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Effective collaboration
Published in Alan Bleakley, Medical Education, Politics and Social Justice, 2020
The same conditions apply to doctors in terms of upholding the Hippocratic injunction to “first, do no harm” and to extend this to consistent ethical and professional behaviour. This ethical injunction does not invite doctors to step out of their own skins and inhabit some angelic ethical territory. Rather, it asks doctors to be inquiring about their own unique approaches to authentic interactions with patients in the face of recognized contradictions. This is to grasp the nettle of responsibility for the consequences of interventions. Good faith demands artistry in developing a personal style of responsible actions. Bad faith would be acting into the role of the doctor as an ideal while failing to tolerate what Donald Schön (1983) calls the “swampy lowlands” of clinical practice – full of uncertainty and values conflict where technical solutions are never the full story.
Consent to treatment
Published in Marc Stauch, Kay Wheat, Text, Cases and Materials on Medical Law and Ethics, 2018
However, while rare, there are cases where doctors have been found to have battered their patients. One example is the Canadian case of Allan v Mount Sinai Hospital,105 in which an anaesthetic injection was given in the patient’s left arm, after she had specifically requested that it not be given there. There are also a few English authorities. As noted above, an early example is Cull v Royal Surrey County Hospital,106 in which a patient had consented to an abortion but received a sterilisation in addition. A battery was also found in Devi v West Midlands RHA,107 where the patient, who consented to a repair to a perforation in her uterus, was sterilised by the surgeon, who believed it to be in her best interests. One area where the courts will clearly protect patients is against deliberate deceptions practised upon them by medical professionals acting in bad faith. Thus, in Appleton v Garrett,108 where a dentist represented falsely to his patients that they needed dental treatment and then carried out unnecessary treatment, the court had no hesitation in finding a battery.
Resource allocation: needs and wants
Published in Ann Orme-Smith, John Spicer, Ethics in General Practice, 2018
If a treatment is being withheld on grounds of cost it is clear that the law on informed consent requires the doctor to tell the patient that this is so. A patient refused treatment by his doctor on what he understands to be clinical grounds will naturally feel aggrieved if he later discovers that this was only part of the truth. Of course, if cost was the only reason for the refusal, and the patient was not privy to this, the doctor could then be said to have acted with ‘bad faith’.
Everything I Really Needed to Know to Be a Clinical Ethicist, I Learned From Elisabeth Kübler-Ross*
Published in The American Journal of Bioethics, 2019
It is a conversational norm that personal disclosure calls for reciprocal disclosure by one’s interlocutor. But this is complicated by the fact the physicians and their patients are in an inherently unequal relationship and reciprocal disclosures can de-center what should be a patient-centered relationship. Nevertheless, as patients pour forth their religious or spiritual beliefs and providers remain unresponsive and say little or nothing that directly addresses the content of what has been told to them, patients can easily see the physician as behaving in a manner that seems to exude superiority. But, how shall we deal with such matters in a way that connects with patients but keeps them at the center of the circle of the relationship? (Cohen et al. 2001; Lo et al. 2002). I have argued elsewhere that respecting patients can sometimes require disclosure on the part of ethicists and clinicians (Kuczewski 2007). The patient or family member’s inferences about the beliefs or lack of religious beliefs of these clinicians can lead to intractable conflicts. And the transparency required by informed consent can oblige us to disclose the model of a good death or the values that are behind our inquiry. This kind of transparency is clearly preferable to hiding behind the bad faith medicalization of all treatment choices that we saw in the futility movement. Nevertheless, as reactions to my argument made clear, striking this balance by increasing the personalization of our dialog is quite controversial (Cohen 2007; Goldberg and Brody 2007) and as with each of these tensions, perhaps inevitably so.
Dimensions of Ethical Direct-to-Consumer Neurotechnologies
Published in AJOB Neuroscience, 2019
In contradistinction, embodied VR may have the opposite effect on an individual’s existential project. Rather than bombarding an individual with her facticity, it completely hides the user’s facticity from her. But fashioning oneself as an authentic being-for-itself requires one to recognize one’s facticity and give meaning to it in order to transcend it. It is only in interpreting and choosing how to incorporate one’s facticity that one lives truly authentically (Sartre 1984 [1943]). “Authenticity consists in having a true and lucid consciousness of the situation, in assuming the responsibilities and risks it involves” (Sartre 1948, 65). Denying one’s facticity also constitutes bad faith, because one fails to take responsibility for the impact one’s being and behavior have on the world. In an experience space that is unbounded by the constraints of reality, one is robbed of the opportunity of learning how to transform one’s facticity to fashion oneself. This affects the development of moral sensibilities as well. In VR the world responds to one’s actions in ways that are unconstrained by reality. How then is one to learn the true moral valuation of the actions one performs?11
Sartre and No Child Left Behind: an existential psychoanalytic anthropology of urban schooling
Published in Journal of Progressive Human Services, 2019
Our clients often come to us at the intersection of various trajectories and amidst the culmination of bad faith choices that have been determined by the very nature of their being. Parker is arguing that the systems in which urban school children (and, for our purposes, our clients) come to be ultimately serve the purpose of complete dehumanization; dehumanization to the point of making their lives utterly disposable. Understanding the vulnerable social location facing our clients as well as the systems in which our clients exist and seek to develop their identity is profound and, arguably, crucial to providing effective and empathic services. Going a step further, in borrowing Parker’s lens, we are required to examine the ways in which social work practice contributes to, or reifies, systems of oppression that continue the “deracination” (p. 109) of our clients.