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symposium on medical errors
1. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Andy Wible Reporting Potential Errors: How Honest Should a Medical Professional Be?
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Medical errors are the third leading cause of death in the United States, and there is growing consensus that medical errors should be discussed after they occur. This essay argues that potential errors should be discussed with patients as well in the informed consent process prior to treatment. While physicians don’t have the obligation to tell patients to go to physicians and hospitals that would present less potential for error, patients should be told of increased risks compared to other options, and be guided through the data on physician and hospital rankings. Suggestions are given to improve this informed consent process.
2. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Ben Almassi Medical Error and Moral Repair
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One limitation of medical ethics modeled on ideal moral theory is its relative silence on the aftermath of medical error: not just on the recognition and avoidance of malpractice, wrongdoing, or other such failures of medical ethics, but on how to respond given medical wrongdoing. Ideally, we would never do each other wrong; but given that inevitably we do, as fallible, imperfect agents we require non-ideal ethical guidance. For such non-ideal contexts, Nancy Berlinger’s analysis of medical error and Margaret Walker’s account of moral repair present powerful hermeneutical and practical tools toward understanding and enacting what is needed to restore relationships, trust, and moral standing in the aftermath of medical error and wrongdoing. Where restitutive justice aims to make injured parties whole and retributive justice to mete out punishment, reparative justice, as Walker describes it, “involves the restoration or reconstruction of confidence, trust, and hope in the reality of shared moral standards and of our reliability in meeting and enforcing them.” Medical moral repair is not without its challenges, however, in both theory and practice; the standard ways of holding medical professionals and institutions responsible for medical mistakes or malpractice function retributively and restitutively, either impeding or giving benign inattention to patient-practitioner relationship repair. This paper argues for the value of medical moral repair, while considering some complications of extending and synthesizing Berlinger’s and Walker’s respective accounts on medical error and moral repair.
3. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Raymond J. Higbea, Alyssa Luboff Care for the Root Cause of Medical Errors
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In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the provider-patient relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it.
4. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Mark Huston Medical Conspiracy Theories and Medical Errors
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In this essay, at the epistemological level I focus on groups, and not merely individuals, when examining medical errors on behalf of both the medical industry and patients who engage in medical conspiracy theories. Specifically, I use the work in virtue and vice epistemology by Quassim Cassam and Miranda Fricker to diagnose some of the problems that arise with medical conspiracism. Cassam identifies the vice conspiracist mentality to help explain the preponderance of conspiracy theorizing. Fricker provides a framework for thinking about group errors by identifying the vices of testimonial and hermeneutic injustice. I argue that medical conspiracists present a warped version of Fricker’s vices by acting as if they are the victims of these injustices instead of the purveyors of them. In addition, I argue that errors on behalf of various medical groups, such as hospitals and health organizations, reinforce many conspiracy theories.
5. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Christopher A. Riddle Assisted Dying, Disability Rights, and Medical Error
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In this brief paper, a case is made for the moral permissibility of assisted dying. The paper proceeds by highlighting a common critique from within disability rights scholarship and advocacy that emphasizes the vulnerability of people with disabilities and the risks associated with permitting assisted dying. The paper suggests that because medicine necessarily involves risk, primarily through the high likelihood of medical error, that the risk and harm being utilized as a justification to prohibit assisted dying by disability rights scholars is in fact, not conceptually or morally unique. Finally, it is argued that because all medicine involves a risk of harm, and assisted dying is not unique in this respect, that one cannot effectively launch a critique of assisted dying on this basis.
6. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Jessica Adkins Thinking Epistemically about Gender and Physician Assisted Death
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Feminists continue to express concerns over the legalization of physician-assisted death (PAD). Some worry that women are more likely than men to request PAD due to societal stereotypes and the pressures put on women to be self-sacrificing. Others worry that women will have their requests ignored more often than men because women’s voices are traditionally silenced or disregarded in western culture. Rather than join in the above argument of speculating which way women may be marginalized, I accept PAD as potentially dangerous and offer a solution in order to avoid the risks of injustice associated with PAD. I reframe the concerns as epistemological worries, and ultimately, I turn to Benjamin McMyler’s virtue epistemology as a way to avoid testimonial injustice in requests for life hastening medication, suggesting that the injustice comes from a narrow and individualistic perception of knowledge, and injustice can be avoided if we understand testimonial knowledge to be both cognitive and social.
7. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Michael Davis The Legality of the Nuremberg Trials: A Brief Lockean Memoir
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Just over seventy years ago, three trials took place in Nuremberg, Germany. At the time, they seemed a turning point in international relations—and, indeed, proved to be. The trials involved the prosecution of prominent members of the political, military, economic, and judicial leadership of Nazi Germany, those who planned, oversaw, or otherwise participated in the Holocaust and other large crimes. At the time, the Trials were widely condemned for using retroactive criminal statutes. The most famous discussion is what became known as the Hart-Fuller Debate. This paper argues that Locke provides the best account of the lawfulness of the Trials—at least when compared to the accounts offered by Fuller, Hart, and Ronald Dworkin.
8. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Tracey L. Cohen Expendable Commodities: The Exploitation of Human Research Subjects in the Developing World
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Human subjects in the developing world historically have been, and continue to be, treated like expendable commodities in clinical research. This paper will explore some of the factors that make those in the third world prime targets for exploitation. It will also challenge a deeply-entrenched view that has permitted this unethical conduct to persist—namely, the belief that the standard of medical care should vary depending upon where a research subject lives. The paper will also discuss the Food and Drug Administration’s 2008 decision to disavow the Declaration of Helsinki, to the further detriment of research subjects in developing countries. Finally, the paper will suggest a possible solution to help address this ethical crisis.
9. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Patrick Fleming On Street Harassment (or Why It Can be Wrong to be Friendly to Strangers)
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This paper argues that it can be morally wrong to be friendly to strangers. More specifically, the paper argues there is a salient pro tanto moral reason against being friendly to strangers in virtue of the structure of interaction. By ‘a salient pro tanto reason’ I mean a reason that is not always decisive, but it is often significant enough that it ought to factor in moral deliberation. My argument is perfectly general, but it is presented to shed light on one specific practical problem. By considering this issue I think we will be able to see what is distinctly wrong with street harassment. I hope to explain why this sort of behavior is morally problematic. Basically, even in its most benign cases, street harassment attempts to place a moral burden on a stranger to respond in kind. The stranger may not wish to bear this burden and that is why there are reasons against creating this burden. It is wrong because it involves treating others as if they owe you attention and acknowledgment, which is to treat strangers as friends.
10. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
Stephen Kershnar In Defense of Asian Romantic Preference
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Asian romantic preference is not wrong because it does not infringe on someone’s moral right. Nor is it unjust in some other way. It is not intrinsically bad because it is neither false nor does it consist of the love of evil or hatred of the good. It is not clear if it is instrumentally bad because it is not clear whether it is good for Asian women and, if it is, whether the good for them is outweighed by the bad for others. People have many preferences when it comes to marriage, dating, and sex. Consider heterosexual men’s preferences for women who are thin, feminine, normal height, symmetrical, and so on. The preference to marry, date, or have sex with Asian women is morally similar to these preferences.
11. International Journal of Applied Philosophy: Volume > 32 > Issue: 2
About the Contributors
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12. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Johann Go Mill and the Limits of Freedom of Expression: Truth, Lies, and Harm
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The rise of fake news, climate change denial, and the anti-vaccination movement all pose important challenges to contemporary views about freedom of expression. This paper attempts to delineate the limits of freedom of expression, specifically with regard to truth, lies, and harm. My strategy is to offer a critical reading of John Stuart Mill’s On Liberty to demonstrate its enduring relevance to contemporary issues in the freedom of expression. My critical reading of Mill provides guidance on when state interference is justified, the role of education, the nature of harm in the age of mass media and globalisation, and the relevance of truth and lies in the freedom of expression. Ultimately, I demonstrate that the Millian account I present can deal adequately with contemporary issues in the freedom of expression in line with the current social context, relevant empirical facts, and our considered judgements.
13. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
James Stacey Taylor The Case Against the Case for Colonialism
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In a recent paper entitled “The Case for Colonialism” Bruce Gilley argued that Western colonialism was “as a general rule” both beneficial to those subject to it and considered by them to be legitimate. He then advocated for a return to the Western colonization of the Third World. Gilley’s article provoked a furious response, with calls for its retraction being followed by the resignation of much of the publishing journal’s editorial board. In this paper I note that Gilley’s article meets none of the criteria required to justify its retraction, and that instead of retracting it it should be rebutted. I then argue that his arguments against those who oppose colonialism are all fatally flawed, and that he has provided no justification for his claims that colonialism was either beneficial to those who lived under it, or considered by them to be legitimate.
14. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Joseph Farrell DACA-ptives: On the Moral Quality of the Deferred Action for Childhood Arrivals Program
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The play on words in the title is used to illustrate a problem facing the United States government, United States citizens, and illegal immigrants. Recent estimates describe the number of illegal immigrants living in the United States at between eleven and twelve million individuals. To address issues with some of our illegal immigrants, on June 15, 2012, President Obama initiated the Deferred Action for Childhood Arrivals program. This is an Executive Order easing the burdens of immigration law on some illegal immigrants living in the United Stated. In what follows, I will explain how in spite of there being a right on the part of the United States and nations in general to exclude immigrants and to deport illegal immigrants, the DACA program is actually morally good if not a right on the part of the people in question insofar as they are captives of the will of their parents/guardians who brought them here originally and captives of a system of laws from which they cannot escape without help. In a sense, the DACA program liberates captives and rescues said captives from a legal and moral prison created by all those around them. Rescinding it involves moral turpitude.
15. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
S. K. Wertz Little White Lies: A Pragmatic Defense
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Samuel Johnson has an interesting comment on consequences and the telling of “white lies.” For example “Sick People and Children are often to be deceived for their Good.” David Hume apparently endorses this concept in one of his letters. Both Johnson and Rousseau anticipate Kant’s argument about consequences in that one is to tell the truth under all circumstances. Hume, I argue, would take issue with this claim in that there are cases (like the two above) that warrant telling white lies. Elsewhere (second Enquiry) he speaks about “harmless liars” who indulge in “lying or fiction . . . in humorous stories.” And he says “Noble pride and spirit may openly display itself when one lies under calamity [defamation or slander] or opposition of any kind,” especially if the opposition puts one’s life in grave danger, so one’s self-preservation is threatened. Under situations like these, lying is justified. In regard to fiction, if lying is for the purpose of entertainment and where “truth is not of any importance,” it is permissible. These cases are discussed in some detail, and they offer, along with their analysis, a pragmatic defense of Hume’s position.
16. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Robert Boyd Skipper Education and Bureaucracy
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I argue that bureaucracies, as described by Max Weber, have essential characteristics that clash with basic educational values. On the one hand, bureaucracies, because of their divisions of labor, inevitably narrow all those who participate. Bureaucracies also, because of the need for impartiality, inevitably dehumanize all who participate. On the other hand, education aims to broaden and humanize those who participate in it. This tension between bureaucracy and education makes bureaucracy an unsuitable mechanism for delivering an education. Bureaucracies are often the best ways to accomplish large tasks involving many people; however, the task of educating all humanity is not one of those tasks. Problems in education can only be exacerbated by “fixing” the bureaucracy, because efficiency, the greatest bureaucratic virtue, is harmful to education. While I offer no solution, I share some thoughts about how a humanizing, broadening, and suitably inefficient education might look.
17. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Joshua M. Hall Bodily-Social Copresence Androgyny: Rehabilitating a Progressive Strategy
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Historically, the concept of androgyny has been as problematic as it has been appealing to (especially white) Western progressives. The appeal clearly includes, inter alia, the opportunity to abandon or ameliorate certain identities (including essentialized femininity and toxic masculinity). As for the problematic dimension, the central problem seems to be the reduction of otherness (often unconscious and unwitting) to the norms of straight white middle/upper-class Western cismen, particularly because of the consequent worsening of actual others’ marginalization and exclusion from social institutions. Despite these problems, I wish to suggest that androgyny—as evidenced by the enthusiasm felt for it by many Westerners—bespeaks something larger and more important than the concept itself, and that modified conception of it might be helpful in pursuit of social justice.
18. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Sigmund Loland Sport, Performance-enhancing Drugs, and the Art of Self-imposed Constraints
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Should the use of performance-enhancing drugs (PED) be banned in sport? A proper response to this question depends upon ideas of the meaning and value of sport. To a certain extent, sport is associated with ideal values such as equality of opportunity, fair play, performance and progress. PED use is considered contrary to these values. On the other hand, critics see sport as an expression of non-sustainable and competitive individualism that threatens human welfare and development. PED use is considered a logical consequence of these values. I challenge both views as simplistic and inadequate. I develop what I refer to as the normative structure of sport consisting of self-imposed constraints at three levels: in the formal rules, in norms for fair play, and in the interpretation of athletic excellence as a morally relevant instantiation of human excellence. I argue that the question of a ban on PED should be discussed at the third level and depends upon interpretations of athletic excellence as a form of human excellence. I conclude that, in the current situation of elite sport, proponents of a ban on PED seem to have the strongest arguments.
19. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Jane Duran Avian Preservation: The Case of the Condor
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The case of the reintroduction efforts made on behalf of the California condor is examined, with a view toward discussing both the environmental difficulties and the overall cost. The work of Singer, Snyder, and others is cited, and it is concluded that the work was worthy, but that a full articulation of the problems has seldom been made.
20. International Journal of Applied Philosophy: Volume > 32 > Issue: 1
Ben Almassi What’s Wrong With Ponzi Schemes? Trust and Its Exploitation in Financial Investment
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The role of trust in financial investment has been a matter of some contention, one often obscured by two misconceptions: (1) that financial relationships are fit only for wary predictive reliance where trust has no rational basis, and (2) that in those relationships where trust is operative it must be worth preserving. Following Baier’s contention that trust, like air, is more easily seen when polluted, here I consider Ponzi schemes as exemplars of corrupt and polluted trust. Without attending to the role of trust in financial relationships, I argue, we can not make sense of how Ponzi schemes work, why investors are fooled, what it is that makes Ponzi schemes distinctively wrong, and what differentiates them from structurally similar yet legitimate financial practices.