1
|
Crutchfield P, Scheall S. Abolishing morality in biomedical ethics. Bioethics 2024; 38:316-325. [PMID: 38367255 DOI: 10.1111/bioe.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
In biomedical ethics, there is widespread acceptance of moral realism, the view that moral claims express a proposition and that at least some of these propositions are true. Biomedical ethics is also in the business of attributing moral obligations, such as "S should do X." The problem, as we argue, is that against the background of moral realism, most of these attributions are erroneous or inaccurate. The typical obligation attribution issued by a biomedical ethicist fails to truly capture the person's actual obligations. We offer a novel argument for rife error in obligation attribution. The argument starts with the idea of an epistemic burden. Epistemic burdens are all of those epistemic obstacles one must surmount in order to achieve some aim. Epistemic burdens shape decision-making such that given two otherwise equal options, a person will choose the option that has the lesser of epistemic burdens. Epistemic burdens determine one's potential obligations and, conversely, their non-obligations. The problem for biomedical ethics is that ethicists have little to no access to others' epistemic burdens. Given this lack of access and the fact that epistemic burdens determine potential obligations, biomedical ethicists often can only attribute accurate obligations out of luck. This suggests that the practice of attributing obligations in biomedical ethics is rife with error. To resolve this widespread error, we argue that this practice should be abolished from the discourse of biomedical ethics.
Collapse
Affiliation(s)
- Parker Crutchfield
- Department of Medical Ethics, Humanities, and Law, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Scott Scheall
- College of Integrative Sciences and Arts, School of Applied Science and Arts, Arizona State University, Tempe, Arizona, USA
| |
Collapse
|
2
|
Carroll E, Crutchfield P. Welfare, Abortion, and Organ Donation: A Reply to the Restrictivist. Camb Q Healthc Ethics 2024; 33:290-295. [PMID: 37057676 DOI: 10.1017/s0963180123000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
We argued in a recent issue of this journal that if abortion is restricted,1 then there are parallel obligations for parents to donate body parts to their children. The strength of this obligation to donate is proportional to the strength of the abortion restrictions. If abortion is never permissible, then a parent must always donate any organ if they are a match. If abortion is sometimes permissible and sometimes not, then organ donation is sometimes obligatory and sometimes not. Our argument was based on the following ideas: (a) that a fetus has full moral status, (b) that parents have special obligations to their offspring, fetus or not, and (c) that this special obligation is to protect them. The result is the conclusion that abortion restrictivists cannot also consistently deny that organ donation should be compulsory.
Collapse
Affiliation(s)
- Emily Carroll
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Parker Crutchfield
- Department of Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
3
|
Crutchfield P, Redinger M. Basic Liberties, Consent, and Chemical Restraints. AJOB Neurosci 2024; 15:W1-W3. [PMID: 38568709 DOI: 10.1080/21507740.2024.2326900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
| | - Michael Redinger
- Western Michigan University Homer Stryker M.D. School of Medicine
| |
Collapse
|
4
|
Abstract
The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints.
Collapse
Affiliation(s)
| | - Michael Redinger
- Western Michigan University Homer Stryker M.D. School of Medicine
| |
Collapse
|
5
|
Brummett A, Crutchfield P. The pain lottery. Ann Palliat Med 2023; 12:919-924. [PMID: 37164967 DOI: 10.21037/apm-22-1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/14/2023] [Indexed: 05/12/2023]
Abstract
Moral challenges with addiction and overdosing have resulted from the abundance of opioids, but the coronavirus disease of 2019 has prompted reflection on ethical issues that could arise from a shortage. Driven by a duty to plan, some jurisdictions have formed committees to see if standard allocation considerations extend to cover a shortage of opioid pain medication. The problem, we argue, is that the standard allocation protocols do not apply to a shortage of opioids because prognosis only has limited relevance and the moral disvalue of pain is not dependent upon a patient's status as a frontline worker, age, or residence in a disadvantaged community. While the use of lotteries in allocation schemes has been deemphasized in standard allocation schema, we argue for and outline the details of a tiered lottery that first prioritizes opioids needed for emergent procedures and then moves on to allocate opioids based on the severity of a patient's pain. Additionally, we argue that some deception, in the form of withholding information from patients about the implementation and details of a pain lottery, is ethically permissible to address the unique moral tension between transparency and beneficence that arises for the treatment of pain in conditions of opioid scarcity.
