For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in (...) defining thefield, training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education. (shrink)

There is the world of ideas and the world of practice; the French are often for sup pressing the one and the English the other; but neither is to be suppressed. -Matthew Arnold The Function of Criticism at the Present Time From its inception, bioethics has confronted the need to reconcile theory and practice. At first the confrontation was purely intellectual, as writers on ethical theory (within phi losophy, theology, or other humanistic disciplines) turned their attention to topics from the (...) world of medical practice. Recently the confrontation has grown more intense. The ap pointment of clinical ethicists in hospitals and other health care settings is an accelerating trend in North America. Concomitantly, those institutions involved in training peo ple in clinical ethics have added organized exposure to the world of practice, in the form of placement requirements, to the normal academic course load. In common with other dis ciplines, bioethics has begun to see clinical training as a con dition of didactic theory and apprenticeship. (shrink)

Norms, Values, and Society is the second Yearbook of the Vienna Circle Institute, which was founded in October 1991. The main part of the book contains original contributions to an international symposium the Institute held in October 1993 on ethics and social philosophy. The papers deal among others with questions of justice, equality, just social institutions, human rights, the connections between rationality and morality and the methodological problems of applied ethics. The Documentation section contains previously unpublished (...) papers by Rudolf Carnap, Philipp Frank, Charles W. Morris and Edgar Zilsel, and the review section presents new publications on the Vienna Circle. The Vienna Circle Institute is devoted to the critical advancement of science and philosophy in the broad tradition of the Vienna Circle, as well as to the focusing of cross-disciplinary interest on the history and philosophy of science in a social context. The Institute's Yearbooks will, for the most part, document its activities and provide a forum for the discussion of exact philosophy, logical and empirical investigations, and analysis of language. (shrink)

Consists of lectures delivered at the Institute on human values, a series of lectures presented at Creighton University in 1968-69. Includes bibliographies.

AbstractDuring the Covid-19 pandemic, ethicists and researchers proposed human challenge studies as a way to speed development of a vaccine that could prevent disease and end the global public health crisis. The risks to healthy volunteers of being deliberately infected with a deadly and novel pathogen were not low, but the benefits could have been immense. This essay is a history of the three major efforts to set up a challenge model and run challenge studies in 2020 and 2021. (...) The pharmaceutical company Johnson and Johnson, the National Institutes of Health in the United States, and a private-public partnership of industry, university, and government partners in Britain all undertook preparations. The United Kingdom’s consortium began their Human Challenge Programme in March of 2021.Beyond documenting each effort, the essay puts these scientific and ethical debates in dialogue with the social, epidemiological, and institutional conditions of the pandemic as well as the commercial, intellectual, and political systems in which medical research and Covid-19 challenge studies operated. It shows how different institutions understood risk, benefit, and social value depending on their specific contexts. Ultimately the example of Covid-19 challenge studies highlights the constructedness of such assessments and reveals the utility of deconstructing them retrospectively so as to better understand the interplay of medical research and research ethics with larger social systems and historical contexts. (shrink)

Introduction The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. Objective The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. Methods Curricula and teaching projects of 175 Brazilian medical schools were analyzed using (...) a retrospective historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. Results Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1 – ethics in research (26); 2 – ethical procedures and advanced technology (46); 3 – ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. Conclusion The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.1 (2004) 47-54 [Access article in PDF] Ethical Guidelines for Human Embryonic Stem Cell Research*(A Recommended Manuscript) Adopted on 16 October 2001Revised on 20 August 2002 Ethics Committee of the Chinese National Human Genome Center at Shanghai, Shanghai 201203 Human embryonic stem cell (ES) research is a great project in the frontier of biomedical science for the twenty-first century. Be- (...) cause the research involves the use of human embryos, it triggers serious debate on ethical issues. Opponents consider the embryo to be an early form of human life that should be respected and not destroyed. However, the majority of scientists support embryonic stem cell research, believing that it offers good prospects for the treatment of diseases that have remained incurable until now and so will benefit humankind. The Ethics Committee of the Department of Ethical, Legal, and Social Implications of the Chinese National Human Genome Center at Shanghai seriously discussed the ethical debate initiated by embryonic stem cell research. We concluded that we should support the scientists of our country in actively carrying out human embryonic stem cell research for the noble cause of "medicine being a beneficent art." For the healthy and orderly development of human embryonic stem cell research in our country, we put forward the following recommended Ethical Guidelines for Human Embryonic Stem Cell Research as a reference for leaders, administrative departments, and related scientists. Preface Article 1. Human embryonic stem cells are the primitive cells that play the main role in the growth and development of a human body. These [End Page 47] primitive cells have the potential for infinite proliferation, self-renewal, and multi-directional differentiation. If scientists can discover the mechanism of differentiation of human embryonic stem cells, it will be possible to induce differentiation of human embryonic stem cells to form various types of human cells for clinical cell therapy. If human embryonic stem cell research can be integrated with modern biomedical engineering techniques, it also will be possible to make repair and replacement of human tissues and organs a reality. Article 2. There are two ways to classify human embryonic stem cells. One way is to classify them according to their potential for differentiation. There could be three kinds of stem cells: totipotent stem cells, pluripotent stem cells, and unipotent stem cells.A totipotent stem cell has the potential to develop into a whole individual. It can differentiate into the more than 200 cell types in the whole body, construct any tissue or organ of the body, and finally develop into a whole individual. The fertilized egg and the cleavage cells at the very early stage of embryonic development are totipotent stem cells.A pluripotent stem cell has the potential to differentiate into many cell types derived from the three embryonic layers. However, it has lost the capacity to develop into a complete organism.A unipotent stem cell is derived from the further differentiation of the pluripotent stem cell. It can differentiate only into one cell type such as a hematopoietic stem cell, neural stem cell, and others.The other way is to classify human stem cells according to their source. There could be two kinds of human stem cells: embryonic stem cells and tissue stem cells (also called adult stem cells). The former involves experimentation with embryos, which has serious ethical implications. Ethical issues associated with the latter are mainly expressed in the various opinions regarding the allocation of health resources. Article 3. Human embryonic stem cells are the group of cells called the blastocyst inner cell mass during the early stage of embryonic development. They are the main source of totipotent stem cells, and hence the focal and hot point in stem cell research. Studies on the clinical application of embryonic stem cells probably will involve use of the somatic cell nucleus transfer (SCNT) technique, which destroys the early human embryo. At present, the ethical and moral debate is very serious in human embryonic stem cell research regarding whether the research will develop... (shrink)

