Tuesday, December 2, 2014

Everyday Morality

BACKGROUND: most studies of morality have looked at artificial laboratory settings.

QUESTION: how is everyday morality expressed outside of a research lab?

METHODS: 1252 people were evaluated, looking for episodes of moral and immoral acts in their life

RESULTS: Liberals and conservatives had slightly different moral dimensions, but religious versus nonreligious people did not differ in their moral dimensions. Receiving moral or immoral deeds had a strongest impact on happiness, whereas committing moral or immoral deeds a strong impact on sense of purpose.

Science. 2014 Sep 12;345(6202):1340-3

Monday, November 10, 2014

Are Neural Responses to Moral Dilemmas Different in Atheists?

QUESTION: are neural responses to standard moral dilemmas are influenced by religious belief?

METHODS: 11 Christians and 13 atheists were confronted with 48 different moral dilemmas and their neural activity measured.

RESULTS: a difference in neural activity between the atheists and the Christians was observed in the precuneus and in prefrontal, frontal and temporal regions.

CONCLUSION: the neurological response to moral judgment appears to be influenced by religious belief.

Soc Cogn Affect Neurosci. 2014 Feb;9(2):240-9

Monday, October 20, 2014

Ethics in medical research and publication

Ethics in medical research and publication.
OBJECTIVE: To present the basic principles and standards of Ethics in medical research and publishing

METHODS: An analysis of relevant materials and documents, sources from the published literature.

CONCLUSIONS: Invest in education of researches and potential researches, already in the level of medical schools. Educating them on research bioethics, what constitutes research misconduct and the seriousness of it repercussion is essential for finding a solution to this problem and ensuring careers are constructed on honesty and integrity.

Int J Prev Med. 2014 Sep;5(9):1073-82

Thursday, October 16, 2014

Hope as a Moral Competency in Nursing

Sustaining hope as a moral competency in the context of aggressive care.
OBJECTIVE: How can nurses preserve the hope of seriously ill patients without providing false hope?
FINDINGS: One overarching theme was identified: 'Mediating the tension between providing false hope and destroying hope within biomedicine.'

DISCUSSION: This competency represents a complex set of skills. Nurses must be able to imagine possible future hopes, be able to acknowledge death, and challenge those around them when the provision of aggressive care is a form of providing false hope.

Nurs Ethics. 2014 Oct 14;

Saturday, March 29, 2014

The ethics of the missing straw.

This case report details the emergency department course of a 34 year-old female who presented with abdominal pain and vaginal bleeding after reportedly falling one week earlier. She was subsequently found to have a drinking straw within her uterus next to an eight week-old live intrauterine pregnancy on ultrasound. This case report and discussion reviews the literature on retained foreign bodies in pregnancy while addressing the added complications of an evasive patient and a difficult consultant with significant intra-specialty disagreement.

West J Emerg Med. 2014 Mar;15(2):131-3

Moral development of first-year pharmacy students in the United kingdom.

Objective. To investigate the moral development of pharmacy students over their first academic year of study at a university in the United Kingdom. Methods. Pharmacy students completed Defining Issues Test (DIT) at the start of their first year (phase 1) and again at the end of their first year (phase 2) of the program. Results. Pharmacy students (N=116) had significantly higher moral reasoning at the beginning of their first year than by the end of it. Scores differed by students' gender and age; however, these findings differed between phase 1 and phase 2. Conclusion. First-year pharmacy students in the United Kingdom scored lower on moral reasoning than did pharmacy students in the United States and Canada.

Am J Pharm Educ. 2014 Mar 12;78(2):36

Friday, March 21, 2014

Seeing Responsibility: Can Neuroimaging Teach Us About Morality?

As imaging technologies help us understand the structure and function of the brain, providing insight into human capabilities as basic as vision and as complex as memory, and human conditions as impairing as depression and as fraught as psychopathy, some have asked whether they can also help us understand human agency. Specifically, could neuroimaging lead us to reassess the socially significant practice of assigning and taking responsibility? While responsibility itself is not a psychological process open to investigation through neuroimaging, decision-making is. Over the past decade, different researchers and scholars have sought to use neuroimaging (or the results of neuroimaging studies) to investigate what is going on in the brain when we make decisions. The results of this research raise the question whether neuroscience-especially now that it includes neuroimaging-can and should alter our understandings of responsibility and our related practice of holding people responsible. It is this question that we investigate here.

Hastings Cent Rep. 2014 Mar;44 Suppl 2:S37-49

Wednesday, March 19, 2014

What does public health ethics tell (or not tell) us

Obesity has been described as pandemic and a public health crisis. It has been argued that concerted research efforts are needed to enhance our understanding and develop effective interventions for the complex and multiple dimensions of the health challenges posed by obesity. This would provide a secure evidence base in order to justify clinical interventions and public policy. This paper critically examines these claims through the examination of models of public health and public health ethics. I argue that the concept of an effective public health intervention is unclear and underdeveloped and, as a consequence, normative frameworks reliant on meeting the effectiveness criterion may miss morally salient dimensions of the problems. I conclude by arguing for the need to consider both an ecological model of public health and inclusion of a critical public health ethics perspective for an adequate account of the public health challenges posed by obesity.  J Bioeth Inq. 2013 Mar;10(1):19-28

Moral judgment modulation

Modern theories of moral judgment predict that both conscious reasoning and unconscious emotional influences affect the way people decide about right and wrong.

