online lectures and classes, providing valuable support for African maxillofacial surgeons who lack the luxury of taking breaks from work to update their knowledge, as they may be the only available option [7]. One of the remarkable features of AI is its ability to discover knowledge gaps. The use of simple tools like reference organizers is rapidly evolving and can become automated or semi-automated through AI. However, we must carefully consider whether we should refrain from relying too heavily on AI in certain cases, as this could be seen as a significant regression. -/- On the other hand, we must be cautious about freely allowing AI tools to circulate in scientific journals and books without proper regulation [8]. Currently, accurately identifying texts generated by AI is challenging, and their effectiveness remains relatively low, at less than 30%. This means that only about 30 out of every 100 texts can be confidently classified as AI-generated. The technology must advance further to increase detection accuracy or at least raise suspicion. Academic journals no longer view authors acknowledging artificial intelligence tools as co-authors in their research favorably. This is crucial to prevent certain unscrupulous individuals, such as "false prophets," charlatans, and flat-earthers, from infiltrating the realm of science, potentially impeding the progress of serious research conducted by professionals dedicated to advancing humanity through science. -/- It is essential to keep in mind that AI does not generate anything novel. Human authors can not be fully substituted [9]. In research involving groundbreaking concepts, innovations, case reports, or technical notes, the use of AI tends to be less frequent due to its lack of capability in creating innovative outcomes. On the other hand, reviews, whether narrative, systematic, or scoping, are based on existing publications. To address potential fraudulent practices, editors, reviewers, and journals themselves should exercise greater vigilance and apply more stringent filters for this type of publication. -/- An article from over a decade ago already discussed the professions most susceptible to replacement by computerization [10]. Maxillofacial surgeons, physicians, dentists, and psychologists are among the professions that are less likely to be displaced. This position can be attributed to the significant level of patient-professional interaction, the development of specific manual skills over time, and the ability to make adaptable decisions during procedures. These intricacies pose formidable challenges for AI to grasp, regardless of its level of advancement. -/- We should maintain a composed yet vigilant stance at this juncture. Just as Portuguese navigators feared encountering serpents and sea monsters when they ventured into uncharted waters, the uncertainty and novelty of AI can evoke apprehension in us all. Nonetheless, we must embrace the benefits that AI can offer while imposing strict regulations and appropriate penalties to prevent any potential abuses carried out "in the name of science." -/- Sincerely yours,. (shrink)

Background The health care sector is experiencing a drastic transition all over the world. This has an impact not only on the way hospitals, clinics, special-care homes etc. are organized, but also on patients, personnel and other stakeholders involved. The consequences of changes for both physicians and patients are investigated using a comprehensive health care reform in Ukraine as an example. -/- Methods The analysis is based on empirical data collected from general physicians in 2 Ukrainian cities. Based on the (...) Job Demands-Resources Model, we developed a set of hypotheses and tested them using the structural equation modelling technique. A total of 178 general physicians (81% of the approached population) participated in the study. -/- Results Our investigation reveals a clear relationship between the organizational job demands (additional tasks, structural changes, new processes) and their psychological effects (e. g., burnout). The latter have a negative impact on cooperation of physicians in hospitals leading to lower patient satisfaction. -/- Discussion and Conclusions Change in health care is inevitable. The example of Ukraine shows that openness of hospitals towards change reduces the probability of physicians’ burnout and, eventually, increases patient satisfaction. We strongly suggest applying the process management approach in order to increase openness to change, especially in turbulent times. (shrink)

In various writings Michel Foucault has shown how, in the beginning of the 19th century, in settings such as army barracks, psychiatric hospitals and penitentiary institutions, the modern human sciences were ‹born› as an ensemble of disciplines (medical biology, psychiatry, psychology, criminology, and the like) From the beginning, the nature-nurture de- bate has been one of its key disputes. Are human individuals malleable by environmental factors (such as psychiatric treatments or disciplinary regimes), or do they rather display inborn predispositions for (...) delin- quency and other forms of antisocial behaviour? In the current era of genetic testing, in behavioural genomics and neuroscience, this issue is as controversial and topical as ever. Büchner’s unfinished drama Woyzeck (written in 1836) is a remarkable anticipation of this debate, staging the birth of the human individual as a research subject. It is the story of a destitute soldier who, according to his superiors, displays er- rant behaviour and is therefore recruited to serve as a research subject in an experiment. His army physician turns him into a ‹case›, which can be meticulously monitored and studied so as to record the genesis of a crime. In this paper, Büchner’s unsettling play is analysed in detail as one of the great anticipatory literary documents of the 19th century, ex- ploring the idea of predictive psychiatry and the quest for genetic pre- dispositions: a primal scene as it were of the nature-nurture debate as it unfolds from predictive criminology up to behavioural genomics. (shrink)

