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In 1902, Albert Moll, who at that time ran a private practice for nervous diseases in Berlin, published his comprehensive book on medical ethics, Ärztliche Ethik. Based on the concept of a contractual relationship between doctor and client, it gave more room to the self-determination of patients than the contemporary, usually rather paternalistic, works of this genre. In the first part of the present paper this is illustrated by examining Moll’s views and advice on matters such as truthfulness towards patients, euthanasia, and abortion. The second part of this article discusses how Moll engaged with the then publicly debated issues of experimentation on hospital patients and the ‘trade’ of foreign private patients between agents and medical consultants. In both matters Moll collected evidence of unethical practices and tried to use it to bring about change without damaging his or the profession’s reputation. However, with his tactical manoeuvres, Moll made no friends for himself among his colleagues or the authorities; his book on ethics also met with a generally cool response from the medical profession and seems to have been more appreciated by lawyers than by other doctors.

This special section of the Journal of Empirical Research on Human Research Ethics (JERHRE) is based upon the assumption that much of the best empirical data relevant to research ethics is hidden from the view of Research Ethics Committee (REC) members and others who are interested in research ethics. There are at least three different senses in which ethics-relevant empirical research may be hidden: (1) it may be published in a journal that ethics committee members would not regularly read, (2) it may not use key words that would guide one to its ethics-relevant content, or (3) it may be sequestered in part of a research article that is about something else. This special section of JERHRE reviews all of these types of “hidden ethics” articles on the following issues: What is the relative frequency of hidden ethics articles in journals that focus on vulnerable populations? What does the non-ethics literature in clinical research and experimental economic decision theory teach us about ways of improving subjects’ comprehension of risk information? How satisfied are parents and children with their experience with pediatric psychotrophic medication trials? And, how can retention rates be improved in longitudinal studies of difficult regimens such as drug rehabilitation? There is a major amount of ethics-relevant literature that is hidden. Without better ways of communicating the existence of this literature through use of key words, or recasting of the information to highlight its relevance to research ethics in journals that ethics committee members read, the benefits of evidence-based ethical problem solving will be lost.

Philosophical theories of collective action have produced a number of alternative accounts of the rationality and morality of self-interest and altruism. These have obvious applications to communicable disease control, the avoidance of antibiotic resistance, the responsibility of healthcare professionals to patients with serious communicable diseases, and the sharing of personal data in epidemiological research.

Background

Although clinical ethicists are becoming more prevalent in healthcare settings, their required training and education have not been clearly delineated. Most agree that training and education are important, but their nature and delivery remain topics of debate. One option is through completion of a clinical ethics fellowship.

Method

In this paper, the first four fellows to complete a newly developed fellowship program discuss their experiences. They describe the goals, structure, participants and activities of the fellowship. They identify key elements for succeeding as a clinical ethicist and sustaining a clinical ethics program. They critically reflect upon the challenges faced in the program.

Results

The one-year fellowship provided real-time clinical opportunities that helped them to develop the necessary knowledge and skills, gain insight into the role and scope of practice of clinical ethicists and hone valuable character traits.

Conclusion

The fellowship enabled each of the fellows to assume confidently and competently a position as a clinical ethicist upon completion.

The prediction of voting behavior of undecided voters poses a challenge to psychologists and pollsters. Recently, researchers argued that implicit attitudes would predict voting behavior particularly for undecided voters whereas explicit attitudes would predict voting behavior particularly for decided voters. We tested this assumption in two studies in two countries with distinct political systems in the context of real political elections. Results revealed that (a) explicit attitudes predicted voting behavior better than implicit attitudes for both decided and undecided voters, and (b) implicit attitudes predicted voting behavior better for decided than undecided voters. We propose that greater elaboration of attitudes produces stronger convergence between implicit and explicit attitudes resulting in better predictive validity of both, and less incremental validity of implicit over explicit attitudes for the prediction of voting behavior. However, greater incremental predictive validity of implicit over explicit attitudes may be associated with less elaboration.

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect

Design, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life".

Results–Practitioners accept the relevance of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment.

Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners.

Key Words: Death and dying • withdrawal of care • refusal of treatment

Few issues raise more questions for physicians than the resuscitation of seriously ill patients. In the following exchange of letters, Dr. John Quinlan discusses two difficult cases involving patient resuscitation, while Dr. William Cook responds by referring to the Joint Statement on Resuscitative Interventions that was approved last year by the CMA and several other health care organizations.