This research found that on average, subliminal priming of disgust facial expressions resulted in higher rates of utilitarian judgments compared to neutral facial expressions.

Front Psychol. 2014;5:194

Monday, March 17, 2014

The ethics of forgoing life-sustaining treatmen

Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient's life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forego life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoretical-ethical considerations can guide clinical-ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed.

Multidiscip Respir Med. 2014 Mar 11;9(1):14

Thursday, March 13, 2014

Models of morality.

Moral dilemmas engender conflicts between two traditions: 

  • consequentialism, which evaluates actions based on their outcomes, and
  • deontology, which evaluates actions themselves.
These strikingly resemble two distinct decision-making architectures: a model-based system that selects actions based on inferences about their consequences; and a model-free system that selects actions based on their reinforcement history. Here, I consider how these systems, along with a Pavlovian system that responds reflexively to rewards and punishments, can illuminate puzzles in moral psychology.

Trends Cogn Sci. 2013 Aug;17(8):363-6

Wednesday, March 12, 2014

Japanese and American Children's Moral Evaluations

This research study looked at American and Japanese children in terms of the reporting of peers' transgressions to authority figures. 
  • In both countries, participants across all age groups considered it appropriate to report major transgressions.
  • Compared with older children, younger children thought it was appropriate to tattle. 
  • Japanese children were more likely to consider it appropriate to report minor transgressions.
Dev Psychol. 2014 Mar 3

Monday, March 10, 2014

Enhancing Moral Conformity and Enhancing Moral Worth.

Enhancing Moral Conformity and Enhancing Moral Worth.
Neuroethics. 2014;7:75-91
Authors: Douglas T

It is plausible that we have moral reasons to become better at conforming to our moral reasons. However, it is not always clear what means to greater moral conformity we should adopt. John Harris has recently argued that we have reason to adopt traditional, deliberative means in preference to means that alter our affective or conative states directly-that is, without engaging our deliberative faculties. One of Harris' concerns about direct means is that they would produce only a superficial kind of moral improvement. Though they might increase our moral conformity, there is some deeper kind of moral improvement that they would fail to produce, or would produce to a lesser degree than more traditional means. I consider whether this concern might be justified by appeal to the concept of moral worth. I assess three attempts to show that, even where they were equally effective at increasing one's moral conformity, direct interventions would be less conducive to moral worth than typical deliberative alternatives. Each of these attempts is inspired by Kant's views on moral worth. Each, I argue, fails.

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Giving consent without getting informed: a cross-cultural issue in research ethics.

Giving consent without getting informed: a cross-cultural issue in research ethics.
J Empir Res Hum Res Ethics. 2013 Jul;8(3):12-21
Authors: Ghandour L, Yasmine R, El-Kak F

Informed consent forms (ICFs) maintain the integrity of research ethics and preserve participants' rights. Using cross-sectional online survey data on sexuality and sexual practices of private university students from Lebanon, this paper questions whether participants thoroughly read ICFs, and whether time taken to read ICFs is associated with data completeness. A total of 2,534 surveys were completed; a median time of 18.66 seconds was taken to read the 815-word ICF; 65% of participants consented within the first 30 seconds and 90% in less than the minimum predicted time (2.7 minutes). Our data indicates potential participant neglect of ICFs, raising the question of whether participants who endorse an informed consent form are truly informed of the study objectives and their rights.

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Charting a moral life

Charting a moral life: the influence of stigma and filial duties on marital decisions among Chinese men who have sex with men.
PLoS One. 2013;8(8):e71778
Authors: Steward WT, Miège P, Choi KH

INTRODUCTION: Stigma constitutes a critical challenge to the rising rates of HIV among Chinese men who have sex with men (MSM). It reduces willingness to disclose one's sexual orientation and can lead to concurrent sexual partnerships. Disclosure decisions are also affected by cultural norms that place pressures on sons to marry. In this manuscript, we characterize how stigma and cultural factors influenced Chinese MSM's decisions around disclosure and marriage. We seek to show that MSM's actions were motivated by moral considerations, even when those choices posed HIV transmission risks.
METHODS: We conducted qualitative interviews with 30 MSM in Beijing, China. Interviews were audio-recorded, transcribed, and translated into English for analysis. Transcripts were coded using a procedure that allowed for themes to emerge organically.
RESULTS: Participants struggled with feelings of shame and believed that others possessed stigmatizing attitudes about homosexuality. They had experienced relatively little discrimination because they infrequently disclosed their MSM status. In response to marital pressures, participant had to reconcile same-sex attractions with filial expectations. Their choices included: not being involved with women; putting on the appearance of a heterosexual relationship by marrying a lesbian; or fulfilling family expectations by marrying a heterosexual woman. Regardless of the decision, many rooted the justifications for their choices in the considerations they had given to others' needs.
CONCLUSION: The growing epidemic among MSM in China requires action from the public health community. As programs are scaled up to serve these men, it is critical to remember that MSM, who often fear social sanction if they were to reveal their sexual orientation, continue to face the same pressures from culturally normative social duties as heterosexual men. Interventions must find ways to help men navigate a balance between their own needs and the responsibilities they feel toward their parents and others.

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Sunday, March 9, 2014

A Health Care Chaplain's Pastoral Response to Moral Distress.