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a (...) “physician-qua-friend model” of the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying. (shrink)

Euthanasia and the duty to die have both been thoroughly discussed in the field of bioethics as morally justifiable practices within medical healthcare contexts. The existence of a narrow connection between both could also be established, for people having a duty to die should be allowed to actively hasten their death by the active means offered by euthanasia. Choosing the right time to end one’s own life is a decisive factor to retain autonomy at the end of our lives. However, (...) there is no definitive consensus on why physicians should be the ones performing the medical procedure to end a person’s life. The moral problems arising from such assertion are not to be taken lightly, for medical tradition has long regarded the duty not to kill, not to actively end a patient’s life, as the core moral obligation that gives meaning to the medical profession. Our concern is to question the moral justifiability of the arguments offered by physicians not to actively help patients die. (shrink)

Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?

This brief commentary reappraises the issue of emigration of physicians from developing countries to developed countries. A methodological framework is developed for assessing the impact of physician emigration on population health outcomes. The evidence from macro and micro studies suggest that developing countries especially in sub-Saharan Africa would benefit from regulating physician emigration because the loss of physicians can lower quality of healthcare services and lead to worse health outcomes. Further discussion is contained in an e-letter: http://jme.bmj.com/content/early/2013/05/30/medethics-2013-101409/reply.

This paper argues that there is reason to distinguish between moral responsibility and blameworthiness and, in particular, that we can acknowledge that a person is responsible for the negative outcomes of their behavior without this necessarily informing our judgments about the person’s blameworthiness. This general theme is elaborated in the context of a discussion of some of Björn Petersson’s work on collective moral responsibility.

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Medical billing has become so intertwined with patient care, that in order to be truly committed to the physician's telos of managing a patient's medical suffering, it is imperative that physician ought to reexamine many of the ethical considerations about billing.

In states where Physician Assisted Dying (PAD) is legal, physicians occasionally receive requests for this form of end-of-life care. Here, I describe the ethically ambiguous sphere and why PAD falls into it. I argue that, given the ethical ambiguity of PAD, physicians should consider patient autonomy as the highest value in the four principles approach and act as informers and educators.

This paper examines the question whether physicians are obligated by their professional ethos to defend a pacifist position. The question is a more concrete and applied formulation of the general thesis that there are what I will call “pacifist professions”: professions whose ethos requires their members to act in a pacifist way. Since the present paper is rather one in applied philosophy than a theoretical one about the foundation of pacifism, it will concentrate on the practical issue of whether and (...) how physicians can execute their profession in or during war. Theoretical questions on the nature and extent of pacifism will be considered only to the extent necessary to treat the main issue. The introductory section will give a short overview of some histori- cal aspects of physicians’ participation in war and show the relevance of the issue with recent examples. The remainder of this section will thus serve to set the stage and to outline the connections between the medical profession and questions of war and peace. The paper will then be divided into three other main parts: the first part will be devoted to defining in a general manner so-called “professional pacifism”. The second part will investigate whether and to what extent the medical profession can be classified as a pacifist profession, and the third part will look at the consequences of such a classification. (shrink)

