Egalitarianism, moral status and abortion: a reply to Miller
Calum Miller recently argued that a commitment to a very modest form of egalitarianism—equality between non-disabled human adults—implies fetal personhood. Miller claims that the most plausible basis for human equality is in being human—an attribute which fetuses have—therefore, abortion is likely to be morally wrong. In this paper, I offer a plausible defence for the view that equality between non-disabled human adults does not imply fetal personhood. I also offer a challenge for Miller’s view. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Räsänen, J. Tags: Response Source Type: research
Against abandoning the dead donor rule: reply to Smith
Smith argues that death caused by transplant surgery will not harm permanently unconscious patients, because they will not suffer a setback to their interests in the context of donation. Therefore, so the argument goes, the dead donor rule can be abandoned, because requiring a death declaration before procurement does not protect any relevant interest from being thwarted. Smith contends that a virtue of his argument is that it avoids the controversies over defining and determining death. I argue that it does not and explain why no change in policy is justified. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Omelianchuk, A. Tags: Response Source Type: research
Abandoning the Dead Donor Rule
The Dead Donor Rule is intended to protect the public and patients, but it remains contentious. Here, I argue that we can abandon the Dead Donor Rule. Using Joel Feinberg’s account of harm, I argue that, in most cases, particularly when patients consent to being organ donors, death does not harm permanently unconscious (PUC) patients. In these cases, then, causing the death of PUC patients is not morally wrong. This undermines the strongest argument for the Dead Donor Rule—that doctors ought not kill their patients. Thus, there is nothing wrong with abandoning the Dead Donor Rule with regard to PUC patients. Im...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Smith, A. P. Tags: Extended essay Source Type: research
Withering Minds: towards a unified embodied mind theory of personal identity for understanding dementia
A prominent view on personal identity over time, Jeff McMahan’s ‘Embodied Mind Account’ (2002) holds that we cease to exist only once our brains can no longer sustain the basic capacity to uphold consciousness. One of the many implications of this view on identity persistence is that we continue to exist throughout even the most severe cases of dementia, until our consciousness irreversibly shuts down. In this paper, I argue that, while the most convincing of prominent accounts of personal identity over time, McMahan’s account faces serious challenges in explanatory power of dementias and related ne...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Lyreskog, D. M. Tags: Open access, Editor's choice Extended essay Source Type: research
Non-clinical uses of antipsychotics in resource-constrained long-term care facilities: ethically justifiable as lesser of two evils?
Residents with dementia in long-term care facilities (LTCFs) often receive antipsychotic (AP) medications without clear clinical indications. One non-clinical factor influencing the use of APs in LTCFs is low staff levels. Often, using APs is viewed and rationalised by healthcare professionals in LTCFs as a lesser evil option to manage low staff levels. This paper investigates the ethical plausibility of using APs as a lesser of two evils in resource-constrained LTCFs. I examine the practice vis-à-vis the three frequently invoked conditions of lesser evil justifications as specified in the wider philosophical litera...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Soofi, H. Tags: Original research Source Type: research
Professional virtue of civility: responding to commentaries
In our ‘The Professional Virtue of Civility and the Responsibilities of Medical Educators and Academic Leaders’,1 we provided an historically based conceptual account of the professional virtue of civility and the role of leaders of academic health centres in creating and sustaining an organisational culture of professionalism that promotes civility among healthcare professionals and between medical educators and learners. Going beyond We emphasised that any adequate understanding of the virtues, including professional virtues, has cognitive, affective, behavioural and social components. Some of the commentator...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: McCullough, L. B., Coverdale, J., Chervenak, F. A. Tags: Commentary Source Type: research
There is no 'I in team, but there are two in civil
McCullough et al’s article about the professional virtue of civility makes a persuasive case that civility should be a core value in medical education, and that civility facilitates the development of organisational cultures committed to excellence in clinical and scientific reasoning.1 In particular, the negative implications of incivility on the well-being of individuals, on team-working dynamics and on patient safety, creates a strong argument that incivility from healthcare professionals is entirely unacceptable. However, in terms of professional attitudes, civility is the bare minimum that modern clinicians requ...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Donaldson, T. Tags: Commentary Source Type: research
Physicians as citizens and the indispensability of civic virtues for professional practice