Volume 39 of the Tanner Lectures on Human Values includes lectures initially scheduled during the academic year 2019-2020. Owing to the global coronavirus pandemic, some were delivered at a later date. The Tanner Lectures are published in an annual volume. In addition to permanent lectures at nine universities, the Tanner Lectures on Human Values funds special one-time lectures at selected higher educational institutions in the United States and around the world.

Volume 39 of the Tanner Lectures on Human Values includes lectures initially scheduled during the academic year 2019-2020. Owing to the global coronavirus pandemic, some were delivered at a later date. The Tanner Lectures are published in an annual volume. In addition to permanent lectures at nine universities, the Tanner Lectures on Human Values funds special one-time lectures at selected higher educational institutions in the United States and around the world.

The truth can be dangerous. It is because they realise this that the Roman Catholic Church forbid cremation. Cremation is, of course, theologically permissible, and in times of epidemic the Church allows it. But in normal times it is forbidden — Why? The reason is that the Church fears the influence of the image associated with it. It is difficult enough for the faithful to accept the notion of bodily resurrection after having seen a burial. But the image of the (...) whole body being consumed by flames and changing within a few minutes to a heap of ashes is an even more powerful apparent contradiction of the theological claim of bodily resurrection at the Day of Judgement. In short, instead of relying only on abstract theological argument, which very likely would not convince their flock in any case, the Church deals with this threat to faith by attacking the concrete image. (shrink)

The truth can be dangerous. It is because they realise this that the Roman Catholic Church forbid cremation. Cremation is, of course, theologically permissible, and in times of epidemic the Church allows it. But in normal times it is forbidden — Why? The reason is that the Church fears the influence of the image associated with it. It is difficult enough for the faithful to accept the notion of bodily resurrection after having seen a burial. But the image of the (...) whole body being consumed by flames and changing within a few minutes to a heap of ashes is an even more powerful apparent contradiction of the theological claim of bodily resurrection at the Day of Judgement. In short, instead of relying only on abstract theological argument, which very likely would not convince their flock in any case, the Church deals with this threat to faith by attacking the concrete image. (shrink)

Quality of life is an important outcome measure in mental health care. Currently, QoL is mainly measured with paper and pencil questionnaires. To contribute to the evaluation of treatment, and to enhance substantiated policy decisions in the allocation of resources, a web-based, personalized, patient-friendly and easy to administer QoL instrument has been developed: the QoL-ME. While human values play a significant role in shaping future use practices of technologies, it is important to anticipate on them during the design (...) of the QoL-instrument. The value sensitive design approach offers a theory and method for addressing these values in a systematic and principled manner in the design of technologies. While the VSD approach has been applied in the field of somatic care, we extended the VSD approach to the field of mental healthcare with the aim to enable developers of the QoL-instrument to reflect on important human values and anticipate potential value conflicts in its design. We therefore explored how VSD can be used by investigating the human values that are relevant for the design of the QoL-ME. Our exploration reveals that the values autonomy, efficiency, empowerment, universal usability, privacy, redifinition of roles, of responsibilites, reliability, solidarity, surveillance and trust are at stake for the future users of the technology. However, we argue that theoretical reflections on the potential ethical impact of a technology in the design phase can only go so far. To be able to comprehensively evaluate the usability the VSD approach, a supplementary study of the use practices of the technology is needed. (shrink)

In this paper, we take inspiration from original institutional economics (OIE) as an approach to study value change within the highly complex assembly of sociotechnical transformations that make up the energy transition. OIE is examined here as a suitable perspective, as it combines Dewey’s pragmatist philosophy and a methodological interactionist perspective on value change, behavior and institutions, with technology figuring as a transformational factor. This combination overcomes conceptual and methodological shortcomings of alternative accounts of values. We will present the (...) contours of an OIE based conceptual framework connecting nature, humans, technology, the economic process, society, culture and institutions and habits, valuation and behavior. We illustrate how to use this framework to examine and understand how environmental, ecologic, safety, economic, and social concerns about the energy transition are (re)framed as (new) values in the belief systems and habits of individuals and groups. Moreover, we will explore how that may give rise to collective action, via the institutionalization of such revised values in the procedures, arrangements, norms and incentives guiding transactions. As such, this approach allows us in a fine-grained manner to conceptually and theoretically understand the way in which values change in the energy-transition, as a complex interaction of technology development and social relations. (shrink)