As populations grow and arable land becomes increasingly scarce, large-scale long- term land leases are signed at a growing rate. Countries and investors with large amounts of financial resources and a strong agricultural industry seek long-term land leases for agricultural exploitation or investment purposes. Leaders of financially poorer countries often advertise such deals as a fast way to attract foreign capital. Much has been said about the short-term social costs these types of leases involve, however, less has been said about (...) the normative dimension of their long-term environmental impact. We therefore will focus on the likely impact such deals have for soil conservation, by (1) briefly introducing the basics of long-term leasing arrangements by comparing land leases to the renting of buildings, (2) explaining from a soil sciences perspective the difficulties in assessing the current value of an estate and in calculating the damages of soil erosion and degradation, and (3) show how difficult it is to incentivize the conservation of soil quality when one cannot sufficiently and cost-effectively valorize existing environmental capital and eventual future damages. Attempting to oblige tenants through contracts to invest in sustainable stewardship has limited potential when liability payments do not reflect true costs and are hard to enforce. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy (...) with respect to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)

In her paper, The case for physician assisted suicide: not proven, Bonnie Steinbock argues that the experience with Oregon’s Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this (...) brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide. (shrink)

eSports practice designates a unique set of activities tethered to competitive, virtual environments, or worlds. This correlation between eSports practitioner and virtual world, we argue, is inadequately accounted for solely in terms of something physical or intellectual. Instead, we favor a perspective on eSports practice to be analyzed as a perceptual and embodied phenomenon. In this article, we present the phenomenological approach and focus on the embodied sensations of eSports practitioners as they cope with and perceive within their virtual worlds. (...) By approaching eSports phenomenologically, we uncover ways in which its unique forms of virtual involvement overlap with as well as differentiate themselves from traditional structures of embodiment. (shrink)

A natural starting point for theories of perceptual states is ordinary perception, in which a subject is successfully related to her mind-independent surroundings. Correspondingly, the simplest theory of perceptual states models all such states on perception. Typically, this simple, common-factor relational view of perceptual states has received a perfunctory dismissal on the grounds that hallucinations are nonperceptual. But I argue that the nonperceptual view of hallucinations has been accepted too quickly. I consider three observations thought to support the view, and (...) argue that all three are dealt with equally well by an alternative view, illusionism, on which hallucinations do involve perception. Since this is so, adopting a common-factor relational view of all perceptual states remains a tenable option. (shrink)

Background: This article addressed one of the issues of research ethics that is called the nature of plagiarism coupled with involvement of intention. By definition, plagiarism is the attribution of others’ works to one’s own. This may be done intentionally and/or unintentionally. Some researchers believe that intention is not involved in the nature of plagiarism and an author who forgets to make references to the used sources has committed plagiarism since this forgetfulness has led to the attribution of others’ (...) work to one’s own. In contrast, some experts call such a person a wrongdoer, not a plagiarist. Conclusion: By likening this problem to the issue of involvement of intention in telling a lie, the author separates two kinds of plagiarism: act-plagiarism and agent-plagiarism. The intention does not involve in the act-plagiarism (to be an act an instance of plagiarism), but it is involved in the agent-plagiarism (to call someone plagiarist). As a result, an author who forgets to make reference is not a plagiarist, but his/her act is an instance of plagiarism. Keywords: Intention, Plagiarism, Intentional Plagiarism, Unintentional Plagiarism. (shrink)

Review of Psyche And Soma: Physicians and Metaphysicians on the Mind-Body Problem from Antiquity to Enlightenment.

Book Information Psyche And Soma: Physicians and Metaphysicians on the Mind-Body Problem from Antiquity to Enlightenment. Psyche And Soma: Physicians and Metaphysicians on the Mind-Body Problem from Antiquity to Enlightenment John P. Wright Paul Potter Oxford Clarendon Press 2000 xii + 298, Hardback £45.00 Edited by John P. Wright; Paul Potter . Clarendon Press. Oxford. Pp. xii + 298,. Hardback:£45.00.

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of two (...) possible scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. (shrink)

In 2008 the authors held Involving Interface, a lively interdisciplinary event focusing on issues of biological, sociocultural, and technological interfacing (see Acknowledgments). Inspired by discussions at this event, in this article, we further discuss the value of input from neuroscience for developing robots and machine interfaces, and the value of philosophy, the humanities, and the arts for identifying persistent links between human interfacing and broader ethical concerns. The importance of ongoing interdisciplinary debate and public communication on scientific and technical advances (...) is also highlighted. Throughout, the authors explore the implications of the extended mind hypothesis for notions of moral accountability and robotics. (shrink)