Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end of life discussions. Patients have (...) the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options. (shrink)

Advance directives are critically important for capable individuals who wish to avoid the burdens of life-prolonging interventions in the advanced stages of dementia. However, this paper will argue that advance directives should have less application to questions about feeding patients during the clinical course of dementia than often has been presumed. The argument will be framed within the debate between Ronald Dworkin and Rebecca Dresser regarding the moral authority of precedent autonomy to determine an individual’s future end-of-life care plan. We (...) will use a brief analysis of the positions taken in two important papers that come out of the Dworkin/Dresser debate and a hypothetical patient, John, who will be followed from diagnosis of dementia to death, to show how advance directives should apply to key points in the progression of his disease, particularly in relation to food and nutrition. (shrink)

“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)

We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This orientation, combined with (...) a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (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...

Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably. But these emotions are distinct, and they are not all equally fitting in the same circumstances. This indicates a problematic ambiguity in the moral distress concept that obscures its distinctiveness, its relevant circumstances, (...) and how individual clinicians and the medical community should practically respond to it. We argue that, in a range of situations that are said to be morally distressing, the characteristic emotion can be well‐understood in terms of what Bernard Williams calls “agent‐regret.” We show what can thereby be gained in terms of a less ambiguous concept and a more adequate ethical response to this distinctive and complex clinician experience. (shrink)

Injuries from failed suicide attempts account for a large number of patients cared for in the emergency and trauma setting. While a fundamental underpinning of clinical ethics is that patients have a right to refuse treatment, individuals presenting with life-threating injuries resulting from suicide attempts are almost universally treated in this acute care setting. Here we discuss the limitations on physician ability to determine capacity in this setting and the challenges these pose in carrying out patient wishes.

This paper attempts to provide a descriptive theoretical overview of the medical futility debate. I will first argue that quantitative data cannot alone resolve the medical futility debate. I will then examine two aspects of medical futility, which I call the prospective and immediate, respectively. The first involves making prospective factual and value judgments about the efficacy of proposed medical interventions, while the latter involves making value judgments about ongoing medical conditions where the clinical data are clear. At stake is (...) the nature and scope of individual rights. Thus, I maintain there is an undeveloped aspect to the medical futility debate and, briefly, analyze two political perspectives which give rise to different understandings of medical futility. The view that I will defend is that only a system with defined collective goals can accommodate a normative concept of medical futility. These larger questions are the value options which, if unaddressed, may be settled by default of economic grounds. (shrink)

Medical students’ concerns during clinical clerkships may not always be addressed with mentors who work under significant time constraints. This study examined 3rd year students’ survey responses regarding patient encounters to elucidate what may be hidden aspects of their learning environment. We analyzed results to an 18-item survey completed during a required ethics and professionalism course in third-year medicine clerkships over a period of 18 months. The survey covered types of concerns elicited by patient encounters, interactions with mentors about concerns, (...) perceptions of mentors, and level of moral distress. We also examined results of a 7-item evaluation of small group discussions during the study period. 1210 surveys and 195 evaluations constituted the study samples. Students’ concerns related primarily to ethics (36.4%, n = 441) and quality of care (34.5%, n = 418). Concerns had not been raised with a mentor in 535 (44.2%) instances. Students experienced moral distress in connection with 35.4% (n = 324) of cases; this was particularly common when a concern applied to a mentor. Higher levels of moral distress were associated with a lower likelihood of wishing to emulate the mentor (r = -0.27, p <.001). Two thirds of students, 66.9% (n = 107), stated that small group discussions where concerns were discussed lowered their stress levels. We suggest that clinical mentors be made aware of students’ learning needs and that structured discussions be available for students to articulate concerns with peers and facilitators in efforts to uncover elements of the hidden curriculum with the goal of optimizing students’ well-being, learning and professional development. (shrink)

This is a patient in the relatively early stages of a serious chronic disease requiring ongoing vigilant management if acute complications are to be minimized. In today's healthcare system, we see...

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)

AbstractHow far can smart machines, or carebots, go in performing the profoundly intimate human work of patient caregivers? How will mechanization alter how we understand the essential features of the human task of caregiving and the role of the caregiver? It is these complex questions, with real world implications, that this article discusses in reviewing “Caregiving, Carebots, and Contagion” by philosopher and bioethicist Michael Brannagan.

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees , almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

The critique to which Blumenthal-Barby et al. (2022), respond—that philosophy has little left to do in bioethics—reflects a common assumption that normative theorizing first generates general moral...

