“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day (...) if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field. (shrink)

As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities has published core knowledge (...) competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. (shrink)

Fins and colleagues rightly note that “clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems” for which “progress in developing standards for q...

The article by Professor Fiester (2015) expresses concern about the long-term moral distress or negative moral emotions, both aspects of moral residue, that linger in some stakeholders’ experiences...

Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission (...) and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)

Foreword -- 1. The War Within -- 2. The Cult of Experience -- 3. The Long March -- 4. America's Transformers -- 5. American Restoration -- 6. Twenty-twenty Vision -- Acknowledgments.

I present a general theory for the initial domestication of plants and animals that is based on niche construction theory and incorporates several behavioral ecological concepts, including central-place provisioning, resource catchment, resource ownership and defensibility, and traditional ecological knowledge. This theory provides an alternative to, and replacement for, current explanations, including diet breadth models of optimal foraging theory, that are based on an outmoded concept of asymmetrical adaptation and that attempt to explain domestication as an adaptive response to resource imbalance (...) resulting from either environmental decline or human population growth. The small-scale human societies that first domesticated plants and animals share a number of basic interrelated attributes that when considered as an integrated and coherent set of behaviors provide the context for explaining initial domestication not as an adaptive response to an adverse environmental shift or to human population growth or packing but rather as the result of deliberate human enhancement of resource-rich environments in situations where evidence of resource imbalance is absent. (shrink)

Can we legitimately speak of ethicsexperts? Recent literature in philosophy and medical ethics addresses this important question but does not offer a satisfactory answer. Part of the problem is the absence of an examination of what it means to be an expert in general. I therefore begin by reviewing my analysis of expertise which appeared earlier in this journal. We speak of two kinds of experts: persons whose expertise is in virtue of what theyknow (epistemic expertise), or what theydo (performative (...) expertise). Applying this analysis to the domain of ethics, I argue that we may speak of ethical expertise in three epistemic senses: a) expertise indescriptive ethics, b) expertise inmetaethics, c) expertise innormative ethics, and in a performative sense: d) expertise inliving a good life. I conclude with a brief description of some social roles of ethics experts. (shrink)

Explores the impact of expert witnessing on the integrity of forensic scientific information. Complaints on the behavior of expert witnesses; Factors stimulating the susceptibility of experts to abandon their scientific integrity; Implications of the reliance of expert witnesses on ethics codes.

Experts play an important role in society, but there has been little investigation about the nature of expertise. I argue that there are two kinds of experts: those whose expertise is a function of what theyknow (epistemic expertise), or what theydo (performative expertise). Epistemic expertise is the capacity to provide strong justifications for a range of propositions in a domain, while performative expertise is the capacity to perform a skill well according to the rules and virtues of a practice. Both (...) epistemic and performative experts may legitimately disagree with one another, and the two senses are conceptually and logically distinct. (shrink)

One of the gaps in the current international marketing literature is in the area of consumer ethics. Using a sample drawn from Japanese consumers, this study investigates these individuals' reported ethical ideology and their perception of a number of different ethical situations in the realm of consumer behavior. Comparisons are then made across several demographic characteristics. The results reveal differences which provide theoretical support for expanded research in the area of cross-cultural/cross-national consumer ethics and highlight the need for managers to (...) consider possible differences in the ethical behavior of consumers when entering a new international market. In addition, this study extends current knowledge in international marketing ethics by utilizing a research design and survey instruments similar to previous studies on consumer ethics. (shrink)

In the two-envelope problem, a reasoner is offered two envelopes, one containing exactly twice the money in the other. After observing the amount in one envelope, it can be traded for the unseen contents of the other. It appears that it should not matter whether the envelope is traded, but recent mathematical analyses have shown that gains could be made if trading was a probabilistic function of amount observed. As a problem with a purely probabilistic solution, it provides a potentially (...) interesting way to test people's consistency with probabilistic models. Three experiments did this by varying the size of both the observed and maximum amounts, and their possible distribution. The results showed that trading decisions were affected by where the observed amount in the opened envelope fell in the distribution, though its size did not always do so. This suggests that participants’ trade decisions could be affected by the perceived probabilities of different observed amounts, which is consistent with the pro.. (shrink)