Collapse
Affiliation(s)
- Abram Brummett
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Parker Crutchfield
- Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
6
|
Crutchfield P, Gibb TS, Redinger MJ. Default Positions in Clinical Ethics. J Clin Ethics 2023; 34:258-269. [PMID: 37831647 DOI: 10.1086/726809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
AbstractDefault positions, predetermined starting points that aid in complex decision-making, are common in clinical medicine. In this article, we identify and critically examine common default positions in clinical ethics practice. Whether default positions ought to be held is an important normative question, but here we are primarily interested in the descriptive, rather than normative, properties of default positions. We argue that default positions in clinical ethics function to protect and promote important values in medicine-respect for persons, utility, and justice. Further, default positions in clinical ethics may also guard against harm. Where default positions exist, there are epistemic burdens to overturn them. The person wishing to reject the default position, rather than the person endorsing it, bears this burden. The person who bears the burden of meeting the epistemic requirements must provide evidence proportional to the degree of harm the default position protects against. Default positions that protect against significant harm impose significant epistemic requirements to overturn. This asymmetry not only makes medical decision-making more economical but also serves to promote and protect certain values. The identification and analysis of common and recognizable default positions can help to identify other default positions and the conditions under which their associated epistemic requirements are met. The article concludes with considerations of potential problems with the use of default positions in clinical ethics.
Collapse
|
7
|
Kaplan H, Guidry-Grimes L, Crutchfield P, Hulkower A, Horner C, Burke JE, Fedson S. An Open Discussion of the Impact of OpenNotes on Clinical Ethics: A Justification for Harm-Based Exclusions from Clinical Ethics Documentation. The Journal of Clinical Ethics 2022. [DOI: 10.1086/jce2022334303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
8
|
Brummett A, Crutchfield P. Two internal critiques for theists who oppose moral enhancement on a process virtue basis. Bioethics 2022; 36:367-373. [PMID: 34897749 DOI: 10.1111/bioe.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Some bioconservatives reject the use of biotechnology for moral enhancement while simultaneously purporting to accept standard theism and process virtue. Standard theism holds that God is a personal, omniscient, omnibenevolent, omnipotent, transcendent being. Process virtue holds that virtue can only be obtained through a specific process and not by means of biotechnological shortcuts. For example, proponents of the view may claim that the virtue of compassion cannot be achieved by taking a pill but must come about from organic life experience that involves suffering, and reflection. We describe two internal critiques that arise by combining standard theism and process virtue. The first critique arises when the process virtue view is applied to the concept of God himself. Because God is thought to have always been perfectly virtuous, it follows he did not obtain his virtue through a process. Theistic bioconservatives must either give up the notion that God has always been perfectly virtuous or give up their claim that virtue must be obtained through a particular kind of process. The second critique argues that rejecting moral enhancement on the basis of process virtue is selfish, which is a vice by the lights of all mainstream manifestations of standard theism. Process virtue is selfish because it requires prioritizing the development of one's own personal virtue over moral enhancement that will improve one's other-regarding virtues. We conclude that the combination of standard theism and process virtue does not serve as a strong basis from which to oppose moral enhancement.
