Christian miller invites further clarification about the relationship between accountability and autonomy. Whereas embracing accountability to others for one’s responsibilities in those relationships emphasizes relationality, autonomy accents the individual’s own capacities to exhibit agency in enacting one’s decisions. Accordingly, we theorize that relational capacities for empathic concern and perspective-taking are especially important in the virtue of accountability. The capacity for self-regulation may serve both one’s autonomous pursuits and accountability for carrying out one’s responsibilities...

Higher education has expanded at astonishing rates around the world. We seek to understand the oppositions that periodically arise, which may produce enrollment declines and/or imposition of political controls. The post-1945 growth of higher education was – to a greater extent than is often recognized – propelled by the liberal, and later neoliberal, international order. Oppositions arise from illiberal alternatives, which also may organize globally. The recent weakening of the global liberal order, associated with growing populism and nationalism, creates conditions (...) for a new wave of oppositions. We hypothesize that attacks on higher education emerge in countries less integrated into world society and in countries linked to international structures that support illiberal alternatives. We examine cross-national data on higher education over the period 1960–2017. Enrollments and funding are higher in societies more tightly linked to world society and lower in countries tied to illiberal international organizations. Analyses of enrollments in various fields, constraints on academic freedom, and terrorist attacks on education institutions show similar pattern. Finally, we observe heterogeneity in the forms of illiberal opposition: countries that suppress academic freedom generally are less likely to restrict enrollments. (shrink)

Scholars and professional organizations in bioethics describe various approaches to “quality assessment” in clinical ethics. Although much of this work represents significant contributions to the literature, it is not clear that there is a robust and shared understanding of what constitutes “quality” in clinical ethics, what activities should be measured when tracking clinical ethics work, and what metrics should be used when measuring those activities. Further, even the most robust quality assessment efforts to date are idiosyncratic, in that they represent (...) evaluation of single activities or domains of clinical ethics activities, or a range of activities at a single hospital or healthcare system. Countering this trend, in this article we propose a framework for moving beyond our current ways of understanding clinical ethics quality, toward comprehensive quality assessment. We first describe a way to conceptualize quality assessment as a process of measuring disparate, isolated work activities; then, we describe quality assessment in terms of tracking interconnected work activities holistically, across different levels of assessment. We conclude by inviting future efforts in quality improvement to adopt a comprehensive approach to quality assessment into their improvement practices, and offer recommendations for how the field might move in this direction. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

Blumenthal-Barby (2024) argues that the concept of personhood should not be used in bioethics, and part of her justification is that personhood is not consistent with the public’s values. In this c...

To gain insight into human nature philosophers often discuss the inferior performance that results from deficits such as blindsight or amnesia. Less often do they look at superior abilities. A notable exception is Herbert Dreyfus who has developed a theory of expertise according to which expert action generally proceeds automatically and unreflectively. We address one of Dreyfus’s primary examples of expertise: chess. At first glance, chess would seem an obvious counterexample to Dreyfus’s view since, clearly, chess experts are engaged in (...) deep strategic thought. However, Dreyfus’s argument is subtle. He accepts that analysis and deliberation play a role in chess, yet he thinks that all such thought is predicated on intuitive, arational expert perception, and action. We argue that even the so-called intuitive aspect of chess is rational through and through. (shrink)

The requirement of the Association to Advance Collegiate Schools of Business to include business ethics in the curriculum has prompted business programs to teach ethics either integrated across the curriculum or in standalone classes. The question addressed here is how to engage students in thinking deeply and empathetically about ethical issues impacting corporate social responsibility. This research focused on using a thought experiment developed by John Rawls in which students examined CSR issues from the perspective of six stakeholder groups. (...) A pre-test/post-test design measured the effectiveness of an instruction module on CSR coupled with an active exercise using Rawls’ veil of ignorance and original position. Results indicate that students placed greater responsibility on the stockholders and board of directors after taking this module. The implication of the Rawlsian technique to use stakeholder empathy is discussed as a tool for engaging business ethics students. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system was significantly faster than the manual system for lung function evaluation, loan of equipment, and checking for overdue equipment. The production of correspondence was slightly slower with the computer. b. All outpatient episodes, but only 43 of 65 of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high. Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice. After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system (CS) was significantly faster than the manual system (MS) for lung function evaluation (CS=7.63 min/test, MS=12.25 min/test), loan of equipment (CS=0.40 min/loan, MS=2.07 min/loan), and checking for overdue equipment (CS=0.49 s/record, MS=9 s/record). The production of correspondence was slightly slower with the computer (CS=9.30 min/letter, MS=8.54 min/letter). b. All outpatient episodes, but only 43 of 65 (66%) of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high (£72 178). Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice (£4049–4765). After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

Rather than treating them as discrete and incommensurable ideas, we sketch some connections between human flourishing and human dignity, and link them to human rights. We contend that the metaphor of flourishing provides an illuminating aspirational framework for thinking about human development and obligations, and that the idea of human dignity is a critical element within that discussion. We conclude with some suggestions as to how these conceptions of human dignity and human flourishing might underpin and inform appeals to human (...) rights. (shrink)