A Health Care Chaplain's Pastoral Response to Moral Distress.
J Health Care Chaplain. 2014 January-March;20(1):3-15
Authors: Guthrie M

This article offers health care chaplains a pastoral response to moral distress experienced by health care professionals. The article offers a broad definition, explores its impact on health care professionals, and looks at various interventions to ameliorate its effects. The article goes on to clarify the concept of moral distress by differentiating it from the experience of moral dilemmas, and looking closer at the aspects of initial and reactive distress. After defining moral distress, the article explores two clinical models that create a better context to understand the phenomenon. Finally, the article proposes a pastoral response to moral distress from the integration of the five functions of pastoral care: "healing," "sustaining," "guiding," "reconciling," and "nurturing" based on the work of William Clebsch, Charles Jaekle, and Howard Clinebell. The author then applies the pastoral response to moral distress by illustrating the outcome of a scenario with a critical care nurse.

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Thursday, March 6, 2014

The nature of ethical conflicts and the meaning of moral community in oncology practice.

The nature of ethical conflicts and the meaning of moral community in oncology practice.
Oncol Nurs Forum. 2014 Mar 1;41(2):130-40
Authors: Pavlish C, Brown-Saltzman K, Jakel P, Fine A

Purpose/Objectives: To explore ethical conflicts in oncology practice and the nature of healthcare contexts in which ethical conflicts can be averted or mitigated.Research Approach: Ethnography.Setting: Medical centers and community hospitals with inpatient and outpatient oncology units in southern California and Minnesota.Participants: 30 oncology nurses, 6 ethicists, 4 nurse administrators, and 2 oncologists.Methodologic Approach: 30 nurses participated in six focus groups that were conducted using a semistructured interview guide. Twelve key informants were individually interviewed. Coding, sorting, and constant comparison were used to reveal themes.Findings: Most ethical conflicts pertained to complex end-of-life situations. Three factors were associated with ethical conflicts: delaying or avoiding difficult conversations, feeling torn between competing obligations, and the silencing of different moral perspectives. Moral communities were characterized by respectful team relationships, timely communication, ethics-minded leadership, readily available ethics resources, and provider awareness and willingness to use ethics resources.Conclusions: Moral disagreements are expected to occur in complex clinical practice. However, when they progress to ethical conflicts, care becomes more complicated and often places seriously ill patients at the epicenter.Interpretation: Practice environments as moral communities could foster comfortable dialogue about moral differences and prevent or mitigate ethical conflicts and the moral distress that frequently follows.

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Tuesday, March 4, 2014

Ethics support in institutional elderly care: a review of the literature.

Ethics support in institutional elderly care: a review of the literature.
J Med Ethics. 2014 Feb 27;
Authors: van der Dam S, Molewijk B, Widdershoven GA, Abma TA

Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases (Pubmed, CINAHL/PsycINFO, Ethxweb). Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: 'institutional bodies' (ethics committee and consultation team); 'frameworks' (analytical tools to assist care professionals); 'educational programmes and moral case deliberation'; and 'written documents and policies'. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation.

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Sunday, March 2, 2014

The desired moral attitude of the physician: care.

The desired moral attitude of the physician: (III) care.
Med Health Care Philos. 2013 May;16(2):125-39
Authors: Gelhaus P

In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude-compassion-has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad-"care"-is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician's ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. 'Empathic compassionate care' does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, 'empathic compassionate care' has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of "empathic compassionate care" and "responsibility" is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.

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Thursday, February 27, 2014

Ethics of facial transplantation revisited.

Ethics of facial transplantation revisited.
Curr Opin Organ Transplant. 2014 Feb 22;
Authors: Coffman KL, Siemionow MZ

PURPOSE OF REVIEW: There have been 26 cases of facial transplantation reported, and three deaths, 11.5%. Mortality raises the issue of risk versus benefit for face transplantation, a procedure intended to improve quality of life, rather than saving life. Thus, one of the most innovative surgical procedures has opened the debate on the ethical, legal, and philosophical aspects of face transplantation.
RECENT FINDINGS: Morbidity in face transplant recipients includes infections and metabolic consequences. No graft loss caused by technical failure, hyperacute, or chronic graft rejection or graft-versus-host disease has been reported. One case of posttransplant lymphoproliferative disorder, 3.45% and one case of lymphoma in an HIV-positive recipient were reported. Psychological issues in candidates can include chronic pain, mood disorders, preexisting psychotic disorders, post-traumatic stress disorder (PTSD), and substance abuse.
SUMMARY: Early publications on ethical aspects of face transplantation focused mainly on informed consent. Many other ethical issues have been identified, including lack of coercion, donor family consent and confidentiality, respect for the integrity of the donor's body, and financial promotion of the recipient and transplant team, as well as the cost to society for such a highly technical procedure, requiring lifelong immunosuppression.

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National electronic health records and the digital disruption of moral orders.

National electronic health records and the digital disruption of moral orders.
Soc Sci Med. 2014 Jan;101:70-7
Authors: Garrety K, McLoughlin I, Wilson R, Zelle G, Martin M

The digitalisation of patient health data to provide national electronic health record systems (NEHRS) is a major objective of many governments. Proponents claim that NEHRS will streamline care, reduce mistakes and cut costs. However, building these systems has proved highly problematic. Using recent developments in Australia as an example, we argue that a hitherto unexamined source of difficulty concerns the way NEHRS disrupt the moral orders governing the production, ownership, use of and responsibility for health records. Policies that pursue digitalisation as a self-evident 'solution' to problems in healthcare without due regard to these disruptions risk alienating key stakeholders. We propose a more emergent approach to the development and implementation of NEHRS that supports moral re-ordering around rights and responsibilities appropriate to the intentions of those involved in healthcare relationships.