Use of humanities content in American medical education has been debated for well over 60 years. While many respected scholars and medical educators have purported the value of humanities content in medical training, its inclusion remains unstandardized, and the undergraduate medical curriculum continues to be focused on scientific and technical content. Cited barriers to the integration of humanities include time and space in an already overburdened curriculum, and a lack of consensus on the exact content, pedagogy and instruction. Edmund Pellegrino, (...) physician and scholar of the latter twentieth century, spent much of his professional life promoting the value and importance of the humanities in medical education, seeking the best way to incorporate and teach this content in clinically relevant ways. His efforts included the founding of multiple enterprises starting in the 1960s and 1970s to promote human values in medical education, including the Society for Health and Human Values and its Institute on Human Values in Medicine. Regardless of his efforts and those of many others into the current century, the medical humanities remains a curricular orphan, unable to find a lasting home in medical education and training. (shrink)

The Tanner Lectures on Human Values, founded July 1, 1978, at Clare Hall, Cambridge University, was established by the American scholar, industrialist, and philanthropist Obert Clark Tanner. Lectureships are awarded to outstanding scholars or leaders in broadly defined fields of human values and transcend ethnic, national, religious, or ideological distinctions. Volume 32 features lectures given during the academic year 2011–2012 at the University of Michigan; Princeton University; Stanford University; the University of California, Berkeley; the University of (...) Utah; and Yale University. This volume includes the following lectures:_ John Broome_, “The Public and Private Morality of Climate Change”_John Broome is the Whites Professor of Moral Philosophy at the University of Oxford and a fellow of Corpus Christi College in Oxford. He has written six books. John M. Cooper_, “Ancient Philosophies as Ways of Life”_John Cooper is the Henry Putnam University Professor of Philosophy at Princeton University. His books include _Pursuits of Wisdom: Six Ways of Ancient Philosophy from Socrates to Plotinus _and _Panentheism: The Other God of the Philosophers_. Stephen Greenblatt_, “Shakespeare and the End of Life History”_Stephen Greenblatt is the John Cogan University Professor of the Humanities at Harvard University. He is the author of several books, including the 2012 Pulitzer Prize–winning _The Swerve: How the World Became Modern _and _Will in the World: How Shakespeare Became Shakespeare_. Lisa Jardine_, “The Sorcerer’s Apprentice: C. P. Snow and J. Bronowski” and “Science and Government: C. P. Snow and the Corridors of Power”_Lisa Jardine is a professor of Renaissance studies at University College London, where she is the director of the Interdisciplinary Centre for Research in the Humanities and the Centre for Editing Lives and Letters. She has published more than fifty scholarly articles and seventeen books, including _Going Dutch: How England Plundered Holland’s Glory_. Samuel Scheffler_, “The Afterlife”_Samuel Scheffler is University Professor and a professor of philosophy and law at New York University. He has published four books in the areas of moral and political philosophy, including _Equality and Tradition_. Abraham Verghese_, “Two Souls Intertwined” Abraham Verghese is a professor of medicine and senior associate chair for the Theory and Practice of Medicine at Stanford University. He has published widely across disciplines, including _My Own Country: A Doctor’s Story _and the novel _Cutting for Stone_. He is perhaps best known for his deep interest in bedside medicine and work in the medical humanities. (shrink)

This is the third of three volumes containing a report from the International Panel on Social Progress. The IPSP is an independent association of top research scholars with the goal of assessing methods for improving the main institutions of modern societies. Written in accessible language by scholars across the social sciences and humanities, these volumes assess the achievements of world societies in past centuries, the current trends, the dangers that we are now facing, and the possible futures in the twenty-first (...) century. It covers the main socio-economic, political, and cultural dimensions of social progress, global as well as regional issues, and the diversity of challenges and their interplay around the world. This particular volume covers topics such as world cultures and religions, families, global health, education, and the contributions of social sciences to institutional change. (shrink)

Critically exploring medical thought in a cultural milieu with no discernible influence from the European Enlightenment, _Being Human_ reveals an otherwise unnoticed intersection of early modern sensibilities and religious values in traditional Tibetan medicine. It further studies the adaptation of Buddhist concepts and values to medical concerns and suggests important dimensions of Buddhism's role in the development of Asian and global civilization. Through its unique focus and sophisticated reading of source materials,_ Being Human_ adds a crucial chapter (...) in the larger historiography of science and religion. The book opens with the bold achievements in Tibetan medical illustration, commentary, and institution building during the period of the Fifth Dalai Lama and his regent, Desi Sangye Gyatso, then looks back to the work of earlier thinkers, tracing a strategically astute dialectic between scriptural and empirical authority on questions of history and the nature of human anatomy. It follows key differences between medicine and Buddhism in attitudes toward gender and sex and the moral character of the physician, who had to serve both the patient's and the practitioner's well-being. _Being Human_ ultimately finds that Tibetan medical scholars absorbed ethical and epistemological categories from Buddhism yet shied away from ideal systems and absolutes, instead embracing the imperfectability of the human condition. (shrink)

The current paradigm in medicine generally distinguishes between genetic and environmental causes of disease. Although the word paradigm has become a commonplace, the theories of Thomas Kuhn have not received much attention in the journals of medicine. Kuhn's structuralist method differs radically from the daily activities of the scientific method itself. Using linguistic theory, this essay offers a structuralist reading of Thomas Kuhn's The Structure of Scientific Revolutions. Our purpose is to highlight the similarities between these structuralist models (...) of science and language. In part, we focus on the logic that enables Kuhn to assert the priority of perception over interpretation in the history of science. To illustrate some of these issues, we refer to the distinction between environmental and genetic causes of disease. While the activity of scientific research results in the revision of concepts in science, the production of significant differences that shape our knowledge is in part a social and linguistic process. (shrink)