Collapse
Affiliation(s)
- Abram Brummett
- Department of Foundational Medical Studies, Oakland University, William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Parker Crutchfield
- Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| |
Collapse
|
9
|
Fogler JM, Ratliff-Schaub K, McGuinn L, Crutchfield P, Schwartz J, Soares N. OpenNotes: Anticipatory Guidance and Ethical Considerations for Pediatric Psychologists in Interprofessional Settings. J Pediatr Psychol 2021; 47:189-194. [PMID: 34383944 DOI: 10.1093/jpepsy/jsab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The 21st Century Cures Act included an "OpenNotes" mandate to foster transparent communication among patients, families, and clinicians by offering rapid electronic access to clinical notes. This article seeks to address concerns about increased documentation burden, vulnerability to patient complaints, and other unforeseen consequences of patients having near-real-time access to their records. METHODS This topical review explores both extant literature, and case examples from the authors' direct experience, about potential responses/reactions to OpenNotes. RESULTS The ethics of disclosing medical information calls for nuanced approaches: Although too little access can undermine a patient's autonomy and the capacity for truly egalitarian shared decision-making, unfettered access to all medical information has significant potential to harm them. Suggested strategies for mitigating risks in premature disclosure include patient and provider education and "modularizing" sensitive information in notes. CONCLUSION The OpenNotes era has ushered in the possibilities of greater patient and family collaboration in shared decision-making and reduced barriers to documentation sharing. However, it has raised new ethical and clinician documentation considerations. In addition to clinician education, patients and families could benefit from education around the purpose of clinical documentation, how to utilize OpenNotes, and the benefits of engaging in dialogue regarding the content and tone of documentation.
Collapse
Affiliation(s)
- Jason M Fogler
- Boston Children's Hospital and Harvard Medical School, USA
| | - Karen Ratliff-Schaub
- Prisma Health and University of South Carolina School of Medicine Greenville, USA
| | | | | | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
| |
Collapse
|
10
|
Gibb TS, Crutchfield P, Redinger MJ, Minser J. Ethical and Professional Considerations in Integrated Behavioral Health. Pediatr Clin North Am 2021; 68:607-619. [PMID: 34044988 DOI: 10.1016/j.pcl.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Integrated behavioral health models of care offer many benefits for patient experience and outcomes. However, multidisciplinary teams are comprised of professionals who each may have different professional norms and ethical obligations, which may at times be in conflict. This article offers a framework for negotiating potential conflicts between professional norms and expectations across disciplines involved in integrated behavioral health teams.
Collapse
Affiliation(s)
- Tyler S Gibb
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA.
| | - Parker Crutchfield
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA
| | - Michael J Redinger
- Department of Psychiatry, Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA. https://twitter.com/MikeRedingerMD
| | - John Minser
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA
| |
Collapse
|
11
|
Kanungo S, Barr J, Crutchfield P, Fealko C, Soares N. Ethical Considerations on Pediatric Genetic Testing Results in Electronic Health Records. Appl Clin Inform 2020; 11:755-763. [PMID: 33176390 DOI: 10.1055/s-0040-1718753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Advances in technology and access to expanded genetic testing have resulted in more children and adolescents receiving genetic testing for diagnostic and prognostic purposes. With increased adoption of the electronic health record (EHR), genetic testing is increasingly resulted in the EHR. However, this leads to challenges in both storage and disclosure of genetic results, particularly when parental results are combined with child genetic results. PRIVACY AND ETHICAL CONSIDERATIONS Accidental disclosure and erroneous documentation of genetic results can occur due to the nature of their presentation in the EHR and documentation processes by clinicians. Genetic information is both sensitive and identifying, and requires a considered approach to both timing and extent of disclosure to families and access to clinicians. METHODS This article uses an interdisciplinary approach to explore ethical issues surrounding privacy, confidentiality of genetic data, and access to genetic results by health care providers and family members, and provides suggestions in a stakeholder format for best practices on this topic for clinicians and informaticians. Suggestions are made for clinicians on documenting and accessing genetic information in the EHR, and on collaborating with genetics specialists and disclosure of genetic results to families. Additional considerations for families including ethics around results of adolescents and special scenarios for blended families and foster minors are also provided. Finally, administrators and informaticians are provided best practices on both institutional processes and EHR architecture, including security and access control, with emphasis on the minimum necessary paradigm and parent/patient engagement and control of the use and disclosure of data. CONCLUSION The authors hope that these best practices energize specialty societies to craft practice guidelines on genetic information management in the EHR with interdisciplinary input that addresses all stakeholder needs.
