The Pitfalls of Proceduralism: An Exploration of the Goods Internal to the Practice of Clinical Ethics Consultation.

In an age of professionalization and specialization, the practice of clinical ethics is facing an identity crisis. Are clinical ethicists moral experts, ethics experts, or merely quasi-lawyers giving legal advice? Are they extensions of the hospital, always working to advance the hospital's interests? Or is there another option? Since 1998, when the American Society for Bioethics and Humanities (ASBH) first issued its Core Competencies for Healthcare Ethics Consultation, there has been debate about the role of standardization and proceduralism in clinical ethics consultation. Now, as ASBH continues to move forward with its credentialing program, proceduralism in clinical ethics must be critically examined.

WASP: (Write a Scientific Paper). Doctors in Star Trek - Correctly compassionate, caring Kantian Zampolit.

Doctors in Star Trek are vital and central characters, often crucial in helping their captains to reach command decisions. They are also interdisciplinarians, performing not only medical tasks but also any form of work related to all fields of biology. Furthermore, these doctors also carry out any required research that pertains to the biological sciences.

Gender by Dasein? A Heideggerian critique of Suzanne Kessler and the medical management of infants born with disorders of sexual development.

This article explores the relationship between gender, technology, language, and how infants and children born with disorders of sexual development are shaped into intelligible members of the community. The contemporary medical model maintains that children ought to be both socially and surgically assigned and reared as one particular gender. Gender scholar Suzanne Kessler rejects this position and argues for the acceptance of greater genital variability through the use of language.

Two Troubling Trends in the Conversation Over Whether Clinical Ethics Consultants Have Ethics Expertise.

In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise.

Still Human: A Call for Increased Focus on Ethical Standards in Cadaver Research.

Research on human cadavers is an important mechanism of scientific progress and comprises a large industry in the United States. However, despite its importance and influence, there is little ethical or regulatory oversight of cadaver-based research. This lack of transparency raises important ethical questions.

Priorities for Patient-Centered Outcomes Research: The Views of Minority and Underserved Communities.

Objective: To learn how minority and underserved communities would set priorities for patient-centered outcomes research (PCOR).

Data Sources: Sixteen groups (n = 183) from minority and underserved communities in two states deliberated about PCOR priorities using the simulation exercise CHoosing All Together (CHAT). Most participants were minority, one-third reported income <$10,000, and one-fourth reported fair/poor health.

Questioning Engelhardt's assumptions in Bioethics and Secular Humanism.

In Bioethics and Secular Humanism: The Search for a Common Morality, Tristram Engelhardt examines various possibilities of finding common ground for moral discourse among people from different traditions and concludes their futility. In this paper I will argue that many of the assumptions on which Engelhardt bases his conclusion about the impossibility of a content-full secular bioethics are problematic. By starting with the notion of moral strangers, there is no possibility, by definition, for a content-full moral discourse among moral strangers.

Confronting Ethical and Regulatory Challenges of Emergency Care Research With Conscious Patients.

Barriers to informed consent are ubiquitous in the conduct of emergency care research across a wide range of conditions and clinical contexts. They are largely unavoidable; can be related to time constraints, physical symptoms, emotional stress, and cognitive impairment; and affect patients and surrogates. US regulations permit an exception from informed consent for certain clinical trials in emergency settings, but these regulations have generally been used to facilitate trials in which patients are unconscious and no surrogate is available.

Feasibility and Perception of Using Text Messages as an Adjunct Therapy for Low-Income, Minority Mothers With Postpartum Depression.

Background: Postpartum depression (PPD) is the most common medical problem among new mothers that can have a negative impact on infant health. Traditional treatments are often difficult for low-income mothers to complete, particularly given the numerous barriers families face.

Objective: Among low-income, primarily racial, and ethnic minority mothers with postpartum depression, our aim was to evaluate (1) the feasibility of sending supportive text messages, and (2) the perception of receiving private, supportive text messages for postpartum depression.