For Lack of a Better Plan: A Framework for Ethical, Legal, and Clinical Challenges in Complex Inpatient Discharge Planning Content Type Journal Article Pages 311-326 DOI 10.1007/s10730-009-9117-6 Authors Jane Jankowski, Albany Medical Center Albany NY 12208 USA Terese Seastrum, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Robert N. Swidler, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Wayne Shelton, Alden March Bioethics Institute, Albany Medical College 47 New Scotland Avenue, MC 153 Albany NY 12208-3478 USA (...) Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Perceptual attention is essential to both thought and agency, for there is arguably no demonstrative thought or bodily action without it. Psychologists and philosophers since William James have taken attention to be a ubiquitous and distinctive form of consciousness, one that leaves a characteristic mark on perceptual experience. As a process of selecting specific perceptual inputs, attention influences the way things perceptually appear. It may then seem that it is a specific feature of perceptual representation that constitutes what it is (...) like to consciously attend to an object. In fact conscious attention is more complicated. In what follows, I argue that the phenomenology of conscious attention to what is perceived involves not just a way of perceptually locking on to a specific object. It necessarily involves a way of cognitively locking on to it as well. (shrink)

Your perspective on life can be your power or your prison. It can serve your anxiety, your stress, and your depression, or it can support your peace, your courage, and your growth. Trent Shelton, one of the most groundbreaking and dynamic teachers of our time, wants to help you chart your path to a new perspective. Protect Your Peace offers tools to reshape your mindset and redefine the meaning you find in your life-tools that he knows can work for (...) you, because he has used them himself to transform his own life. In these pages, Trent outlines nine essential principles to help you: · Protect your energy from the things that drain it · Protect your mind from the things that distract you · Protect your soul from the things that don't fulfill you You'll learn simple strategies for setting clear boundaries, disconnecting from negativity, honing your vision and your focus, and bringing your life into alignment with your true power and purpose-with Trent as your straight-talking, profoundly inspiring guide who's with you every step of the way. Trent lets you know in no uncertain terms that there is a war on-a war for your worth. The toughest battle in it is the one you're fighting within yourself. And Protect Your Peace gives you a road map to victory. (shrink)

In 2004, the agricultural economies of many rural communities in the United States were impacted by the cessation of a price-support and supply-control program for tobacco production. Tobacco was not only an important livelihood, but also was central to social and cultural life. Using a social–ecological systems lens and the adaptive cycle metaphor, we examine the reorganization of agriculture in communities that previously produced tobacco under the program. Specifically, we seek to understand how transitional policy that provided financial support to (...) tobacco farmers interacted with other social, cultural, physical and human capitals to condition system reorganization. We conducted semi-structured interviews with farmers, extension agents, and policy makers in Kentucky as well as examined trends in income and number of farmers before and after the transition as indicators of reorganization. We determined that the financial support was perceived as helpful in supporting the transition and that tobacco farmers reorganized their livelihoods primarily around existing, remnant assets and endogenous capacities. In addition, we determined that though the agricultural system may be reorganizing economically, it is not necessarily supportive of the same social bonds and values that co-existed with tobacco economy. Understanding agricultural economies as part of complex social–ecological systems that consist of interconnected values, identities, ecology and social ties is important for developing policies to support systems and communities through economic transitions. (shrink)

This chapter will review selected aspects of the terrain of discussions about probabilities in statistical mechanics (with no pretensions to exhaustiveness, though the major issues will be touched upon), and will argue for a number of claims. None of the claims to be defended is entirely original, but all deserve emphasis. The first, and least controversial, is that probabilistic notions are needed to make sense of statistical mechanics. The reason for this is the same reason that convinced Maxwell, Gibbs, and (...) Boltzmann that probabilities would be needed, namely, that the second law of thermodynamics, which in its original formulation says that certain processes are impossible, must, on the kinetic theory, be replaced by a weaker formulation according to which what the original version deems impossible is merely improbable. Second is that we ought not take the standard measures invoked in equilibrium statistical mechanics as giving, in any sense, the correct probabilities about microstates of the system. We can settle for a much weaker claim: that the probabilities for outcomes of experiments yielded by the standard distributions are effectively the same as those yielded by any distribution that we should take as a representing probabilities over microstates. Lastly, (and most controversially): in asking about the status of probabilities in statistical mechanics, the familiar dichotomy between epistemic probabilities (credences, or degrees of belief) and ontic (physical) probabilities is insufficient; the concept of probability that is best suited to the needs of statistical mechanics is one that combines epistemic and physical considerations. (shrink)

This article provides a detailed overview of the neuroscience of consciousness.