Collapse
Affiliation(s)
- Shibani Kanungo
- Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Jayne Barr
- Internal Medicine-Pediatrics, MetroHealth, Cleveland, Ohio, United States
| | - Parker Crutchfield
- Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Casey Fealko
- Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Neelkamal Soares
- Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| |
Collapse
|
12
|
Crutchfield P. Engendering moral post-persons: A novel self-help strategy. Bioethics 2020; 34:679-686. [PMID: 32037579 DOI: 10.1111/bioe.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
Humans are morally deficient in a variety of ways. Some of these deficiencies threaten the continued existence of our species. For example, we appear to be incapable of responding to climate change in ways that are likely to prevent the consequent suffering. Some people are morally better than others, but we could all be better. The price of not becoming morally better is that when those events that threaten us occur, we will suffer from them. If we can prevent this suffering from occurring, then we ought to do so. That we ought to make ourselves morally better in order to prevent very bad things from happening justifies, according to some, the development and administration of moral enhancement. I address in this paper the idea that moral enhancement could give rise to moral transhumans, or moral post-persons. Contrary to recent arguments that we shouldn't engender moral post-persons, I argue that we should. Roughly, the reasons for this conclusion are that we can expect moral post-persons to resemble the morally best of us, our moral exemplars. Since moral exemplars promote their interests by promoting the interests of others (or they promote others' interests at the expense of their own) we can expect moral post-persons to pursue our interests. Since we should also pursue our own interests, we should bring about moral post-persons.
Collapse
Affiliation(s)
- Parker Crutchfield
- Program in Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| |
Collapse
|
13
|
Affiliation(s)
| | - Tyler S Gibb
- Western Michigan University Homer Stryker M.D. School of Medicine
| | | | - William Fales
- Western Michigan University Homer Stryker M.D. School of Medicine
- Michigan Department of Health and Human Services
| |
Collapse
|
14
|
Crutchfield P. It is better to be ignorant of our moral enhancement: A reply to Zambrano. Bioethics 2020; 34:190-194. [PMID: 31639224 DOI: 10.1111/bioe.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
In a recent issue of Bioethics, I argued that compulsory moral bioenhancement should be administered covertly. Alexander Zambrano has criticized this argument on two fronts. First, contrary to my claim, Zambrano claims that the prevention of ultimate harm by covert moral bioenhancement fails to meet conditions for permissible liberty-restricting public health interventions. Second, contrary to my claim, Zambrano claims that covert moral bioenhancement undermines autonomy to a greater degree than does overt moral bioenhancement. In this paper, I rebut both of these arguments, then finish by noting important avenues of research that Zambrano's arguments motivate.
Collapse
Affiliation(s)
- Parker Crutchfield
- Western Michigan University Homer Stryker MD School of Medicine, Medical Ethics, Humanities, and Law, Michigan
| |
Collapse
|
15
|
Crutchfield P. Delusion, Proper Function, and Justification. NEUROETHICS-NETH 2020. [DOI: 10.1007/s12152-020-09429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Crutchfield P, Scheall S. Epistemic burdens and the incentives of surrogate decision-makers. Med Health Care Philos 2019; 22:613-621. [PMID: 31004263 DOI: 10.1007/s11019-019-09899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will either be neglected altogether or deeply discounted in the surrogate's incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon.
Collapse
Affiliation(s)
- Parker Crutchfield
- Medial Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA.
| | - Scott Scheall
- Faculty of Social Science, College of Integrative Sciences and Arts, Arizona State University Polytechnic Campus, Santa Catalina Hall, 250A, 7271 E Sonoran Arroyo Mall, Mesa, AZ, 85212, USA
| |
Collapse
|
17
|
Crutchfield P. Moral Normative Force and Clinical Ethics Expertise. Am J Bioeth 2019; 19:89-91. [PMID: 31661411 DOI: 10.1080/15265161.2019.1665733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
18
|
Abstract
Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is a matter of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program.
