Philosophy Publications

Health Care Ethics in Canada

Françoise Baylis et al. — Thu, 23 Feb 2012 21:10:01 PST

The Broadview Anthology of Social and Political Thought: Essential Readings

Andrew Bailey et al. — Thu, 23 Feb 2012 20:36:59 PST

"This volume features a careful selection of major works in political and social philosophy from ancient times through to the present. Every reading has been painstakingly annotated, and each figure is given a substantial introduction highlighting his or her major contribution to the tradition. The anthology offers both depth and breadth in its selection of material by central figures, while also representing other currents of political thought. Thirty-two authors are represented, including fourteen from the 20th century. The editors have made every effort to include translations that are both readable and reliable." (From online book description)

That’s the Policy; That’s the Law: Alternatives to Suspension from School for Students With a Developmental Handicap

Barry Hoffmaster et al. — Fri, 10 Feb 2012 15:48:40 PST

Responsible But Not Guilty? The Accountability of Persons with Developmental Disabilities or Psychiatric Impairments

Barry Hoffmaster et al. — Fri, 10 Feb 2012 15:48:37 PST

Caring for Retarded Persons

Barry Hoffmaster — Fri, 10 Feb 2012 15:34:20 PST

Ethical Considerations in Caring for Retarded Patients

Ronald J. Christie et al. — Fri, 10 Feb 2012 15:28:13 PST

The treatment of the mentally retarded patient may raise dramatic ethical issues for the family physician. A case is used to illustrate an example of ethical decision-making and the moral issues explored.

Deadlines and Diversity: Journalism Ethics in a Changing World

Valerie Alia et al. — Fri, 10 Feb 2012 15:23:08 PST

A Survey Method for Investigating Ethical Decision Making in Family Practice

Barry Hoffmaster et al. — Thu, 09 Feb 2012 20:39:14 PST

BACKGROUND: The tension between respect for patient autonomy versus concern for patient welfare is a challenging ethical issue for physicians. The purpose of this research was to describe a method for analyzing ethical decisions and to report the results of a survey of ethical decision making among family physicians.

METHODS: We developed a survey instrument that used simulated case scenarios, each of which posed an ethical dilemma. The ethical problems on the survey included the extent to which diagnostic information should be revealed to patients, the extent to which physicians should become involved in patients' life-style issues, and how to deal with patients' family problems. We mailed the questionnaire to 1,300 US family physicians.

RESULTS: Six hundred seventy-four physicians responded. Respondents did not deal with the simulated ethical problems in a uniform manner and often tended to respond more to specific details of a case rather than the overall ethical dilemma posed. Physicians who chose a course of action giving patients more control were motivated by factors that showed respect for patient autonomy. On the other hand, physicians who chose a course of action giving patients less control were not motivated by factors suggesting a concern for patient welfare.

CONCLUSIONS: Based on responses to simulated case scenarios, family physicians did not demonstrate a uniform approach but rather a more contextual one. Respect for patient autonomy was linked to family physicians' reported courses of action.

Ethical Decision Making by Family Doctors in Canada, Britain and the United States

Barry Hoffmaster et al. — Thu, 09 Feb 2012 20:29:27 PST

Family doctors in Canada and the U.S. and general practitioners in England and Wales were sent a questionnaire containing six cases that raised moral issues. The doctors were asked to select the most appropriate course of action for each case as well as reasons for that decision. The ethical problems concerned how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients, and how to deal with a possible family problem. The respondents selected different courses of action for the cases. More U.S. than Canadian or British physicians chose to divulge information, while more British than Canadian or U.S. physicians chose not to become involved in patients' lifestyles. Physicians who chose to divulge information were likely to be young, male, live in a small community, and have no academic affiliation. Physicians who chose not to become involved in lifestyle issues were likely to be young, church attenders, and in group practice in a small community.

Ethical Decision Making by British General Practitioners

Ronald J. Christie et al. — Thu, 09 Feb 2012 20:19:57 PST

General practitioners in England and Wales were sent a questionnaire asking how they would handle the ethical problems posed by six case vignettes and their reasons for their decisions. The ethical problems included: how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients and how to deal with a possible family problem. The varying patterns of response to the six cases suggested that ethical issues are resolved in a case-by-case, not a theoretical, basis.

Ethical Decision Making by Canadian Family Physicians

Ronald J. Christie et al. — Thu, 09 Feb 2012 20:11:21 PST

Canadian family physicians were sent questionnaires that asked how they would handle the ethical problems posed by six sample cases and what reasons were relevant to their decisions. The ethical problems concerned how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients and how to deal with a possible family problem. The study identified characteristics of family physicians that affect their ethical decision making and tested a theoretical model that regards ethical problems as conflicts between respecting patient autonomy and promoting patient welfare. The varied responses suggested that ethical issues are resolved on a case-by-case, rather than a theoretical, basis. Certification in family medicine was the only characteristic associated with a consistent pattern of responses; certificants were more likely than other physicians to involve patients in decisions.