An exploration of the moral and ethical implications of new biotechnologies Many of the ethical issues raised by new technologies have not been widely examined, discussed, or indeed settled. For example, robotics technology challenges the notion of personhood. Should a robot, capable of making what humans would call ethical decisions, be held responsible for those decisions and the resultant actions? Should society reward and punish robots in the same way that it does humans? Likewise, issues of safety, environmental concerns, and (...) distributive justice arise with the increasing acceptance of genetically modified organisms in food production nanotechnology in engineering and medicine, and human gene therapy and enhancement. The problem of dual-use—when a technology can be used both to benefit and to harm—exists with virtually all new technologies but is central in the context of emerging 21st century technologies ranging from artificial intelligence and robotics to human gene-editing and brain-computer interfacing. In Re-Creating Nature: Science, Technology, and Human Values in the Twenty-First Century, James T. Bradley addresses emerging biotechnologies with prodigious potential to benefit humankind but that are also fraught with ethical consequences. Some actually possess the power to directly alter the evolution of life on earth including human. Specifically, these topics include stem cells, synthetic biology, GMOs in agriculture, nanotechnology, bioterrorism, CRISPR gene-editing technology, three-parent babies, robotics and roboethics, artificial intelligence, and human brain research and neurotechnologies. Offering clear explanations of these various technologies, a pragmatic presentation of the conundrums involved, and questions that illuminate hypothetical situations, Bradley guides discussions of these and other thorny issues resulting from the development of new biotechnologies. He also highlights the responsibilities of scientists to conduct research in an ethical manner and the responsibilities of nonscientists to become “science literate” in the twenty-first century. (shrink)

The “Universal Declaration of Human Rights” and the “Geneva Declaration” by the World Medical Association, both in 1948, were preceded by the foundation of the United Nations in New York (1945), the World Medical Association in London (1946) and the World Health Organization in Geneva (1948). After the end of World War II the community of nations strove to achieve and sustain their primary goals of peace and security, as well as their basic premise, namely the health of (...) class='Hi'>human beings. All these associations were well aware of the crimes by medicine, in particular by the accused Nazi physicians at the Nuremberg Doctors Trial (1946/47, sentence: August 1947). During the first conference of the World Medical Association (September 1947) issues of medical ethics played a major role: and a new document was drafted concerning the values of the medical profession. After the catastrophe of the War and the criminal activities of scientists, the late 1940s saw increased scrutiny paid to fundamental questions of human rights and medical ethics, which are still highly relevant for today’s medicine and morality. The article focuses on the development of medical ethics and human rights reflected in the statement of important persons, codes and institutions in the field. (shrink)

World politics, international relations, representative government. Author's works in demand.

"The Bush administration and Congress are in concert on the goal of developing a fleet of unmanned aircraft that can reduce both defense costs and aircrew losses in combat by taking on at least the most dangerous combat missions. Unmanned combat aerial vehicles (UCAVs) will be neither inexpensive enough to be readily expendable nor-- at least in early development-- capable of performing every combat mission alongside or in lieu of manned sorties. Yet the tremendous potential of such systems is widely (...) recognized, and allies as well as potential adversaries are moving quickly to mount their own research and development programs. The United States is committed to fielding UCAV capabilities by 2010, principally for the missions of suppression of enemy air defense and deep strike, which are among the highest risk tasks for the Air Force and naval aviation."--Overview. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of MedicineRuth Ellen Bulger (bio)IN 1863 the National Academy of Sciences (NAS) was established by federal charter to advise the government on scientific matters. Almost 100 years later, in 1971, the Academy created the Institute of Medicine within the NAS to focus on health-related problems and issues. Today the IOM has a program budget of about $13 million, which includes both private and government (...) funds, and is regarded as a leading center for health policy research.After briefly explaining the structure and general goals of IOM, this article describes several new or anticipated projects as well as some recently completed reports that have a strong ethical component.The IOMThe IOM's distinguished membership is made up of health care professionals of all sorts, scientists working in health-related disciplines, and lawyers, economists, and others knowledgeable in and involved with policies and activities associated with health issues. It is organized around eight working groups or divisions: Health Sciences Policy; Health Care Services; Health Promotion and Disease Prevention, including AIDS activities; International Health; Biobehavioral Sciences and Mental Disorders; the Food and Nutrition Board; the Medical Follow-up Agency; and the Health Policy Fellowship Programs. Each of these divisions is assisted by an oversight board that provides advice on its activities.It is important to know at the outset that IOM has decided that each of the divisions will include consideration of human values and ethical issues in their activities. Therefore, no separate locus was established within the IOM to deal with these matters. I am director of the Division of Health Sciences Policy, which is the only division that has made ethics a priority in its work, and it is the focus of this article.We have addressed questions of ethics, human values, social values, decision making, and priority setting in many of the division's reports. In fact, most of our reports at least raise ethical questions. In addition, a portion of the interest from endowment funds given to IOM by the Howard Hughes Medical Institute has been devoted to work in this area. [End Page 73]The division's advisory board, headed by Claude Bennett, chairman of the Department of Medicine, University of Alabama at Birmingham School of Medicine, has decided on two major priorities for the division: (1) foster an environment conducive to productive research, and (2) anticipate the impact of scientific—especially biomedical—advances on society, monitoring and considering the social and ethical factors that accompany basic scientific and technological progress. These two priorities are interdependent because the fostering of a good environment for research presupposes that the results of this research will produce beneficial effects for the society that supports the research.Upcoming StudiesSociety has been unable to establish a mechanism for discussing in a meaningful way—and possibly resolving—a number of pressing national issues with social, ethical, legal, and scientific ramifications. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research considered several such issues and produced important reports about them. However, the commission was funded only until 1983. The Congressional Biomedical Ethics Advisory Committee was authorized in 1985 to address these contentious issues, but it was caught in the crossfire of congressional abortion politics and subsequently died. A new model is needed to attempt to develop national consensus on these complex, contentious issues.The Board on Health Sciences Policy has wrestled with this idea. Recently, it approved a proposal to establish a study committee charged with developing effective alternative methodologies for anticipating and addressing the social, legal, and ethical issues that may accompany rapid advances in biomedical science and technology. This multidisciplinary committee will be given a series of tasks: (1) to explore past experiences with some of these varying methodologies (i.e., town meetings, consensus conferences, forums, commissions, etc.); (2) to develop an agenda of issues likely to arise in the future; (3) to define and test a variety of alternative methodological approaches to these questions; (4) to evaluate strengths, weaknesses, and impact of the various approaches; and (5) to make recommendations on the process and structure by which this fact-finding, analytical, and decision-making function could be... (shrink)