Collapse
Affiliation(s)
- Parker Crutchfield
- Medical Ethics, Humanities, and Law, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA
| |
Collapse
|
19
|
Crutchfield P, Gibb TS, Redinger MJ, Ferman D, Livingstone J. The Conditions for Ethical Application of Restraints. Chest 2018; 155:617-625. [PMID: 30578755 DOI: 10.1016/j.chest.2018.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/05/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022] Open
Abstract
Despite the lack of evidence for the effectiveness of physical restraints, their use in patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, the use of restraints would nevertheless be unethical, so long as well-known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions are that the physician obtained informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness.
Collapse
Affiliation(s)
- Parker Crutchfield
- Program in Medical Ethics, Humanities and Law, Western Michigan University Homer Stryker M.D. School of Medicine.
| | - Tyler S Gibb
- Program in Medical Ethics, Humanities and Law, Western Michigan University Homer Stryker M.D. School of Medicine
| | - Michael J Redinger
- Program in Medical Ethics, Humanities and Law, Western Michigan University Homer Stryker M.D. School of Medicine
| | - Daniel Ferman
- Western Michigan University Homer Stryker M.D. School of Medicine
| | - John Livingstone
- Western Michigan University Homer Stryker M.D. School of Medicine; Department of Orthopedic Surgery, University of Hawaii Orthopaedic Residency Program
| |
Collapse
|
20
|
Affiliation(s)
- Parker Crutchfield
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| |
Collapse
|
21
|
Crutchfield P, Pazdernik V, Hansen G, Malone J, Wagenknecht M. Being Hungry Affects Oral Size Perception. Iperception 2018; 9:2041669518777513. [PMID: 29854379 PMCID: PMC5968662 DOI: 10.1177/2041669518777513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/26/2018] [Indexed: 11/20/2022] Open
Abstract
Oral size perception is not veridical, and there is disagreement on whether this nonveridicality tends to underestimate or overestimate size. Further, being hungry has been shown to affect oral size perception. In this study, we investigated the effect of hunger on oral size perception. Overall, being hungry had a small but significant effect on oral size perception and seemed to support that oral size perception tends to underestimate the size of objects. Both hungry and sated participants tended to underestimate the size of intraoral objects, but hungry participants underestimated to a significantly lesser degree. Unlike previous research, this tendency was independent of the order and number of assessments of size. We, therefore, offer a novel explanation for these findings: Oral size perception is modulated by a hierarchy of Bayesian predictions, and being hungry changes the priors in these predictions.
Collapse
Affiliation(s)
- Parker Crutchfield
- Western Michigan University Homer Stryker M.D., School of Medicine, Kalamazoo, MI, USA; Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO, USA
| | - Vanessa Pazdernik
- Department of Research Support, A.T. Still University, Kirksville, MO, USA
| | - Gina Hansen
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO, USA
| | - Jacob Malone
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO, USA
| | - Molly Wagenknecht
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO, USA
| |
Collapse
|
22
|
Redinger MJ, Crutchfield P, Gibb TS, Longstreet P, Strung R. Conversion Disorder Diagnosis and Medically Unexplained Symptoms. Am J Bioeth 2018; 18:31-33. [PMID: 29697337 DOI: 10.1080/15265161.2018.1445317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Tyler S Gibb
- a Western Michigan University Homer Stryker MD School of Medicine
| | - Peter Longstreet
- a Western Michigan University Homer Stryker MD School of Medicine
| | - Robert Strung
- a Western Michigan University Homer Stryker MD School of Medicine
| |
Collapse
|
23
|
Crutchfield P. The Ethics of Anti-aging Clinical Trials. Sci Eng Ethics 2018; 24:441-453. [PMID: 28484906 DOI: 10.1007/s11948-017-9917-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
Interventions aiming to slow, stop, or reverse the aging process are starting to enter clinical trials. Though this line of research is nascent, it has the potential to not only prevent prolonged human suffering, but also to extend human well-being. As this line of research develops, it is important to understand the ethical constraints of conducting such research. This paper discusses some of these constraints. In particular, it discusses the ethical difficulties of conducting this research in a way that would produce reliable data regarding the effectiveness of an anti-aging intervention. Clinical trials of such interventions, I argue, will be faced with a dilemma between two confounding variables. Eliminating the variables requires introducing ethically problematic research practices. Thus, researchers must either perform research in ethically problematic ways, or forego the conduct of high-impact clinical research on anti-aging interventions.