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Tuesday, February 25, 2014

Good epidemiology, good ethics: empirical and ethical dimensions of global public health.

Good epidemiology, good ethics: empirical and ethical dimensions of global public health.
Indian J Med Ethics. 2012 Oct-Dec;9(4):235-41
Authors: Rentmeester CA, Dasgupta R

This paper examines the following ethically and epidemiologically relevant challenges, as yet neglected in public health ethics: how to distribute resources and health risks and benefits, how to define evidentiary criteria that justify public health interventions, and how to define terms in which programme goals, successes, and failures will be assessed and monitored. We illuminate critical intersections of empirical and ethical dimensions of public health work, drawing upon three global public health interventions-inclusion of the Hepatitis B vaccine in the Universal Immunisation Programme, Universal Salt Iodisation, and the Global Polio Eradication Initiative-and suggest strategies for addressing and responding to them.

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Perceptions about training and knowledge of HIV/AIDS ethics among health care providers at teaching hospitals of a medical college in Karnataka, India.

Perceptions about training and knowledge of HIV/AIDS ethics among health care providers at teaching hospitals of a medical college in Karnataka, India.
Indian J Med Ethics. 2012 Oct-Dec;9(4):242-4
Authors: Unnikrishnan B, Papanna MB, Vaman K, Nithin K, Rekha T, Prasanna Mithra P

A cross sectional study was conducted to evaluate perceptions of HIV/AIDS ethics among health care professionals at three associate hospitals of Kasturba Medical College Mangalore. A total of 144 health care professionals were included, of which 106 (73.6%) were doctors and 38 (26.4%) were nurses.Only 52.8% of doctors and 56.6% of nurses agreed that they had received adequate training related to HIV data confidentiality. 85.8% of doctors and 76.3% of nurses perceived that they need additional training in HIV policies & procedures. With respect to rights of HIV-positive clients 92.5% of doctors and 84.2% of nurses felt the need for further training. 69% of doctors and 52.6% of nurses agreed that confidentiality could be breached in case of subpoena or other judicial processes. Only 68.4% nurses agreed that it is an offence to intentionally disclose HIV/AIDS confidential information to anyone who is not legally authorised.

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Regulating professional behavior: codes of ethics or law? Suggested criteria.

Regulating professional behavior: codes of ethics or law? Suggested criteria.
Med Law. 2013 Sep;32(3):235-50
Authors: Libman LA

This paper suggests considering a few parameters when making policy decisions as to the proper "tool" to regulate professional behavior: law or professional ethics. This is done on the background of understanding the place of codes of professional ethics between "pure" ethics and law. Suggested criteria are then illustrated using a few examples. Further discourse may reveal additional factors to support a more rational process of decision-making in this field.

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Sunday, February 23, 2014

Dissociable neural systems for moral judgment of anti- and pro-social lying.

Dissociable neural systems for moral judgment of anti- and pro-social lying.
Brain Res. 2014 Feb 12;
Authors: Hayashi A, Abe N, Fujii T, Ito A, Ueno A, Koseki Y, Mugikura S, Takahashi S, Mori E

Pro-social lying, which serves to benefit listeners, is considered more socially and morally acceptable than anti-social lying, which serves to harm listeners. However, it is still unclear whether the neural mechanisms underlying the moral judgment of pro-social lying differ from those underlying the moral judgment of anti-social lying. We used functional magnetic resonance imaging (fMRI) to examine the neural activities associated with moral judgment in anti- and pro-social lying. During fMRI scanning, subjects were provided with scenarios describing a protagonist's anti- and pro-social lying and were then asked to judge whether the protagonist's act was morally appropriate. The behavioral data showed that anti-social lying was mostly judged to be morally inappropriate and that pro-social lying was mainly judged to be morally appropriate. The functional imaging data revealed dissociable neural systems for moral judgment in anti- and pro-social lying. The anti-social lying, which was judged to be morally inappropriate, was associated with increased activity in the right ventromedial prefrontal cortex, right middle frontal gyrus, right precuneus/posterior cingulate gyrus, left posterior cingulate gyrus, and bilateral temporoparietal junction when compared with the control condition. The pro-social lying, which was judged to be morally appropriate, was associated with increased activity in the right middle temporal gyrus, right supramarginal gyrus, and the left middle cingulate gyrus when compared with the control condition. No overlapping activity was observed during the moral judgment of anti- and pro-social lying. Our data suggest that cognitive and neural processes for the moral judgment of lying are modulated by whether the lie serves to harm or benefit listeners.

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In search of salience: phenomenological analysis of moral distress.