This critical notice argues for the existence of a new trend in bioethics, a complex and dynamic field of philosophical enquiry that goes beyond applied ethics and professional deontological codes. This trend supplements their traditionally “minimalist” ethics—and its concern with harm, rights or justice—with “inflationary” positions open to an integration of medicine with the humanities. By comparing and contrasting the views of two quite different philosophers, Diego Gracia and Alfred Tauber, and placing them within the theoretical background delineated by (...) George Khushf, I argue that the main contribution of this “inflationary bioethics” is an understanding of health and disease as intrinsically normative concepts, which in turn brings about a blurring of the distinction between facts and values. By refusing to construe the distinction as a dichotomy, a post-positivist philosophy of medicine must become more epistemological in order to help us clarify concepts in which the evaluative and the factual are impossible to separate. As a result, the “language of principles” in standard bioethics is being substituted by a more encompassing “language of values”; health and disease are increasingly understood as biopsychosocial phenomena; and the field is open to a process of moralization that challenges traditional models of patient autonomy and physician responsibility. (shrink)

BackgroundInstitutional review boards (IRBs) are formally designated to review, approve, and monitor biomedical research. They are responsible for ensuring that researchers comply with the ethical guidelines concerning human research participants. Given that IRBs might face different obstacles that cause delays in their processes or conflicts with investigators, this study aims to report the functions, roles, resources, and review process of IRBs in Saudi Arabia.MethodThis was a cross-sectional self-reported survey conducted from March 2021 to March 2022. The survey was sent (...) to 53 IRB chairpersons and the administration directors (or secretary) across the country through email after receiving verbal consent. The validated survey consisted of eight aspects: (a) organizational aspects, (b) membership and educational training, (c) submission arrangements and materials, (d) minutes, (e) review procedures, (f) communicating a decision, (g) continuing review, and (h) research ethics committee (REC) resources. A total of 200 points indicated optimal IRB functions.ResultsTwenty-six IRBs across Saudi Arabia responded to the survey. Overall, the IRBs in this study scored a total of 150/200 of the points on the self-assessment tool. Relatively newer IRBs (established less than ten years ago) conducted meetings at least once in a month, had annual funding, had more balanced gender representation, tended to score higher than older IRBs. The organizational aspect score was the lowest among all items in the survey (14.3 score difference, p-value < 0.01). The average turnaround time for expedited research from proposal submission to final decision was 7 days, while it was 20.5 days for the full committee review.ConclusionSaudi IRBs performed generally well. However, there is room for focused improvement with respect to extra resources and organizational issues that require closer evaluation and guidance from the regulatory bodies. (shrink)

While human rights treaties provide a formidable set of principles on education and values, domestic Courts often tend to adjudicate claims in terms of local arguments for or against each particular educational practice. This article explores how international human rights law could inspire the interpretation of domestic law and educational practice, without neglecting specific cultural aspects. Firstly, the article reviews the sociological debate on values in education and shows its importance for the legal discussion. Secondly, some (...) critical contestations of international cultural human rights are outlined, as well as certain arguments to justify the importance of this model. The study of international law follows: the UN, the European Court of Human Rights, and three relevant African Charters, as well as every reference to education made by the African Commission on Human and Peoples’ Rights and by the African Court is examined. Lastly, a comparative section reveals a certain cultural commonality inspired by the UN treaties, but also reflects some cultural and institutional differences between the European and the African regional systems. (shrink)

If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken.BackgroundIn the past two decades, the involvement of non-academic sponsors of biomedical research, particularly clinical trial research, has increased exponentially. The value of such sponsored research is difficult to ascertain. However, it is estimated that, between 1980 and 2003, overall research and development expenditures by US pharmaceutical (...) companies increased from $2 billion to $33 billion and that, in 2001, clinical trial research expenditures in Canada totaled $800 million to $1 billion.The source of funding for biomedical research has shifted significantly from predominantly government and private foundations to industry. By 2002,70% of funding for clinical trials came from industry. These factors have affected the conduct of research, particularly clinical trial research, in a variety of ways. (shrink)

