Paola Nicolas

Medical distrust is often the result of social injustices, discrimination, systemic racism, and the repeated experience of epistemic injustices. Signaling medical trustworthiness in this context requires not only demonstrating competence and caring but grappling with the source of distrust rooted in experience. While we should be wary of framing every unmediatable conflict as an issue of distrust, which may simplify a complex human experience to an identity-based response, we argue that a community-engaged intersectional approach to mediation can address conflicts rooted in distrust and is fundamentally aligned with Nancy Dubler’s legacy of addressing power differentials. We present a case where traditional tools of mediation—including addressing informational and emotional gaps—were insufficient at reaching a “principled resolution.” In this case, the distance between the family member’s and the medical team’s understanding of the facts was so profound that it could not be overcome. Far from being irrational or unreasonable, this outcome was a direct response to the perpetual unequal access to epistemic authority experienced by this Black family. Mediators often belong to social groups with more power, and this bias can impact mediation practices, communication norms, and assumptions about conflict. Inclusive mediation models rooted in conflict theory can build on Nancy Dubler’s classical work. We argue that bioethicists must engage in risky conversations with local communities to “collaboratively imagine what a more trustworthy system might look like.” We describe the inclusive mediation model and how it expands on Nancy Dubler’s foundational work and honors her tremendous legacy.

Abstract“Sham codes” or “slow codes”—defined here as resuscitative efforts undertaken only to the extent necessary to convey the impression that “everything was done,” rather than to achieve return of spontaneous circulation (ROSC)—have been almost universally condemned for the past five decades. To facilitate an examination of this practice, we consider how the clinician's obligations and prerogatives differ under four scenarios, all of which involve conflict between the physician who desires to withhold cardiopulmonary resuscitation (CPR) and the family who does not. Under two scenarios, involving quality of life considerations and quantitative futility (“long shots”), we argue that slow codes are ethically impermissible. Under two other scenarios, however, we maintain an agnostic view on the moral permissibility of slow codes. We observe that where the case for impermissibility is predicated on considerations of honesty and professional integrity, commonly practiced and commonly defended alternatives to the slow code, such as non‐initiation of CPR after bedside assessment, limited trials of CPR, and futile CPR, are typically undertaken for beneficent reasons and, like the slow code, entail non‐lying deception. Finally, we offer recommendations for care delivery reform that work “upstream” to prevent the conflicts and crises of trust that give rise to intractable conflicts surrounding CPR.

Le but de cet article est de souligner la contribution de certaines des plus grandes figures de la scolastique tardive au débat sur la nature et les limites de la conscience. On verra comment les disciples Thomas d’Aquin introduisent un nouveau concept, celui d’ advertentia spécifiquement conçu pour caractériser l’accès cognitif privilégié que nous avons à nos propres actes mentaux. Les dominicains du XVI e siècle adoptent à ce titre une position très proche de celle de Descartes, du moins d’un point de vue phénoménologique, en faisant de l’ advertentia le critère de la mens.

What is a uterus to a woman and to society? This article calls for a holistic reevaluation of how we perceive and what we expect from women’s uteruses. We explore the powerful and deeply rooted cultural representations of women’s uteruses as mere receptacles and the impact of such representations on biological categories, medical practices, and current policies. Considering controversies surrounding hysterectomies, cesarean sections, and uterus transplants, we elucidate ambivalent narratives that either promote an essentialist approach where the uterus is emblematic of womanhood, or imply that the uterus is a dispensable organ useless outside of reproduction.