Members of the European Parliament (MEPs) have voluntarily formed transnational political groups and invariably follow the voting instructions of these groups. This is intriguing as there are few obvious incentives for doing so. Unlike national parties, for example, the political groups in the European Parliament are not punished by the electorate if they are divided on key issues, as citizens know very little about what goes on inside the European Parliament. This paper pieces together an explanation of why the European political groups exist and why they have become so powerful by looking at the determinants of group cohesion and by undertaking a spatial analysis of voting in the European Parliament. MEPs who share preferences on a range of issues on the European Union policy agenda have an incentive to establish a division-of-labour contract and to share the costs of collecting information. Once internal party policy specialization and agenda setting has been established, MEPs have incentives to follow the voting instructions of their group owing to the advantages of cohesion in a context of repeated voting.

Aim

This article aims at giving an overview of five ethical problem areas relating to traffic safety, thereby providing a general framework for analysing traffic safety from an ethical perspective and encouraging further discussion concerning problems, policies and technology in this area.

Subjects and methods

The problems presented in the article are criminalisation, paternalism, privacy, justice and responsibility, and the reasons for choosing these are the following. First, they are all important areas in moral philosophy. Second, they are fairly general and it should be possible to categorise more specific problems under these headings. Ethical aspects of road traffic have not received the philosophical attention they deserve. Every year, more than 1 million people die globally in traffic accidents, and 20 to 50 million people are injured. Ninety per cent of the road traffic fatalities occur in low- and middle-income countries, where it is a growing problem. Politics, economics, culture and technology affect the number of fatalities and injuries, and the measures used to combat deaths in traffic as well as the role of road traffic should be ethically scrutinised. The topics are analysed and discussed from a moral-philosophical perspective, and the discussion includes both theory and applications.

Results and conclusion

The author concludes with some thoughts on how the ethical discussion can be included in the public debate on how to save lives in road traffic. People in industrialised societies are so used to road traffic that it is almost seen as part of nature. Consequently, we do not acknowledge that we can introduce change and that we can affect the role we have given road traffic and cars. By acknowledging the ethical aspects of road traffic and illuminating the way the choices society makes are ethically charged, it becomes clear that there are alternative ways to design the road traffic system. The most important general conclusion is that discussion concerning these alternative ways of designing the system should be encouraged.

Voting to determine one’s leaders is among the most important decisions we make, yet little is known about the brain’s role in how we come to these decisions. Behavioral studies have indicated that snap judgments of political candidates’ faces can predict election outcomes but that the traits that lead to these judgments differ across cultures. Here we sought to investigate the neural basis for these judgments. American and Japanese natives performed simulated voting judgments of actual American and Japanese political candidates while neural activity was measured using functional magnetic resonance imaging (fMRI). Candidates for whom participants chose to vote elicited stronger responses in the bilateral amygdala than candidates for whom participants chose not to vote. This was true regardless of either the participant’s culture or the target’s culture, suggesting that these voting decisions provoked the same neural response cross-culturally. In addition, we observed a participant culture by target culture interaction in the bilateral amygdala. American and Japanese participants both showed a stronger response to cultural outgroup faces than they did to cultural ingroup faces, however this was unrelated to their voting decisions. These data provide insight to the mechanisms that underlie our snap judgments of others when making voting decisions and provide a neural correlate to cross-cultural consensus in social inferences.

Models of nomination politics in the US often find “gridlock” in equilibrium because of the super-majority requirement in the Senate for the confirmation of presidential nominees. A blocking coalition often prefers to defeat any nominee. Yet empirically nominations are successful. In the present paper we explore the possibility that senators can be induced to vote contrary to their nominal (gridlock-producing) preferences through contributions from the president and/or lobbyists, thus breaking the gridlock and confirming the nominee. We model contributions by the president and lobbyists according to whether payment schedules are conditioned on the entire voting profile, the vote of a senator, or the outcome. We analyze several extensions to our baseline approach, including the possibility that lobbyists may find it more productive to offer inducements to the president in order to affect his proposal behavior, rather than trying to induce senators to vote for or against a given nominee.

We investigated the moral stereotypes political liberals and conservatives have of themselves and each other. In reality, liberals endorse the individual-focused moral concerns of compassion and fairness more than conservatives do, and conservatives endorse the group-focused moral concerns of ingroup loyalty, respect for authorities and traditions, and physical/spiritual purity more than liberals do. 2,212 U.S. participants filled out the Moral Foundations Questionnaire with their own answers, or as a typical liberal or conservative would answer. Across the political spectrum, moral stereotypes about “typical” liberals and conservatives correctly reflected the direction of actual differences in foundation endorsement but exaggerated the magnitude of these differences. Contrary to common theories of stereotyping, the moral stereotypes were not simple underestimations of the political outgroup's morality. Both liberals and conservatives exaggerated the ideological extremity of moral concerns for the ingroup as well as the outgroup. Liberals were least accurate about both groups.