If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken.BackgroundIn the past two decades, the involvement of non-academic sponsors of biomedical research, particularly clinical trial research, has increased exponentially. The value of such sponsored research is difficult to ascertain. However, it is estimated that, between 1980 and 2003, overall research and development expenditures by US pharmaceutical (...) companies increased from $2 billion to $33 billion and that, in 2001, clinical trial research expenditures in Canada totaled $800 million to $1 billion.The source of funding for biomedical research has shifted significantly from predominantly government and private foundations to industry. By 2002,70% of funding for clinical trials came from industry. These factors have affected the conduct of research, particularly clinical trial research, in a variety of ways. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses (...) in what came to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)

In the twenty-first century, Stephen Hawking proclaimed the death of philosophy. Only science can address philosophy’s perennial questions about human values. The essay first examines Nietzsche’s nineteenth century view to the contrary that philosophy alone can create values. A critique of Nietzsche’s contention that philosophy rather than science is competent to judge values follows. The essay then analyzes Edward O. Wilson’s claim that his scientific research provides empirically-based answers to philosophy’s questions about human values. (...) Wilson’s bold new hypothesis about the ‘social conquest of the earth’ challenges Nietzsche’s vision of philosophy’s mission. Confronting both Nietzsche and Wilson, the essay then considers three theoretical proposals for a consilience of philosophy, science, engineering and technology. The conclusion presents a working African model of consilience that addresses the existential problem of poverty in the Global South. (shrink)

Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience (...) their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way? We carried out a qualitative study (Grounded Theory Approach) to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium. Six predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: (1) values-based health care management as managing a large garden, (2) as learning and using a foreign language, (3) going on a trekking with an ethical compass, (4) embodying integrity and authenticity in a credible encounter with everyone, (5) being a present and trustworthy leader during sun and storm, and (6) contributing to human flourishing by giving people wings to fly. Notwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization. (shrink)

There is perhaps no more important value than fundamental human equality. And yet, despite large percentages of people affirming the value, the resources available to explain and defend the basis for such equality are few and far between. In his newest book, Charles Camosy provides a thoughtful defense of human dignity. Telling personal stories like those of Jahi McMath, Terri Schiavo, and Alfie Evans, Camosy, a noted bioethicist and theologian, uses an engaging style to show how the influence (...) of secularized medicine is undermining fundamental human equality in the broader culture. And in a disturbing final chapter, Camosy sounds the alarm about the next population to fall if we stay on our current trajectory: dozens of millions of human beings with dementia. Heeding this alarm, Camosy argues, means doing two things. First, making urgent and genuine attempts to dialogue with a secularized culture which cannot see how it is undermining one of its most foundational values. Second, religious communities which hold the Imago Dei sacred must mobilize their existing institutions (and create new ones) to care for a new set of human beings our throwaway culture may deem nonpersons. (shrink)

Inclusion of the humanities in undergraduate medicine curricula remains controversial. Skeptics have placed the burden of proof of effectiveness upon the shoulders of advocates, but this may lead to pursuing measurement of the immeasurable, deflecting attention away from the more pressing task of defining what we mean by the humanities in medicine. While humanities input can offer a fundamental critical counterweight to a potentially reductive biomedical science education, a new wave of thinking suggests that the kinds of arts (...) and humanities currently used in medical education are neither radical nor critical enough to have a deep effect on students’ learning and may need to be reformulated. The humanities can certainly educate for tolerance of ambiguity as a basis to learning democratic habits for contemporary team-based clinical work. William Empson’s ‘seven types of ambiguity’ model for analyzing poetry is transposed to medical education to: (a) formulate seven values proffered by the humanities for improving medical education; (b) offer seven ways of measuring impact of medical humanities provision, thereby reducing ambiguity; and (c) --as a counterweight to (b) – celebrate seven types of ambiguity in contemporary medical humanities that critically reconsider issues of proof of impact. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Origins and Evolution of Bioethics: Some Personal ReflectionsEdmund D. Pellegrino (bio)AbstractBioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a (...) perceived “dehumanization” of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human “values” into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third—and present—period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise—e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.I have been invited to give a “personal recollection” of the early development of bioethics. Such invitations are notoriously hard to resist, but also problematic when they are the recollections of a participant [End Page 73] in the events to be described. We need only be reminded of the vagaries common to the plethora of memoirs on the book stands today. Few have escaped the perils of selective memory, self-promotion, or the settling of old scores. Yet their perils notwithstanding, memoirs may serve some useful purpose. They are the raw material—verbal kitchen middens so to speak—out of which historians can later sift fact from fancy. They enable “tribal elders” to give witness to the past from which the present can fashion some sense of continuity.I will organize my reflections around three very arbitrary time periods that represent my own way of thinking about the evolution of bioethics: (1) an era of “proto-bioethics” (1960–1972), (2) an era of philosophical bioethics (1972–1985), and (3) an era of global bioethics (1985-present). Each era, of course, overlaps with the others, and the dominant strand of each runs through the others as well.In the proto-bioethics period, the language of human values predominated; in the era of bioethics philosophically construed, it was the language of philosophical ethics; and in the era of bioethics globally construed, the social and behavioral sciences have gained greater prominence. In each period, interest in the traditional humanities other than philosophy waxed and waned. In the earlier years, religion and theology predominated. Beginning in the 1970s, philosophy took a dominant role. In the last two decades, other disciplines, like law, literature, and the social sciences, have exerted more and more influence (McNeur 1963; Pellegrino 1997; Barker 1987).I make no pretense here of writing any part of the formal “history” of bioethics. Works of this nature are beginning to appear (Rothman 1991; Jonsen 1998 ; Dell’Oro and Viafora 1996). Thomas McElhinney and I are preparing our own account of the work and influence of the Institute on Human Values in Medicine, one of the influential programs of the Society for Health and Human Values (Pellegrino and McElhinney, n.d.). Space limitations as well as prudence preclude any attempt to do justice to all the events, institutions, and people who have made the field of bioethics what it is today. I apologize for these omissions, for any unintentional lapses of... (shrink)