Studies of childhood abuse and neglect haveimportant lessons for considerations of natureand nurture. While each child has uniquegenetic potentials, both human and animalstudies point to important needs that everychild has, and severe long-term consequencesfor brain function if those needs are not met. The effects of the childhood environment,favorable or unfavorable, interact with all theprocesses of neurodevelopment (neurogenesis,migration, differentiation, apoptosis,arborization, synaptogenesis, synapticsculpting, and myelination). The time coursesof all these neural processes are reviewed herealong with statements of core principles forboth genetic and (...) environmental influences onall of these processes. Evidence is presentedthat development of synaptic pathways tends tobe a ``use it or lose it'' proposition.Abuse studies from the author's laboratory,studies of children in orphanages who lackedemotional contact, and a large number of animaldeprivation and enrichment studies point to theneed for children and young nonhuman mammals tohave both stable emotional attachments with andtouch from primary adult caregivers, andspontaneous interactions with peers. If theseconnections are lacking, brain development bothof caring behavior and cognitive capacities isdamaged in a lasting fashion.These effects of experience on the brainimply that effects of modern technology can bepositive but need to be monitored. Whiletechnology has raised opportunities forchildren to become economically secure andliterate, more recent inadvertent impacts oftechnology have spawned declines in extendedfamilies, family meals, and spontaneous peerinteractions. The latter changes have deprivedmany children of experiences that promotepositive growth of the cognitive and caringpotentials of their developing brains. (shrink)

The principles for universal reading models proposed by Frost correspond to developmental theories, in which neurocognitive constraints and cultural experiences shape development. We question his contention that Hebrew word identification is fundamentally about roots, excluding verbal and nominal word-pattern morphemes; and we propose that readers use all information available in stimuli, adjusting for volume and usefulness.

Three forms of implicit knowledge are presented (functional, structural, and procedural). These forms differ in the way they are made explicit and hence in how they are represented by the individual. We suggest that the framework presented by Dienes & Perner does not account for these differences.

Following the introduction, the book provides an overview of energy use patterns in the aggregate U.S. building population.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dogma and Ecumenism: Vatican II and Karl Barth's Ad Limina Apostolorum ed. by Matthew Levering, Bruce L. McCormack, and Thomas Joseph White, O.P.Gavin D'CostaDogma and Ecumenism: Vatican II and Karl Barth's Ad Limina Apostolorum edited by Matthew Levering, Bruce L. McCormack, and Thomas Joseph White, O.P. (Washington, DC: Catholic University Press of America Press, 2020), ix + 369 pp.In May 1966 Karl Barth visited (...) Rome. He was invited to reflect on the Second Vatican Council, to ask questions to leading curial figures, and peritus theologians, as well as Pope Paul VI. Barth's book Ad Limina Apostolorum: An Appraisal of Vatican II contains his questions and an account from Barth of his visit, along with some other important essays. It is still deeply challenging in its incisiveness, despite its brevity. I have always been struck by Barth's Marian criticisms that are so central to his viewpoint about divine agency and human cooperation. These give us an excellent insight into his ecclesiology. They represent the reasons for much of his questioning of various Roman Catholic positions on all sorts of matters. Eberhard Busch's diaries, while Barth's assistant during this period, form a fascinating complimentary account of the visit. These tell of the not-so-fruitful visit to Augustin Cardinal Bea and the great highpoint (for Barth) of his one-hour audience with Pope Paul VI. Barth was impressed by the Jesuits during his visit, but not so much by the Dominicans. He thought the latter had absorbed too many streams of liberal modernity. The two Dominicans participating in this book turn those tides. Indeed, all the authors could be located within the conserving wings of their ecclesial membership, which makes the volume all the stronger in raising serious unresolved disagreements and noting important common ground. It is testimony to Barth's enduring value that this volume seems so timely. The Barth Centre at Princeton and the Pontifical Faculty of the Dominican House in Washington were the sponsors of this collection.The volume is structured around five of the key documents commented on by Barth, with a Catholic and Reformed voice reflecting on both the particular document and Barth's input (with the exception of Francesca Aran Murphy, who deals with George Lindbeck rather than Barth), thereby simultaneously pushing forward the Catholic–Reformed engagement with the Council and with Barth. There is a preface with a penetrating introduction by Thomas Joseph White, O.P., and an irenic opening chapter by Matthew Levering on biblical renewal at Vatican II. Then follow the twin reflections on the five documents.First (and rightly so) comes the Dogmatic Constitution on Revelation, Dei Verbum. Katherine Sonderegger develops a nuanced reflection on the metaphor of Scripture as mirror of God (found in Dei Verbum), showing [End Page 971] a deep appreciation of currents within Dei Verbum that Barth had not detected, but which are more connective with his concerns and preoccupations. Lewis Ayres rather impishly takes what Barth saw as the main weakness of the text (its chapter 2: "Handing on Divine Revelation") and makes it the greatest strength. Ayers provides a deeply learned and original exploration of the concept of "tradition" as sacramental. In this duet, Barth comes out looking like he may have missed hearing the melodies while too closely studying the score.Then follow two profound essays on Lumen Gentium, the Dogmatic Constitution on the Church. Christoph Schwöbel builds up a strong Protestant case for the necessary visible ecclesial identity of the Church, thus showing a deep convergence without denying differences that remain. White, in a deeply insightful and probing essay, goes to the heart of the ecclesiological difference between Barth and Yves Congar (and some other key Catholics at the time): the relationship between uncreated divine agency and created human agency, especially within the context of the post-apostolic Church. White suggests that, without some stable ecclesial mediations, there can be no proper relationship envisaged between the transcendent causality of God operating in Christ and the created, active cooperative acts with this grace. While building up both a metaphysical and a theological case against Barth's criticisms... (shrink)