In search of salience: phenomenological analysis of moral distress.
Nurs Philos. 2014 Feb 15;
Authors: Manara DF, Villa G, Moranda D

The nurse's moral competences in the management of situations which present ethical implications are less investigated in literature than other ethical problems related to clinical nursing. Phenomenology affirms that emotional warmth is the first fundamental attitude as well as the premise of any ethical reasoning. Nevertheless, it is not clear how and when this could be confirmed in situations where the effect of emotions on the nurse's decisional process is undiscovered. To explore the processes through which situations of moral distress are determined for the nurses involved in nursing situations, a phenomenological-hermeneutic analysis of a nurse's report of an experience lived by her as a moral distress situation has been conducted. Nursing emerges as a relational doctrine that requires the nurse to have different degrees of personal involvement, the integration between logical-formal thinking and narrative thinking, the perception of the salience of the given situation also through the interpretation and management of one's own emotions, and the capacity to undergo a process of co-construction of shared meanings that the others might consider adequate for the resolution of her problem. Moral action requires the nurse to think constantly about the important things that are happening in a nursing situation. Commitment towards practical situations is directed to training in order to promote the nurse's reflective ability towards finding salience in nursing situations, but it is also directed to the management of nursing assistance and human resources for the initial impact that this reflexive ability has on patients' and their families' lives and on their need to be heard and assisted. The only case analysed does not allow generalizations. Further research is needed to investigate how feelings generated by emotional acceptance influence ethical decision making and moral distress in nursing situations.

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Managing moral hazard in motor vehicle accident insurance claims.

Managing moral hazard in motor vehicle accident insurance claims.
J Public Health Policy. 2013 May;34(2):320-9
Authors: Ebrahim S, Busse JW, Guyatt GH, Birch S

Motor vehicle accident (MVA) insurance in Canada is based primarily on two different compensation systems: (i) no-fault, in which policyholders are unable to seek recovery for losses caused by other parties (unless they have specified dollar or verbal thresholds) and (ii) tort, in which policyholders may seek general damages. As insurance companies pay for MVA-related health care costs, excess use of health care services may occur as a result of consumers' (accident victims) and/or producers' (health care providers) behavior - often referred to as the moral hazard of insurance. In the United States, moral hazard is greater for low dollar threshold no-fault insurance compared with tort systems. In Canada, high dollar threshold or pure no-fault versus tort systems are associated with faster patient recovery and reduced MVA claims. These findings suggest that high threshold no-fault or pure no-fault compensation systems may be associated with improved outcomes for patients and reduced moral hazard.

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The Potential Conflict Between Policy and Ethics in Caring for Undocumented Immigrants at Academic Health Centers.

The Potential Conflict Between Policy and Ethics in Caring for Undocumented Immigrants at Academic Health Centers.
Acad Med. 2014 Feb 19;
Authors: Stone LC, Steimel L, Vasquez-Guzman E, Kaufman A

Academic health centers (AHCs) are at the forefront of delivering care to the diverse medically underserved and uninsured populations in the United States, as well as training the majority of the health care workforce, who are professionally obligated to serve all patients regardless of race or immigration status. Despite AHCs' central leadership role in these endeavors, few consolidated efforts have emerged to resolve potential conflicts between national, state, and local policies that exclude certain classifications of immigrants from receiving federal public assistance and health professionals' social missions and ethical oath to serve humanity. For instance, whereas the 2010 Patient Protection and Affordable Care Act provides a pathway to insurance coverage for more than 30 million Americans, undocumented immigrants and legally documented immigrants residing in the United States for less than five years are ineligible for Medicaid and excluded from purchasing any type of coverage through state exchanges. To inform this debate, the authors describe their experience at the University of New Mexico Hospital (UNMH) and discuss how the UNMH has responded to this challenge and overcome barriers. They offer three recommendations for aligning AHCs' social missions and professional ethics with organizational policies: (1) that AHCs determine eligibility for financial assistance based on residency rather than citizenship, (2) that models of medical education and health professions training provide students with service-learning opportunities and applied community experience, and (3) that frontline staff and health care professionals receive standardized training on eligibility policies to minimize discrimination towards immigrant patients.

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Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.
BMC Med Ethics. 2014 Feb 20;15(1):14
Authors: Raus K, Brown J, Seale C, Rietjens JA, Janssens R, Bruinsma S, Mortier F, Payne S, Sterckx S

BACKGROUND: Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.
METHODS: This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology.
RESULTS: The participants' responses can be captured as different dimensions of 'closeness', i.e. the degree to which one feels connected or 'close' to a certain decision or event. We distinguished four types of 'closeness', namely emotional, physical, decisional, and causal. Using these four dimensions of 'closeness' it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility.
CONCLUSION: Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.

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Patents on inventions related to human embryonic stem cells: the morality clause after Brüstle v. Greenpeace.

Patents on inventions related to human embryonic stem cells: the morality clause after Brüstle v. Greenpeace.
Med Law. 2013 Sep;32(3):347-72
Authors: Panis S

This paper analyses the meaning of Article 6, para. 2, sub c of the Biotechnology Directive prohibiting patents on inventions using human embryos for industrial or commercial purposes. It first examines the evolution ofthe Court of Justice ofthe EU's interpretation of this provision (which is part of the morality clause) and focuses on its most recent decision, Brüstle v. Greenpeace. This is considered a landmark case for three reasons: firstly, because it defines for the first time the term "embryo" in patent law; secondly, because it is the Court of Justice (and not EPO) that ruled on patent law; the third reason is its very broad interpretation of the morality exclusion. The exclusion is no longer limited to embryos but is extended to (even banked) embryonic stem cells and all downstream products made with them. It then looks into the consequences for the patentability of inventions using cells derived from human embryonic stem cells, such as Brüstle's invention. The recent decision by Germany's Federal Court of Justice on the validity of Brüstle's patent emphasises the limited influence on the patentability of those inventions. After that, the paper addresses possible cuts in funding stem cell research and even legislative bans of this type of research. This is followed by an evaluation of the existence and content of the morality exclusion. After a comparative analysis with the US, which is lacking in such morality exclusion, the paper concludes that the morality clause as a whole paid its dues but the provision on the use of human embryos is questionable as there is no European consensus against the use of human embryos for industrial or commercial purposes.