The following volume is published on the occasion of the 15th anniversary of the establishment of the Institute for Axiological Research in Vienna – the first European Institute for the advanced philosophical and interdisciplinary study of values – and is divided in two parts. The first one treats specific problems of women's struggle for rights, freedoms, and recognition, and moves successively to thematically broader methodological and hermeneutical approaches of the phenomena of exclusion and the possibilities of social (...) integration, which are discussed in the second part. Although the defended positions of the essays in the present volume are different from those of Habermas, they should be conceived in relation to the main issues of what he calls the "the postmetaphysical age." Hence, the authors ask such core axiological questions as: How do we think today of community, praxis and values in front of the old and new problems of injustice, oppression and exclusion? How should we consider personal and group identity in the contexts of social and cultural diversity, of world view pluralism and incommensurable lifeworlds, lifestyles and values? Moreover, what is the meaning of the key concept of "European values," can it offer a real basis for integration or does it serve rather as a new form of "dictatorship" and exclusion of otherness? (shrink)

This chapter contains sections titled: Scandalous Research in the Twentieth Century Basic Principles of Research Ethics Respect for Persons Beneficence Justice Conclusion.

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and (...) medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

This is a revised and expanded version of the much praised short book _Universities: The Recovery of An Idea_. It contains chapters on the history of universities; the value of university education; the nature of research; the management and funding of universities plus additional essays on such subjects as human nature and the study of the humanities, interdisciplinary versus multidisciplinary study, information systems and the concept of a library, the prospects for e-learning, reforming universities, intellectual integrity and the realities (...) of funding, and spiritual values and the knowledge economy. (shrink)

Aim:This study explores experiences of patients suffering from Korsakoff’s syndrome. It contributes to improved reflection on the value of patient knowledge.Background:An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients’ individual needs necessary to provide good care. The information given by patients suffering from Korsakoff’s syndrome might be mistaken, invented and even not true. The value of these patients’ experiences and knowledge had not been researched to date.Method:Data (...) from six in-depth interviews were analysed concurrently through the constant comparative method.Ethical considerations:The principles of voluntariness, confidentiality and anonymity were respected during the research process.Findings:Four important themes within patients’ knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective.Conclusion:This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients’ unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the – unintended – effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of patients suffering from Korsakoff’s syndrome. (shrink)

Organizations such as the EU High-Level Expert Group on AI and the IEEE have recently formulated ethical principles and (moral) values that should be adhered to in the design and deployment of artificial intelligence (AI). These include respect for autonomy, non-maleficence, fairness, transparency, explainability, and accountability. But how can we ensure and verify that an AI system actually respects these values? To help answer this question, I propose an account for determining when an AI system can be said (...) to embody certain values. This account understands embodied values as the result of design activities intended to embed those values in such systems. AI systems are here understood as a special kind of sociotechnical system that, like traditional sociotechnical systems, are composed of technical artifacts, human agents, and institutions but—in addition—contain artificial agents and certain technical norms that regulate interactions between artificial agents and other elements of the system. The specific challenges and opportunities of embedding values in AI systems are discussed, and some lessons for better embedding values in AI systems are drawn. (shrink)

This essay is an array of several taxonomies of values which bear on medicine. The first is a rather low-level list of types of values, meant to be adequate to observational data collection about human valuing. It proceeds to a discussion of levels of valuing so that senses of higher and lower values are articulated. Next, it offers a consideration of intrinsic versus extrinsic and of fundamental versus domestic (or mediating, enabling) values, along with (...) the notions of a practice and virtues. Finally it offers an analysis of clusters of value types along the lines of personal values, social values and professional values acting as interlocking force fields affecting the judgments, reactions and decisions of persons working in health care. In addition to the anticipated elucidation contained in the dialectic, two conclusions are intended: (1) the topic of values in medicine is staggeringly complex, and (2) a medical career is in the best sense a tragic fate in that a noble calling is doomed to many failures because of an inability to reconcile conflicts of values as much as because techniques cannot accomplish everything. (shrink)

In 2015, the Chinese pharmacologist, Tu Youyou, was awarded the Nobel Prize for Physiology or Medicine for the discovery of artemisinin. Traditional Chinese medicine (TCM) was the source of inspiration for Tu's discovery and provides an opportunity for the world to know more about TCM as a source of medical knowledge and practice. In this article, the value of TCM is evaluated from an ethical perspective. The characteristics of ‘jian, bian, yan, lian’ are explored in the way they (...) promote accessibility and economic efficiency for TCM. The article also examines how the increased use and prevalence of TCM reflects the scientific, cultural, and ethical values of TCM and their increasing attraction in meeting major challenges to medicine and health systems currently and in the future. The article discusses safety issues within TCM, which is a controversial area, and also comments on some shortcomings and challenges which pose difficulties for more widespread and greater uptake of TCM‐derived clinical or therapeutic interventions. The article concludes that TCM is generally safe if it is used according to TCM theory and where such applications are cognizant of the strengths and weaknesses of TCM. TCM has important bioethical values which may inform potential measures for meeting challenges facing global health care systems and the article argues that it can have an increasing role in improving human health. (shrink)