Incivility poses a serious threat to any healthcare system striving for effectiveness without sacrificing the requirements of humanity. Threats to civility within healthcare not only come from individual ‘bad apples’ exhibiting borderline and inacceptable behaviour, as seen in many ‘high-tech, high-risk, high-responsibility’ environments such as operating or emergency rooms.1 They may also be facilitated by ‘bad trees’ or system-immanent, poor healthcare environments.2 This may be the case when healthcare administrations, facing the challenges of political austerity, set budgetary target...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Monteverde, S. Tags: Commentary Source Type: research
Democratising civility: Commentary on 'McCullough LB et al: Professional virtue of civility and the responsibilities of medical educators and academic leaders
McCullough and colleagues draw an historical line from the writings of Percival, who found himself resolving arguments (sometimes violent) between physicians, surgeons and apothecaries, to the concept of civility as a professional virtue and duty. The authors show that civility is a prerequisite to effective cooperation, which itself underpins patient safety and positive clinical outcomes—desirable endpoints of any discussion about healthcare. They exhort academic leaders to teach, role model and reward correct behaviours.1 Why then, as a clinician manager with a deep interest in fostering civility and psychological ...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Berry, P. A. Tags: Commentary Source Type: research
Boundaries of civility promotion in education and leadership
McCullough et al1 confront a challenge that no organisation has fully eradicated: incivility. They emphasise that civility is not merely a matter of common decency and good conduct but also a moral imperative, an aspirational value that should be promoted and modelled by all the members of the institutions and throughout all the stages of practitioners’ careers. In their fusion of ancient wisdom and philosophical classics with their own insights on contemporary workplaces, they forward a defensible case for why civility matters and is worthy of continuous contemplation. Given the clarity and persuasion of their piece...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Graso, M. Tags: Commentary Source Type: research
How can junior doctors spontaneously pursue the professional virtues of civility? The direct role of academic leaders
In his feature article,1 McCullough LB et al highlights the importance of civility among medical educators and academic leaders in shaping the professional habits of junior doctors. He emphasises the role of medical educators in correcting unprofessional behaviour and emphasises the need for academic leaders to motivate junior doctors to develop virtuous professional habits. The relationship between junior doctors and medical educators can be likened to that between students and teachers. Through active or passive learning from medical educators, junior doctors gain the necessary knowledge, experience and professional virt...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Li, X., Kong, Q., Liu, Y., Yang, J. Tags: Commentary Source Type: research
Incentivising civility in clinical environments
Agent-based or system-based interventions? Several months ago, an Israeli resident in emergency medicine engaged in a hunger strike to protest 26-hour shifts. His protest was part of a country-wide struggle of medical residents from all disciplines against such long shifts, arguing that they are a thing of the past, and that they harm patient care. While there is actually no evidence that long shifts harm patient outcomes, they very likely reduce civility among staff members and towards patients.1 Two kinds of strategies are possible to address this likely source of incivility: expect and train residents to be kinder and m...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Browne, T. K., Lederman, Z. Tags: Commentary Source Type: research
Civility and scientific excellence: two dimensions of medical professionalism
McCullough et al have taken up an important issue that is highly interesting from a theoretical as well as from a practical standpoint in drawing attention to (in)civility as a matter of professional ethics: As a ‘low intensity deviant behaviour’1 p3 incivility seems to widely escape the scope of professional norms as well as legal regulation and jurisdiction. At the same time, empirical evidence suggests that incivility occurs frequently in healthcare and might have an enormous negative impact on the quality of patient care. Against this background medical ethics should no longer hesitate conducting profound c...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Salloch, S. Tags: Commentary Source Type: research
Give incivility a chance
Civility is a nice idea. While we find common ground with the aspirations of a civility-based professional culture in healthcare and acknowledge the potential impacts of incivility on staff and patients, we should be careful in dismissing it entirely, as McCullough et al1 do. As we will argue below, appeals to civility, when understood alongside power, could serve to stifle and mask legitimate dissent, limiting genuine criticism and progress. Crucially, we contend that incivility itself may serve instrumental and communicative purposes that draw attention to injustice or inequity. Our aim is not to defend every act of inci...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: Essex, R., Mainey, L. Tags: Commentary Source Type: research
Professional virtue of civility and the responsibilities of medical educators and academic leaders
Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of ethical reasoning, namely ethical analysis inf...
Source: Journal of Medical Ethics - September 22, 2023 Category: Medical Ethics Authors: McCullough, L. B., Coverdale, J., Chervenak, F. A. Tags: Open access Feature article Source Type: research