From the leader of the nation's most powerful animal-protection organization comes a frontline account of how conscience and creativity are driving a revolution in American business that is changing forever how we treat animals and create wealth. Wayne Pacelle of the Humane Society of the United States reveals how entrepreneurs, Fortune 500 CEOs, world-class scientists, philanthropists, and a new class of political leaders are driving the burgeoning, unstoppable growth of the "humane economy." Every business grounded on animal exploitation, Pacelle (...) argues, is ripe for disruption. Indeed each one of us is, and will be, touched by this far-reaching transformation in food and agriculture; in the pharmaceutical, chemical, and cosmetics industries; in film, television, and live entertainment; in tourism and wildlife management; in the pet trade for dogs and cats and exotic wildlife; and in fur and leather fashions. Collectively it promises to relieve or end the suffering of billions of creatures, while allowing businesses aligned with the best instincts and values of their customers to flourish. Pacelle shows, for instance, how the cruelties of industrial chicken farming are quickly becoming obsolete with a visit to Hampton Creek, the makers of a plant-based egg substitute and the world's fastest-growing food startup ever. Pacelle also recounts the stories of how established companies are joining in this economic transformation: from Petco and PetSmart, which have turned the conventional pet store model on its head by forswearing puppy mill suppliers in favor of shelter dogs; to John Paul Mitchell Systems, the Body Shop, and Lush, which use safe ingredients instead of animal tests for their cosmetics; to major food retailers like Whole Foods, Chipotle, and even Costco and Walmart, which are embracing animal welfare standards that are one by one unwinding the horrors of the factory farm. The Humane Economy is a clarion call to business leaders and to the world's growing animal protection movement; it is equally a warning to the static thinking of animal-use industries and their apologists: "Here, in this humane economy," Pacelle argues, "human ingenuity meets human virtue, and we discover at last that we can have it both ways--a better world for us and for animals, too. (shrink)

The most comprehensive book on the topic, Thinking about Good and Evil traces salient Jewish ideas about why innocent people seem to suffer, why evil individuals seem to prosper, and God's role in matters of (in)justice, from antiquity to modernity.

The Ethics of Artificial Intelligence in Education identifies and confronts key ethical issues generated over years of AI research, development, and deployment in learning contexts. Adaptive, automated, and data-driven education systems are increasingly being implemented in universities, schools, and corporate training worldwide, but the ethical consequences of engaging with these technologies remain unexplored. Featuring expert perspectives from inside and outside the AIED scholarly community, this book provides AI researchers, learning scientists, educational technologists, and others with questions, frameworks, guidelines, policies, and (...) regulations to ensure the positive impact of artificial intelligence in learning. (shrink)

Hegel's very first acknowledged publication was, among other things, an attack on Fichte. In 1801, Hegel was still laboring in almost complete obscurity, while Fichte was an international sensation, though already somewhat past the peak of his meteoric career. In the 1801 Differenzschrift, Hegel cut his teeth by criticizing Fichte's already widelycriticised Wissenschaftslehre, and by demonstrating that Schelling's philosophical system was not simply to be equated with it. Fichte himself never bothered to respond to Hegel's criticisms; indeed he never publicly (...) acknowledged their existence. This was not because he was unconcerned with criticisms of his views; quite the contrary. But at the time he had bigger fish to fry. He responded to Jacobi's criticisms, and to Schelling's; he replied in great detail to critical questions raised by Reinhold, and with vituperative intensity to objections raised by skeptics and purportedly loyal Kantians. But Hegel's Differenzschrift was left without a Fichtean rebuttal. This is a pity, both because of the missed opportunity to illuminate by controversy central issues at stake in the post-Kantian period, but also because it made it easier for Hegel simply to reiterate his youthful criticism as if it were the last word. And reiterate it he did: in one form or another Hegel's early criticisms of Fichte reappear at every subsequent stage of his career: in the Phenomenology, in the Science of Logic, in the Encyclopaedia, as the final chapter in Hegel's History of Philosophy, and in countless other minor works and documents from the Nachlass and correspondence. (shrink)

This books delineates the seismic shifts of the twentieth century humanities by way of a close examination of the dynamic landscape of modern language, criticism and philosophy. In this manner, it argues that both philosophy and literary criticism have dovetailed in the twenty-first century. Starting out as a survey of literary criticism in its broadest terms, later chapters - which are more expository - assess recent movements within modern literary theory. These are located with respect to the post-Russell and Fregean (...) “linguistic turn” in philosophy. Designed for specialists and non-specialists alike; philosophers, literary critics and even students of the modern critical tradition, the argument takes a novel stance towards modern criticism, language and philosophy, arguing for a return to a more formalist and rhetorical approach to literary criticism, while taking care not to indulge too many “political pathologies” when engaging with texts. (shrink)

Abortion and euthanasia are among the most controversial topics in society today. Abortion is simply any action that intentionally causes the death and removal from the womb of an unborn child. Likewise, Euthanasia is the act of intentionally ending the life of a person who is elderly, terminally ill, or suffering from some incurable injury or disease. In this book, Dr. Wayne Grudem attempts to give an accurate summary of biblical teachings related to abortion and euthanasia, and also to (...) represent fairly the arguments of people who disagree with his positions. (shrink)