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Should teachers of medical ethics and health professionals remain value neutral in order to respect the autonomy of students and patients?

Should teachers of medical ethics and health professionals remain value neutral in order to respect the autonomy of students and patients?
Med Law. 2013 Sep;32(3):305-18
Authors: Bøgeskov BO

This article describes the pedagogical and ethical problems that ensue when ethical neutrality is mandated as the sole acceptable stance for teachers of ethics and health professionals (especially in public institutions). This paper argues that such a mandate can (1) violate public employees' own ethical integrity by forcing them to adopt the current legal order as their own ethical code; (2) erode trust, by requiring that the professional or teacher betray the honesty that patients and students commonly expect; and, finally, (3) undermine--by affirming that all opinions are equally acceptable--he pedagogical aim of generating critical thinking. Nevertheless, the article warns teachers and professionals against defending their own convictions by appealing to authority or the power of public office. The correct way to avoid ethical neutrality, this article asserts, is by distinguishing "opinion" from "argument": by not merely articulating, but providing convincing arguments for, one's own professional ethical opinions.

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Friday, February 21, 2014

History, ethics, advantages and limitations of experimental models for hepatic ablation.

History, ethics, advantages and limitations of experimental models for hepatic ablation.
World J Gastroenterol. 2013 Jan 14;19(2):147-54
Authors: Ong SL, Gravante G, Metcalfe MS, Dennison AR

Numerous techniques developed in medicine require careful evaluation to determine their indications, limitations and potential side effects prior to their clinical use. At present this generally involves the use of animal models which is undesirable from an ethical standpoint, requires complex and time-consuming authorization, and is very expensive. This process is exemplified in the development of hepatic ablation techniques, starting experiments on explanted livers and progressing to safety and efficacy studies in living animals prior to clinical studies. The two main approaches used are ex vivo isolated non-perfused liver models and in vivo animal models. Ex vivo non perfused models are less expensive, easier to obtain but not suitable to study the heat sink effect or experiments requiring several hours. In vivo animal models closely resemble clinical subjects but often are expensive and have small sample sizes due to ethical guidelines. Isolated perfused ex vivo liver models have been used to study drug toxicity, liver failure, organ transplantation and hepatic ablation and combine advantages of both previous models.

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The moral economy of contemporary working-class adolescence: managing symbolic capital in a French public 'Adolescent Centre'.

The moral economy of contemporary working-class adolescence: managing symbolic capital in a French public 'Adolescent Centre'.
Br J Sociol. 2013 Jun;64(2):248-66
Authors: Coutant I, Eideliman JS

Working-class adolescents of French urban peripheries are key figures in a new social debate that reactivates the nineteenth century spectre of 'dangerous' classes to be controlled. Since the 1990s, French social counselling has privileged two modalities of response: taking account of suffering and government by listening and speech. We hypothesize that the contemporary moral economy allows for social interactions that go beyond social control and institutional domination. This is partly because professionals engaged in this moral undertaking may keep a critical distance, and partly because the concerned populations aren't necessarily devoid of resources to advance their interests or incapable of resistance. The concept of moral economy, coupled with the ethnographic method, is heuristic for fully comprehending the complexity of these issues and their stakes. Our fieldwork was centred on a French Adolescent Centre in an impoverished commune in Paris's periphery, from January 2010 through March 2011. These institutions were established in the early 2000s to respond to adolescent 'suffering' by crossing social work and psychiatry. Adolescents, parents, and other institutions (especially schools) solicit the professionally diverse staff for assistance, which in turn may take on cases and/or make referrals to other support institutions. By paying attention to all the scenes upon which the story of a counselled adolescent evolves, and bearing more general social evolutions in mind by applying the concept of moral economy, we can consider the multiplicity of seemingly contradictory processes as a whole. We see the destabilization of parents and their loss of symbolic capital, partly due to the norms of contemporary parenthood and partly due to the stigmatization of working-class adolescence. But we also discern possibilities for expressing sentiments of injustice and humiliation, for increasing symbolic capital, and in some cases a reappropriation of the system, particularly in trajectories marked by a! will for social ascension.

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Wednesday, February 19, 2014

Common sense and the common morality in theory and practice.

Common sense and the common morality in theory and practice.
Theor Med Bioeth. 2014 Feb 14;
Authors: Daly P

The unfinished nature of Beauchamp and Childress's account of the common morality after 34 years and seven editions raises questions about what is lacking, specifically in the way they carry out their project, more generally in the presuppositions of the classical liberal tradition on which they rely. Their wide-ranging review of ethical theories has not provided a method by which to move beyond a hypothetical approach to justification or, on a practical level regarding values conflict, beyond a questionable appeal to consensus. My major purpose in this paper is to introduce the thought of Bernard Lonergan as offering a way toward such a methodological breakthrough. In the first section, I consider Beauchamp and Childress's defense of their theory of the common morality. In the second, I relate a persisting vacillation in their argument regarding the relative importance of reason and experience to a similar tension in classical liberal theory. In the third, I consider aspects of Lonergan's generalized empirical method as a way to address problems that surface in the first two sections of the paper: (1) the structural relation of reason and experience in human action; and (2) the importance of theory for practice in terms of what Lonergan calls "common sense" and "general bias."

