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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.
articles
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.