Too Many Rationales, Not Enough Reason: A Call to Examine the Goals of Including Lay Members on Institutional Review Boards.

Every major U.S. commission appointed to review Institutional Review Boards (IRBs) as well as numerous reports and scholarly articles have recommended increasing the number of lay (nonscientist and unaffiliated) members on IRBs.

New places and ethical spaces: philosophical considerations for health care ethics outside of the hospital.

This paper examines the meaning of space and its relationship to value. In this paper, I draw on Henri Lefebvre to suggest that our ethics produce and are produced by spaces. Space is not simply a passive material container or neutral geographic location.

The four-principle formulation of common morality is at the core of bioethics mediation method.

Bioethics mediation is increasingly used as a method in clinical ethics cases. My goal in this paper is to examine the implicit theoretical assumptions of the bioethics mediation method developed by Dubler and Liebman. According to them, the distinguishing feature of bioethics mediation is that the method is useful in most cases of clinical ethics in which conflict is the main issue, which implies that there is either no real ethical issue or if there were, they are not the key to finding a resolution.

An intellectual virtue "vaccination" for physician-pharmaceutical industry interactions.

The pharmaceutical industry's wide range of interactions with physicians, trainees, and other medical professionals--interactions that include information transfer and financial incentives--has been the source of undue influences, especially on physicians' prescription behavior. Current literature has mainly been focused on the financial element of these influences, and the problems in medical professional-pharmaceutical industry interactions are mainly viewed in terms of conflicts of interest. There is often the assumption that physicians are intellectually competent but biased because of financial incentives.

The nature of epistemic virtues in the practice of medicine.

There is an assumption in virtue epistemology that epistemic virtues are the same in different times and places. In this paper, however, I examine this assumption in the practice of medicine as a paradigm example. I identify two different paradigms of medical practice, one before and the other after the rise of bioethics in 1960s.

Piloting a nationally disseminated, interactive human subjects protection program for community partners: unexpected lessons learned from the field.

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings.

Piloting a nationally disseminated, interactive human subjects protection program for community partners: design, content, and evaluation.

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings.

Ethics outside of inpatient care: the need for alliances between clinical and organizational ethics.

The norms and practices of clinical ethics took form relative to the environment and relationships of hospital care. These practices do not easily translate into the outpatient context because the environment and relational dynamics differ. Yet, as outpatient care becomes the center of health care delivery, the experiences of ethical tension for outpatient clinicians warrant greater responses.

Marking Twain.

The first of the following two narratives is a personal reflection by the instructor of "Narrative Approaches to Bioethics," an elective in the PhD program at the Albert Gnaegi Center for Health Care Ethics at Saint Louis University. The author argues that perhaps the primary goal of medical ethics education should be to show how to construct plausible and defensible interpretations of human experience and sensibly resolve the problems that these happenings occasion. To that end, the author engaged the sympathetic reading capacities of his students by "thwarting" their expectations for medicalized case studies to "dissect" and instead chose works that invited careful readings of morally-complex literary works.

Maturing the minor, marginalizing the family: on the social construction of the mature minor.

The doctrine of the mature minor began as an emergency exception to the rule of parental consent. Over time, the doctrine crept into cases that were non-emergent. In this essay, we show how the doctrine also developed in the context of the latter part of the 20th century, at the same time that the sexual revolution, the pill, and sexual liberation came to be seen as important symbols of female liberation--liberation that required that female minors be granted the status of a mature minor.

Understanding the Severity of Wrongdoing in Health Care Delivery and Research: Lessons Learned From a Historiometric Study of 100 Cases.

Background: Wrongdoing among physicians and researchers causes myriad problems for patients and research participants. While many articles have been published on professional wrongdoing, our literature review found no studies that examined the rich contextual details of large sets of historical cases of wrongdoing.

Methods: We examined 100 cases of wrongdoing in healthcare delivery and research using historiometric methods, which involve the statistical description and analysis of coded historical narratives.