Images

Election outcomes correlate with judgments based on a candidate's visual appearance, suggesting that the attributions viewers make based on appearance, so-called thin-slice judgments, influence voting. Yet, it is not known whether the effect of appearance on voting is more strongly influenced by positive or negative attributions, nor which neural mechanisms subserve this effect. We conducted two independent brain imaging studies to address this question. In Study 1, images of losing candidates elicited greater activation in the insula and ventral anterior cingulate than images of winning candidates. Winning candidates elicited no differential activation at all. This suggests that negative attributions from appearance exert greater influence on voting than do positive. We further tested this hypothesis in Study 2 by asking a separate group of participants to judge which unfamiliar candidate in a pair looked more attractive, competent, deceitful and threatening. When negative attribution processing was enhanced (specifically, under judgment of threat), images of losing candidates again elicited greater activation in the insula and ventral anterior cingulate. Together, these findings support the view that negative attributions play a critical role in mediating the effects of appearance on voter decisions, an effect that may be of special importance when other information is absent.

A family had a child in large part to use its marrow in the hopes of saving the life of an older child afflicted with leukaemia. Public response from medical ethicists was negative. This paper argues that what the family did was not clearly wrong and that the ethicists should not have made public pronouncements calling the morals of the family into question.

This paper explores the use of advance directives in clinical dementia research. The focus is on advance consent to participation of demented patients in non-therapeutic research involving more than minimal risks and/or burdens. First, morally relevant differences between advance directives for treatment and care, and advance directives for dementia research are discussed. Then attention is paid to the philosophical issue of dementia and personal identity, and the implications for the moral authority of research advance directives. Thirdly, a number of practical shortcomings of advance directives for non-therapeutic dementia research are explored and attention is paid to the role of proxies. It is concluded that upon a closer look the initial attractiveness of advance directives for dementia research is lessened, and that it is doubtful whether these instruments can compensate for the lack of subject consent in case of non-therapeutic dementia research involving more than minimal risks and/or burdens for the incompetent demented subject.

Recent scholarship and public discourse highlight an apparent waning of civic engagement in the United States. Although the welfare state is generally thought to support democracy by reducing economic inequality, it may paradoxically contribute to political disempowerment of some groups. We examine the effects of state interventions on civic participation among young adults, hypothesizing that involvement with stigmatizing social programs, such as welfare, reduces political engagement while receipt of non-stigmatizing government assistance does not dampen civic involvement. Using official voting records and survey data from the Youth Development Study (YDS), a longitudinal community sample of young adults, a series of regression models suggests that welfare recipients are less likely to vote than non-recipients, whereas recipients of non-means tested government assistance participate similarly to young adults who do not receive government help. These effects hold even when background factors, self-efficacy, and prior voting behavior are controlled. Welfare receipt is not associated, however, with suppressed participation in non-state arenas such as volunteer work. Intensive interviews with YDS welfare recipients are used to illustrate and develop the analysis.

Recent decades have seen a shift in the management and discussion of biomedicine. Issues once considered by doctors and scientists are now handled by a diverse array of participants, including philosophers, lawyers, theologians and lay representatives. This new approach, known as ‘bioethics', has become the norm in regulatory committees and public debate. In this article, I argue that bioethics emerged as a valued enterprise in Britain during the 1980s because it fulfilled, and linked, the concerns of several groups. My analysis centres on the moral philosopher Mary Warnock, who chaired a government inquiry into human fertilization and embryology between 1982 and 1984, and became a strong advocate of bioethics. I detail how Warnock's promotion of bioethics tallied with the Conservative government's desire for increased surveillance of hitherto autonomous professions – while fulfilling her own belief that philosophers should engage in public affairs. And I also show that Warnock simultaneously promoted bioethics to doctors and scientists as an essential safeguard against declining political and public trust. This stance, I argue, framed bioethics as a vital intermediary between politics, the public, and biomedicine, and explains the growth and endurance of what the Guardian identified as an ethics industry.

Recent decades have seen a shift in the management and discussion of biomedicine. Issues once considered by doctors and scientists are now handled by a diverse array of participants, including philosophers, lawyers, theologians and lay representatives. This new approach, known as ‘bioethics', has become the norm in regulatory committees and public debate. In this article, I argue that bioethics emerged as a valued enterprise in Britain during the 1980s because it fulfilled, and linked, the concerns of several groups. My analysis centres on the moral philosopher Mary Warnock, who chaired a government inquiry into human fertilization and embryology between 1982 and 1984, and became a strong advocate of bioethics. I detail how Warnock's promotion of bioethics tallied with the Conservative government's desire for increased surveillance of hitherto autonomous professions – while fulfilling her own belief that philosophers should engage in public affairs. And I also show that Warnock simultaneously promoted bioethics to doctors and scientists as an essential safeguard against declining political and public trust. This stance, I argue, framed bioethics as a vital intermediary between politics, the public, and biomedicine, and explains the growth and endurance of what the Guardian identified as an ethics industry.