Questions concerning issues in Christology in Conflict are addressed. James Buckley’s attention to Barth’s metaphysical account and Rahner’s notion of Jesus as Realsysmbol are highlighted and clarified. Criticisms by Robert Krieg are briefly discussed and answered. Finally, though Rahner’s transcendental account of the person of Jesus is shown to lead to certain logical inconsistencies, it is argued, nevertheless, that his christology, though internally incoherent, is valuable.

Questions concerning issues in Christology in Conflict are addressed. James Buckley’s attention to Barth’s metaphysical account and Rahner’s notion of Jesus as Realsysmbol are highlighted and clarified. Criticisms by Robert Krieg are briefly discussed and answered. Finally, though Rahner’s transcendental account of the person of Jesus is shown to lead to certain logical inconsistencies, it is argued, nevertheless, that his christology, though internally incoherent, is valuable.

The function of meiotic recombination has remained controversial, despite recent inroads into mechanisms. Ideas concerning a possible role of recombination in the elimination or efficient incorporation of mutations have been backed by theoretical studies but have lacked empirical support. Recent investigations into the basis for local variations in recombination frequency in yeast have uncovered a strong association between recombination initiation sites and transcriptional regulatory sequences. Other recent studies indicate a strong correlation between transcription and mutation rates in yeast genes. Taken (...) together, these data imply that distributions of recombination and mutation frequencies may be strongly correlated. This suggests that recombination may be targeted to genomic sites of high mutation frequency; such a ‘mutation‐tracking’ function would clearly aid in the shuffling of mutations to break up unfavorable and create favorable allelic combinations. Moreover, recent insights into the mechanism of gene conversion in yeast reveal a very strong inherent bias in favor of alleles on the non‐initiating homolog. Combined with mutation tracking, these findings suggest a novel and general mechanism by which allelic gene conversion may act to eliminate mutations. (shrink)

Uses real-life examples and five basic moral principles to encourage teens to make the right choices in various situations related to friends, family, school, and relationships.

An expert on ethical issues offers straightforward, easy-to-follow advice on how to handle difficult and complex situations at work, in relationships, and in everyday life, presenting a four-step program designed to help readers make the best decisions possible. Original.