This chapter considers induction, deduction and abduction as methods of obtaining scientific knowledge. The introductory section again ends by highlighting that there is no single method, and refers to claims that scientific reasoning uses various heuristics or rules of thumb based on the specific approach and the background information we have, and that we should recognise that this can introduce various errors of reasoning: by being aware of the potential for making these errors, we are better able to guard against making them. The bulk of the chapter then looks at specific logical fallacies, using neuroscience examples to illustrate them. These include ad hoc reasoning; begging the question; confusing correlation for causation; confirmation and disconfirmation biases; false dichotomies; false metaphors; the appeal to authority, tradition and emotion; the mereological fallacy; the naturalistic fallacy; and straw man arguments.

This chapter reflects on a case involving a pediatric patient with a rare neurogenerative disease whose medical team requested an ethics consultation when his parents disagreed with the medical recommendation to remove his breathing tube, knowing that this could lead to his death. The ethics consultation explored what at first appeared to be conflicting beliefs about the facts of this patient’s condition and quality of life: his medical team believed he had an irreversible, neurodegenerative condition that would become progressively more debilitating and uncomfortable; his parents believed that he may still recover from his disease and survive. Yet on deeper analysis, we came to see that this was not a case of a medical team holding true beliefs and a family holding false beliefs about the clinical facts of the matter, but rather a difference between ways of being in and seeing the world, particularly as it relates to reasoning from a position of faith in what might be. This case shows the importance of differentiating between claims about facts and assertions of values, and how biomedical expectations of evidence can influence perceptions of relevant information during a clinical ethics consultation.

Jo was admitted to our hospital for complex pain and complications of intestinal failure. An 18-year-old with a complex medical and psychiatric history, Jo had been frequently hospitalized for suicidal ideation, chronic pain, and complications from intestinal dysmotility. Ethics was consulted during this stay because Jo requested to stop artificial nutrition and hydration and be allowed to die with support from hospice care. Throughout this case, the care team had concerns for capacity, honoring a patient’s right to refuse medical care, caring for a patient with a history of trauma, belonging to the LGBTQ+ community, with a chronic illness. This case explores the complex course of Jo’s case and identifies ethical options that fit within the narrative of this patient’s complex story.

Decision-making in oncology care is at best consequential and complex. This chapter explores a clinical ethics consultation exploring the difficult task of determining cancer directed therapy for a patient with a profound neurocognitive disability. The case highlights the ethics consultant’s and the multidisciplinary team’s missteps and failure to recognize that the true ethical question was not only “How can we ensure that this patient is treated equitably and receives the standard of care treatment,” but also “Is surgery really the right treatment option for this patient?” While disability rights activists have long proclaimed that all individuals should be granted equal access to healthcare, it is ethically permissible to tailor standards of care to meet the specific and unique needs of the patient sitting in front of you. This chapter illustrates the noble intent of clinicians and the limitations of substituted judgment in deciding for others.

Clinical ethics prides itself on communication, collaboration, interdisciplinary cooperation and mediation. But what happens when all those skills and efforts fail? This chapter describes a difficult situation fraught with clinical uncertainty and complicated by an unbridgeable cultural divide that left the clinical parties feeling as if they failed the patient. This case demonstrates that sometimes there is no real closure, no understanding, and no sense of having been helpful. These are the kinds of cases that haunt us.

How can ethics consultants weigh and balance patients’ physical and psychological needs when they are appear mutually exclusive? How might a disability-aware lens impact the way we address risk? A disconcerting clinical ethics consultation regarding "Jimmy" prompts reflection of these questions and our own complicity with ableism as consultants and providers. Jimmy, who was previously incarcerated, houseless, and facing mental status changes, spent months fighting four-point restraints to maintain a cervical collar meant to prevent disability and death.

The predominant paradigm of acute medical care has not integrated trauma-informed or disability aware lenses despite trauma prevalence among patients and the presence of disability for 25% of adults. The lack of these perspectives has hazardous ramifications in clinical decision making and beside care. The prevailing norm prioritizes physical and functional outcomes over identity and emotional well-being. There is a false assumption that people with disabilities have a worse quality of life than people without disability. This disability illiteracy undermines patient autonomy and the disability community. Medical professionals’ personal experience and relationship to disability can perhaps shift this perspective to a more inclusive and nuanced approach to ethical decision making A broader transformative approach to ethics consultation is needed to avoid complicity in moral harms.

We describe our personal and professional struggles with an organizational ethics consultation involving thoracoabdominal normothermic regional perfusion (TA-NRP), an organ procurement technique used after circulatory death. We ultimately concluded that TA-NRP is ethically permissible (with caveats), yet we are haunted. Our advice was taken seriously, but was it the right advice? Our recommendations might have let us off the hook.

Medical, cultural, and logistical barriers exist across the state of Alaska as healthcare facilities care for our people. Moral, social, and clinical norms established in metropolitan locations do not always easily transfer to rural and remote locations.Reflecting upon these challenges, this essay lives through the early days and short life of an Alaska Native infant. Exploring the assumptions of metrocentric, moralized medicine the author questions the justice of a system that is not designed for or attentive to the needs of Alaskans living in remote locations. Through his own embrace of the emotional and narrative elements of clinical ethics, the author attempts to understand the deep coping that comes through ancient stories and deep emotions.