Ethical Issues in Family Medicine

Ronald J. Christie et al. — Wed, 08 Feb 2012 20:58:48 PST

How Family Physicians Approach Ethical Problems

Ronald J. Christie et al. — Wed, 08 Feb 2012 20:58:45 PST

The defining features of family medicine as described in the literature have important ethical implications. In an attempt to study the day-to-day practice of family physicians regarding these ethical issues, a 28-item questionnaire was sent to 95 part-time and 17 full-time family physician teachers associated with the University of Western Ontario's Department of Family Medicine. Of the 112 questionnaires mailed out, 97 were returned for a response rate of 86.6 percent. There was a significant spread of answers, suggesting there is no uniform opinion in the sample population. The findings suggest that there are important differences between the description of family medicine in the literature and what the family physicians in this study do in their day-to-day practice. The family physicians in this study, while prepared to coerce patients, were not prepared to discharge from their practices patients who were noncompliant. Physician age is an important variable in some ethical decisions, but not in others.

The Patient in the Family and the Family in the Patient

Barry Hoffmaster et al. — Wed, 08 Feb 2012 20:36:40 PST

The notion that the family is the unit of care for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.

Family Medicine as a Social Science

Barry Hoffmaster — Wed, 08 Feb 2012 20:29:19 PST

The branch of clinical medicine most likely to qualify as a social science is family medicine. Whether family medicine is a social science is addressed in four steps. First, the nature of family medicine is outlined. Second, the extent to which social science knowledge is used in family practice is discussed. Third, the extent to which family medicine can qualify as a social science is considered with respect to an orthodox model of the social sciences, that is, one that emphasizes affinities between the natural and social sciences. Finally, the same question is addressed with respect to an unorthodox model of the social sciences, that is, one that stresses the evaluative nature of the social sciences.

Can Ethnography Save the Life of Medical Ethics?

Barry Hoffmaster — Mon, 06 Feb 2012 20:52:31 PST

Since its inception contemporary medical ethics has been regarded by many of its practitioners as ‘applied ethics’, that is, the application of philosophical theories to the moral problems that arise in health care. This ‘applied ethics’ model of medical ethics is, however, beset with internal and external difficulties. The internal difficulties point out that the model is intrinsically flawed. The external difficulties arise because the model does not fit work in the field. Indeed, the strengths of that work are its highly nuanced, particularized analyses of cases and issues and its appreciation of the circumstances and contexts that generate and structure these cases and issues. A shift away from a theory-driven ‘applied ethics’ to a more situational, contextual approach to medical ethics opens the way for ethnographic studies of moral problems in health care as well as a conception of moral theory that is more responsive to the empirical dimensions of those problems.

The Forms and Limits of Medical Ethics

Barry Hoffmaster — Mon, 06 Feb 2012 20:45:03 PST

As medical ethics has evolved over the past several decades, it has come to be regarded as a domain of applied ethics, that is, the application of a rationally based, philosophical theory to moral problems in health care. But an array of difficulties arise in the attempt to apply general moral theories or norms to concrete problems, difficulties that expose the incompleteness and indeterminacy of philosophical moral theory. The doubtful ability of applied ethics to be practically helpful has led to the development of two main competitors. One is the attempt to reprise and rehabilitate the tradition of moral casuistry, which focuses on the analysis of specific cases rather than on the defense and application of theories and norms. The second is the search for moral insight and guidance in narratives or stories. These alternatives suffer from some of the same difficulties that plague applied ethics, however. Another trend in medical ethics rejects the theoretical preoccupation of applied ethics in favour of contextualism—an insistence on situating moral problems in institutional and organizational structures and in social and cultural backgrounds. Social science investigations of medical ethics pay attention to the former, while feminist critiques of medical ethics are concerned with exposing and eradicating cultural biases against women. Contemporary work in medical ethics is diverse, but these manifold approaches hold out the promise of improving our understanding of morality as a truly practical enterprise.

Morality and the Social Sciences

Barry Hoffmaster — Mon, 06 Feb 2012 20:36:00 PST

Bioethics in Social Context

Barry Hoffmaster — Mon, 06 Feb 2012 20:26:22 PST

"The problems of bioethics are embedded in people's lives and social worlds. They are shaped by individual biographies and relationships, by the ethos and institutions of health care, by economic and political pressures, by media depictions, and by the assumptions, beliefs, and values that permeate cultures and times. Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.

The original essays in this volume use qualitative research methods to expose the multiple contexts within which the problems of bioethics arise, are defined and debated, and ultimately resolved. In a provocative concluding essay, one contributor asks his fellow ethnographers to reflect on the ethical problems of ethnography." (from online book description)

The Rationality and Morality of Dying Children

Barry Hoffmaster — Sun, 05 Feb 2012 20:26:45 PST

Formal reason is not adequate to explain how we think through real-life problems and make moral decisions about them. A far richer account of rationality is necessary. Interviews conducted with children who have leukemia, and who must figure out by themselves that they are dying and how they should handle that information, illustrate a range on informal tools that must be part of that account.