The concept of disease remains hotly contested. In light of problems with existing accounts, some theorists argue that the disease concept ought to be eliminated. We answer this skeptical challenge by reframing the discussion in terms of the role that the disease concept plays in the complex network of health-care institutions in which it is deployed. We argue that while prevailing accounts do not suffer from the particular defects that critics have identified, they do suffer from other deficits, and this (...) leads us to propose a new account that satisfies the desiderata for a concept of disease in human medicine. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative Formulation RevisitedOn Seeing the Person in Mental Health RecoveryAnna Bergqvist (bio)The use of narrative in mental health contexts models consciousness as something necessarily embodied, as already part of the world, in an inherently value-laden and perspectival way. As such narrative presents a powerful tool for critical reassessment and reevaluation of preconceived ideas in relating to difficult concepts in clinical interactions.Narrative structures can reveal psychological differences between persons in (...) a way that matters for the provision of effective treatment and management. As emphasized by Solomon (2015), narrative reasoning is also motivated by distinctly first-personal concerns that are operative in the practitioner–client relationship. I maintain that the dynamics of that interpersonal relationship are part and parcel of what it means to address the patient's needs to be seen as a person in humanistic empathetic care—without thereby reducing truth to an individual person's perspective to encourage positive transformation.1The notion of empowering narratives to encourage positive change is a core concept behind the emphasis on the critical role of empathy in explaining human development and psychoanalytic change within the self-psychology tradition but is also key to recovery-based models of the significance of person-centered quality of life in medicine more generally. This is defined in mental health as recovering a good quality of life as determined by the values of (by what matters or is important to) the individual concerned (Allott, Loganathan, & Fulford, 2002; Fulford, 1989, 2004; Fulford, Peile, & Carroll, 2012). The importance of strengths in this regard was reflected for example in the UK government program on values-based mental health assessment. The 3 Keys program, as it was called (National Institute for Mental Health in England, NIMHE, and the Care Services Improvement Partnership, 20082) identified three shared 'keys' to good practice in mental health assessment: three things that were identified in a wide-ranging consultation as being important alike by health professionals of all kinds and by 'service users' thus understood as patients and carers (Fulford, Duhig, Hankin, Hicks, & Keeble, 2015a; Fulford, Dewey, & King, 2015b). The third of these keys was defined in [End Page 7] the subsequently published Good Practice Guidance, as "a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges" (NIMHE, 2008: 6); and the guidance included a number of real-life case examples of best recovery practice reflecting this aspect of mental health care (Slade et al., 2014).What my (Bergqvist, 2018, 2020, 2022, forthcoming) account adds to this claim is that while such choices are revelatory or expressive of a distinctly first-personal stance, they do not constitute or determine selfhood and self-interpretation in a fixed way. Moreover, the reason is that one can also adopt a second-personal stance on one's own experience and address oneself, where the relationship between the first- and the second-personal narrative perspective on experience and self-understanding is itself a dynamic and open-ended evaluative process.Anna Bergqvist Anna Bergqvist is Reader in Philosophy at Manchester Metropolitan University since 2021, and has been Postgraduate Research Coordinator and AHRC North West Doctoral Pathway Consortium Lead for Philosophy since 2020. I was elected to a Visiting Fellowship at St Catherine's College University of Oxford for Michaelmas Term 2021. Her service to the profession out with the University includes acting as Secretary of the World Psychiatric Association (WPA) Section for Philosophy & Humanities in Psychiatry (October 2020 – present), Executive Committee Member of the Royal College of Psychiatry (RCPsych) SIG in Philosophy (February 2020 – present) and External Examiner, University of Liverpool (November 2019 – present, 4-year tenure). She is also Director of the Values-based Theory Network at St Catherine's Collaborating Centre for Values-based Practice at the University of Oxford, and Member of its Whiteness and Race Equality Network. Her approach to philosophy bridges the disciplines of moral philosophy, moral psychology and philosophy of psychiatry to improve lives through her reputable expertise in moral perception and co-production as a mechanism for change.Notes1. Here I side with Goldie (2012) and Solomon (2015), who... (shrink)

Economic environmental valuation remains a much debated and contested issue. Concerns have been voiced that it is unable to capture the manifold immaterial values of ecosystems due to conceptual and methodological issues. Thus, additional value categories (social values) as well as novel valuation approaches like deliberative (monetary) valuation are areas of growing interest, yet the theoretical foundations are rather weak. Against this background, this article aims to develop a consistent conceptual framework for making sense of social values (...) in economic environmental valuation. Based on a holistic view of society and individuals, the role of institutions, the social environment, culture and transcendental values is emphasised. To synthesise diverging concepts of value into an economic concept and to account for the multidimensionality of social values, the framework consists of three spheres: social, natural and contextual. The novel framework demonstrates that social values may be integrated into a preference-based utility framework when denoting a holistic understanding of social preferences and human embeddedness in nature and society. (shrink)

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can (...) arise in the practice of medicine are outlined. (shrink)