Collapse
Affiliation(s)
- Parker Crutchfield
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO, 63501, USA.
| |
Collapse
|
24
|
Abstract
Moral bioenhancement is the potential practice of manipulating individuals' moral behaviors by biological means in order to help resolve pressing moral issues such as climate change and terrorism. This practice has obvious ethical implications, and these implications have been and continue to be discussed in the bioethics literature. What have not been discussed are the epistemological implications of moral bioenhancement. This article details some of these implications of engaging in moral bioenhancement. The argument begins by making the distinction between moral bioenhancement that manipulates the contents of mental states (e.g. beliefs) and that which manipulates other, non-representational states (e.g. motivations). Either way, I argue, the enhanced moral psychology will fail to conform to epistemic norms, and the only way to resolve this failure and allow the moral bioenhancement to be effective in addressing the targeted moral issues is to make the moral bioenhancement covert.
Collapse
|
25
|
Crutchfield P, Mahoney C, Pazdernik V, Rivera C. Cross-modal influence on oral size perception. Arch Oral Biol 2015; 61:89-97. [PMID: 26547021 DOI: 10.1016/j.archoralbio.2015.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/12/2015] [Accepted: 10/25/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Evidence suggests people experience an oral size illusion and commonly perceive oral size inaccurately; however, the nature of the illusion remains unclear. The objectives of the present study were to confirm the presence of an oral size illusion, determine the magnitude (amount) and direction (underestimation or overestimation) of the illusion, and determine whether immediately prior cross-modal perceptual experiences affected the magnitude and direction. DESIGN Participants (N=27) orally assessed 9 sizes of stainless steel spheres (1/16 in to 1/2 in) categorized as small, medium, or big, and matched them with digital and visual reference sets. Each participant completed 20 matching tasks in 3 assessments. For control assessments, 6 oral spheres were matched with reference sets of same-sized spheres. For primer-control assessments, similar to control, 6 matching tasks were preceded by cross-modal experiences of the same-sized sphere. For experimental assessments, 8 matching tasks were preceded by a cross-modal experience of a differently sized sphere. RESULTS For control assessments, small and medium spheres were consistently underestimated, and big spheres were consistently overestimated. For experimental assessments, magnitude and direction of the oral size illusion varied according to the size of the sphere used in the cross-modal experience. CONCLUSION Results seemed to confirm an oral size illusion, but direction of the illusion depended on the size of the object. Immediately prior cross-modal experiences influenced magnitude and direction of the illusion, suggesting that aspects of oral perceptual experience are dependent upon factors outside of oral perceptual anatomy and the properties of the oral stimulus.
Collapse
Affiliation(s)
- Parker Crutchfield
- Missouri School of Dentistry and Oral Health, A.T. Still University, 800 West Jefferson St., Kirksville, Missouri 63501, USA.
| | - Connor Mahoney
- Missouri School of Dentistry and Oral Health, A.T. Still University, 800 West Jefferson St., Kirksville, Missouri 63501, USA.
| | - Vanessa Pazdernik
- Research Support, A.T. Still University, 5835 E. Still Circle Dr., Mesa, Arizona 85206, USA.
| | - Cesar Rivera
- Missouri School of Dentistry and Oral Health, A.T. Still University, 800 West Jefferson St., Kirksville, Missouri 63501, USA.
| |
Collapse
|
26
|
|
27
|
Horton HM, Crutchfield P, Garrison C. Hypospadias: when baby boys need surgery (continuing education credit). RN 1990; 53:48-52. [PMID: 2363007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|