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Monday, February 17, 2014

Law, Ethics, and the Patient Preference Predictor.

Law, Ethics, and the Patient Preference Predictor.
J Med Philos. 2014 Feb 13;
Authors: Dresser R

The Patient Preference Predictor (PPP) is intended to improve treatment decision making for incapacitated patients. The PPP would collect information about the treatment preferences of people with different demographic and other characteristics. It could be used to indicate which treatment option an individual patient would be most likely to prefer, based on data about the preferences of people who resemble the patient. The PPP could be incorporated into existing US law governing treatment for incapacitated patients, although it is unclear whether it would be classified as evidence of a specific patient's preferences or those of a reasonable person sharing certain characteristics with the patient. Ethical concerns about the quality and significance of PPP choices could influence legal decision makers' views of the PPP.

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Friday, February 14, 2014

Patient with a devastating embolic stroke: using weekly multidisciplinary ethics rounds in the neuroscience intensive care unit to facilitate care and communication.

Patient with a devastating embolic stroke: using weekly multidisciplinary ethics rounds in the neuroscience intensive care unit to facilitate care and communication.

Top Stroke Rehabil. 2014 Jan-Feb;21(1):7-11

Authors: Jehle J, Jurchak M

The challenges families face in making decisions for loved ones after a severe stroke are best supported when the treatment team has the opportunity to share information and perspectives. Weekly multidisciplinary ethics rounds provides a very good forum for just such discussions. Using a case example, this article describes the framework for ethics rounds and its utility in a neuroscience intensive care unit.


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Thursday, February 13, 2014

Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography.

Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography.

Arch Sex Behav. 2014 Feb 12;

Authors: Grubbs JB, Exline JJ, Pargament KI, Hook JN, Carlisle RD

Perceived addiction to Internet pornography is increasingly a focus of empirical attention. The present study examined the role that religious belief and moral disapproval of pornography use play in the experience of perceived addiction to Internet pornography. Results from two studies in undergraduate samples (Study 1, N = 331; Study 2, N = 97) indicated that there was a robust positive relationship between religiosity and perceived addiction to pornography and that this relationship was mediated by moral disapproval of pornography use. These results persisted even when actual use of pornography was controlled. Furthermore, although religiosity was negatively predictive of acknowledging any pornography use, among pornography users, religiosity was unrelated to actual levels of use. A structural equation model from a web-based sample of adults (Study 3, N = 208) revealed similar results. Specifically, religiosity was robustly predictive of perceived addiction, even when relevant covariates (e.g., trait self-control, socially desirable responding, neuroticism, use of pornography) were held constant. In sum, the present study indicated that religiosity and moral disapproval of pornography use were robust predictors of perceived addiction to Internet pornography while being unrelated to actual levels of use among pornography consumers.


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Arrested development: early prefrontal lesions impair the maturation of moral judgement.

Arrested development: early prefrontal lesions impair the maturation of moral judgement.

Brain. 2014 Feb 11;

Authors: Taber-Thomas BC, Asp EW, Koenigs M, Sutterer M, Anderson SW, Tranel D

Learning to make moral judgements based on considerations beyond self-interest is a fundamental aspect of moral development. A deficit in such learning is associated with poor socialization and criminal behaviour. The neural systems required for the acquisition and maturation of moral competency are not well understood. Here we show in a unique sample of neurological patients that focal lesions involving ventromedial prefrontal cortex, acquired during development, result in an abnormally egocentric pattern of moral judgement. In response to simple hypothetical moral scenarios, the patients were more likely than comparison participants to endorse self-interested actions that involved breaking moral rules or physically harming others in order to benefit themselves. This pattern (which we also found in subjects with psychopathy) differs from that of patients with adult-onset ventromedial prefrontal cortex lesions-the latter group showed normal rejection of egocentric rule violations. This novel contrast of patients with ventromedial prefrontal cortex lesions acquired during development versus during adulthood yields new evidence suggesting that the ventromedial prefrontal cortex is a critical neural substrate for the acquisition and maturation of moral competency that goes beyond self-interest to consider the welfare of others. Disruption to this affective neural system early in life interrupts moral development.


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Wednesday, February 12, 2014

Medicine as moral technology: somatic economies and the making up of adoptees.

Medicine as moral technology: somatic economies and the making up of adoptees.

Med Anthropol. 2014;33(2):109-27

Authors: van Wichelen S

This article focuses on adoption medicine as a subject of scientific knowledge that increasingly defines the parameters of adoptability in the world of international adoption. While this biomedical discourse alludes to the health of adoptee bodies, it also constitutes ethico-moral practices that produce new justificatory regimes of adoption in particular and humanitarianism in general. Drawing on discourse analysis of scientific texts in adoption medicine on the one hand, and interviews and ethnographic data from a Dutch adoption agency on the other, I demonstrate the emergence of a new moral economy facilitating the legitimacy of international adoption. I argue that this moral economy retools the humanitarian justification of international adoption by privileging the politics of "life itself." This paradigmatic shift constructs new categories of adoptee bodies, rearranges orders of worth, and makes visible biopolitical techniques of morality in present-day humanitarian discourse.