In this case (5) yields the result that A and D are I-related, but neither is I-related to B or C – the original person has two beginnings of existence. To get round this we need to add to (5)’s right-hand side the condition that there is no pair of distinct, simultaneously occurring person-stages u and v such that u is R-related to x and y and v is R-related to x and no pair of distinct, simultaneously occurring personstages u (...) and v such that u is R-related to x and y and v is R-related to y. In fact this condition can replace (iic) on the RHS of (5). (shrink)

Quine (1960, Word and object. Cambridge, Mass.:MIT Press, ch. 2) claims that there are a variety of equally good schemes for translating or interpreting ordinary talk. ‘Rabbit’ might be taken to divide its reference over rabbits, over temporal slices of rabbits, or undetached parts of rabbits, without significantly affecting which sentences get classified as true and which as false. This is the basis of his famous ‘argument from below’ to the conclusion that there can be no fact of the matter (...) as to how reference is to be divided. Putative counterexamples to Quine’s claim have been put forward in the past (see especially Evans 1975; 1975, Journal of Philosophy, LXXII(13), 343–362. Reprinted in McDowell (Ed.), Gareth Evans: Collected papers. Oxford: Clarendon Press.), and various patches have been suggested (e.g. Wright (1997, The indeterminacy of translation. In C. Wright & B. Hale (Eds.), A companion to the philosophy of language (pp. 397–426). Oxford: Blackwell)). One lacuna in this literature is that one does not find any detailed presentation of what exactly these interpretations are supposed to be. Drawing on contemporary literature on persistence, the present paper sets out detailed semantic treatments for fragments of English, whereby predicates such as ‘rabbit’ divide their reference over four-dimensional continuants (Quine’s rabbits), instantaneous temporal slices of those continuants (Quine’s rabbit-slices) and the simple elements which compose those slices (undetached rabbit parts) respectively. Once we have the systematic interpretations on the table, we can get to work evaluating them. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka O. (...) Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

No one who attended the 2010 national public health law conference hosted by the Public Health Law Association and the American Society of Law, Medicine & Ethics could miss the sense of excitement and momentum. The revival of this annual public health law meeting, with the support of the Robert Wood Johnson Foundation, the energetic leadership of the PHLA president and board, ASLME’s expert guidance, and a rousing address by Dr. Tom Frieden, Director of the Centers for Disease Control and (...) Prevention, symbolize the continued commitment of a wide range of important individuals and institutions to the proposition that law is of substantial importance to public health. But there is more than just symbolism to be excited about. CDC’s public health law program continues to champion efforts to promote the use and understanding of law as a public health tool. (shrink)

No one who attended the 2010 national public health law conference hosted by the Public Health Law Association and the American Society of Law, Medicine & Ethics could miss the sense of excitement and momentum. The revival of this annual public health law meeting, with the support of the Robert Wood Johnson Foundation, the energetic leadership of the PHLA president and board, ASLME’s expert guidance, and a rousing address by Dr. Tom Frieden, Director of the Centers for Disease Control and (...) Prevention, symbolize the continued commitment of a wide range of important individuals and institutions to the proposition that law is of substantial importance to public health. But there is more than just symbolism to be excited about. CDC’s public health law program continues to champion efforts to promote the use and understanding of law as a public health tool. (shrink)

Provision of adequate nutrition to elderly patients who develop dysphagia after a stroke can be quite challenging, often leading to the placement of a percutaneous entero‐gastrostomy (PEG) tube for nutritional support. This hypothetical case describes the additional challenge of cross‐cultural belief that leads a daughter to provide oral feeding to her mother, an act that the medical team believes is dangerous and the daughter sees as salubrious. In this case, what is the proper balance between patient safety and deference to (...) cultural traditions and norms? Where are the limits? Two commentaries offer insights for conflict resolution, including recommending that the medical team seek to understand the cultural motivations of the family, balancing safety and respect for cultural norms. The second commentary also disagrees with the team's presumption that the daughter's feeding of her mother is a greater threat to the patient than the PEG tube feeding is. (shrink)

Alcoholism is endemic in Nigeria’s traditional religion and society. This abuse is especially common at New Yam festivals, Ekpe, Ekpo and Nmanwu masquerades festivals, burial rituals, birth, marriage and naming ceremonies. Some claim that this is driven by specific beliefs and activities in African culture, such as beliefs in ancestors, libation, hospitality and entertaining guests and strangers and the desire to maintain the cultural traditions of the ancestors. Alcohol abuse has generated major health and social issues for abusers, their families (...) and society, plunging families, towns and tribes into crises and conflicts that bring economic and political retrogression. This research studied how the African traditional religion encourages alcohol misuse and how to decrease it for national development. This study was on Nigeria’s South-South region. The study uses qualitative and ethnographic research methodologies, including key informants, in-depth and focus group interviews and the reward deficiency syndrome as a theoretical framework. Although African Traditional Religion (ATR) supports alcohol usage, greed, a lack of self-control, peer pressure, indiscipline and lack of moral upbringing led to alcohol misuse, which harms the person, family, community and country as a whole. Education and enlightenment are a remedy to free alcoholics and utilise them for national integration and development.Contribution: Some say Africans drink a lot because their religious heritage promotes drinking, leading to abuse. However, peer pressure, selfishness, a lack of self-control, bad parenting and not religion push persons with reward deficiency syndrome into alcoholism, according to this research. (shrink)