We showed 10-second, silent video clips of unfamiliar gubernatorial debates to a group of experimental participants and asked them to predict the election outcomes. The participants’ predictions explain more than 20 percent of the variation in the actual two-party vote share across the 58 elections in our study, and their importance survives a range of controls, including state fixed effects. In a horse race of alternative forecasting models, participants’ forecasts significantly outperform economic variables in predicting vote shares, and are comparable in predictive power to a measure of incumbency status. Participants’ forecasts seem to rest on judgments of candidates’ personal attributes (such as likeability), rather than inferences about candidates’ policy positions. Though conclusive causal inference is not possible in our context, our findings may be seen as suggestive evidence of a causal effect of candidate appeal on election outcomes.

Background

Throughout human history, a disproportionate degree of political power around the world has been held by men. Even in democracies where the opportunity to serve in top political positions is available to any individual elected by the majority of their constituents, most of the highest political offices are occupied by male leaders. What psychological factors underlie this political gender gap? Contrary to the notion that people use deliberate, rational strategies when deciding whom to vote for in major political elections, research indicates that people use shallow decision heuristics, such as impressions of competence solely from a candidate's facial appearance, when deciding whom to vote for. Because gender has previously been shown to affect a number of inferences made from the face, here we investigated the hypothesis that gender of both voter and candidate affects the kinds of facial impressions that predict voting behavior.

Methodology/Principal Finding

Male and female voters judged a series of male and female political candidates on how competent, dominant, attractive and approachable they seemed based on their facial appearance. Then they saw a series of pairs of political candidates and decided which politician they would vote for in a hypothetical election for President of the United States. Results indicate that both gender of voter and candidate affect the kinds of facial impressions that predict voting behavior. All voters are likely to vote for candidates who appear more competent. However, male candidates that appear more approachable and female candidates who appear more attractive are more likely to win votes. In particular, men are more likely to vote for attractive female candidates whereas women are more likely to vote for approachable male candidates.

Conclusions/Significance

Here we reveal gender biases in the intuitive heuristics that voters use when deciding whom to vote for in major political elections. Our findings underscore the impact of gender and physical appearance on shaping voter decision-making and provide novel insight into the psychological foundations underlying the political gender gap.

There is a unique hospital in Canada-and perhaps in the world-because it is built outside prison walls and it exists specifically for the psychiatric treatment of prisoners. It is on the one hand a hospital and on the other a prison. Moreover it has to provide the same quality and standard of care which is expected of a hospital associated with a university. From the time the hospital was established moral dilemmas appeared which were concerned with conflicts between the medical and custodial treatment of prisoners, and also with the attitudes of those having the status of prisoner-patient. Dr Roy describes these dilemmas and attitudes, and in particular a special conference which was convened to discuss them. Not only doctors and prison officials took part in this meeting but also general practitioners, theologians, philosophers, ex-prisoners, judges, lawyers, Members of Parliament and Senators. This must have been a unique occasion and Dr Roy's description may provide the impetus to examine these prison problems in other settings.

Mindful of the new evolutionary ideas related to an emerging scientific focus known as omics, we propose that spiritual, social, and political behaviors may be tied in part to inheritable reward gene polymorphisms, as has been demonstrated for the addictions. If so, analyses of gene polymorphisms may assist in predicting liberalism or conservatism in partisan attachments. For example, both drinking (alcohol) and obesity seem to cluster in large social networks and are influenced by friends having the same genotype, in particular the DRD2 A1 allele. Likewise, voting, voting turnout and attachment to a particular political ideology is differentially related to various reward genes (e.g., 5HTT, MOA, DRD2, and DRD4), possibly predicting liberalism or conservatism. Moreover, voters’ genetic information may predict presidential outcomes more than the actual issues at hand or the presidential candidates themselves. Thus, political discussions on TV, radio, or other media may be morphed by one’s reward gene polymorphisms and as such, may explain the prevalence of generations of die-hard republicans and equally entrenched democratic legacies. Indeed, even in politics, birds of a feather (homophily) flock together. We caution that our proposal should be viewed mindfully awaiting additional research before definitive statements or conclusions can be derived from the studies to date, and we encourage large scale studies to confirm these earlier reports.