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Tuesday, February 11, 2014

Ethics in the Minutiae: Examining the Role of the Physical Laboratory Environment in Ethical Discourse.

Ethics in the Minutiae: Examining the Role of the Physical Laboratory Environment in Ethical Discourse.

Sci Eng Ethics. 2014 Feb 9;

Authors: Bezuidenhout L

Responsibility within life science research is a highly scrutinised field. Increasingly, scientists are presented with a range of duties and expectations regarding their conduct within the research setting. In many cases, these duties are presented deontologically, forgoing extensive discussion on how these are practically implemented into the minutiae of daily research practices. This de-contextualized duty has proven problematic when it comes to practical issues of compliance, however it is not often considered as a fundamental aspect of building ethics discourse. This paper examines this issue in detail, particularly focusing on how differences in the contrasts between the ideal and real physical research environments cause conceptual problems for scientists and retard ethical engagement. Such issues are particularly pertinent in low- and middle-income countries. This paper combines theoretical and empirical analyses using the concept of "dual-use" as a focalizing topic. The data show that the research environment acts as an intimate component in the interpretation and implementation of ethical actions.


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The essential moral self.

The essential moral self.

Cognition. 2014 Feb 3;131(1):159-171

Authors: Strohminger N, Nichols S

It has often been suggested that the mind is central to personal identity. But do all parts of the mind contribute equally? Across five experiments, we demonstrate that moral traits-more than any other mental faculty-are considered the most essential part of identity, the self, and the soul. Memory, especially emotional and autobiographical memory, is also fairly important. Lower-level cognition and perception have the most tenuous connection to identity, rivaling that of purely physical traits. These findings suggest that folk notions of personal identity are largely informed by the mental faculties affecting social relationships, with a particularly keen focus on moral traits.


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Monday, February 10, 2014

Contextual and perceptual brain processes underlying moral cognition: a quantitative meta-analysis of moral reasoning and moral emotions.

Contextual and perceptual brain processes underlying moral cognition: a quantitative meta-analysis of moral reasoning and moral emotions.

PLoS One. 2014;9(2):e87427

Authors: Sevinc G, Spreng RN

BACKGROUND AND OBJECTIVES: Human morality has been investigated using a variety of tasks ranging from judgments of hypothetical dilemmas to viewing morally salient stimuli. These experiments have provided insight into neural correlates of moral judgments and emotions, yet these approaches reveal important differences in moral cognition. Moral reasoning tasks require active deliberation while moral emotion tasks involve the perception of stimuli with moral implications. We examined convergent and divergent brain activity associated with these experimental paradigms taking a quantitative meta-analytic approach.
DATA SOURCE: A systematic search of the literature yielded 40 studies. Studies involving explicit decisions in a moral situation were categorized as active (n = 22); studies evoking moral emotions were categorized as passive (n = 18). We conducted a coordinate-based meta-analysis using the Activation Likelihood Estimation to determine reliable patterns of brain activity.
RESULTS & CONCLUSIONS: Results revealed a convergent pattern of reliable brain activity for both task categories in regions of the default network, consistent with the social and contextual information processes supported by this brain network. Active tasks revealed more reliable activity in the temporoparietal junction, angular gyrus and temporal pole. Active tasks demand deliberative reasoning and may disproportionately involve the retrieval of social knowledge from memory, mental state attribution, and construction of the context through associative processes. In contrast, passive tasks reliably engaged regions associated with visual and emotional information processing, including lingual gyrus and the amygdala. A laterality effect was observed in dorsomedial prefrontal cortex, with active tasks engaging the left, and passive tasks engaging the right. While overlapping activity patterns suggest a shared neural network for both tasks, differential activity suggests that processing of moral input is affected by task demands. The results provide novel insight into distinct features of moral cognition, including the generation of moral context through associative processes and the perceptual detection of moral salience.


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Principles and ethics in scientific communication in biomedicine.

Acta Inform Med. 2013 Dec;21(4):228-33. Authors: Donev D

INTRODUCTION AND AIM: To present the basic principles and standards of scientific communication and writing a paper, to indicate the importance of honesty and ethical approach to research and publication of results in scientific journals, as well as the need for continuing education in the principles and ethics in science and publication in biomedicine.

METHODS: An analysis of relevant materials and documents, sources from the internet and published literature and personal experience and observations of the author.

RESULTS: In the past more than 20 years there is an increasingly emphasized importance of respecting fundamental principles and standards of scientific communication and ethical approach to research and publication of results in peer review journals. Advances in the scientific community is based on honesty and equity of researchers in conducting and publishing the results of research and to develop guidelines and policies for prevention and punishment of publishing misconduct. Today scientific communication standards and definitions of fraud in science and publishing are generally consistent, but vary considerably policies and approach to ethics education in science, prevention and penal policies for misconduct in research and publication of results in scientific journals.

CONCLUSION: It is necessary to further strengthen the capacity for education and research, and raising awareness about the importance and need for education about the principles of scientific communication, ethics of research and publication of results. The use of various forms of education of the scientific community, in undergraduate teaching and postgraduate master and doctoral studies, in order to create an ethical environment, is one of the most effective ways to prevent the emergence of scientific and publication dishonesty and fraud.

PMID: 24505166

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