For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

Our aim in this paper is to evaluate Frank Jackson and Philip Pettit’s ‘program explanation’ framework as an account of the autonomy of the special sciences. We argue that this framework can only explain the autonomy of a limited range of special science explanations. The reason for this limitation is that the framework overlooks a distinction between two kinds of properties, which we refer to as ‘higher-level’ and ‘higher-order’ properties. The program explanation framework can account for the autonomy of special (...) science explanations that appeal to higher-level properties but it does not account for the autonomy of most of those explanations that appeal to higher-order properties. (shrink)

The primary purpose of this study was to better understand the effects of consumers' perceived self-efficacy on their perceptions of the ethicality of a fear appeal and subsequent attitudes towards the ad, the brand, and purchase intentions. In this study, a total of 305 consumer responses were investigated to determine attitudes toward a fear appeal ad. The results suggest that the use of strong fear appeals may not be perceived as unethical if consumers feel they can use the recommended product (...) to effectively eliminate the threat posed by the ad. (shrink)

A critical examination of contemporary nursing theory suggests that two distinct discourses coexist within this field. On the one hand, proponents of the ‘knowledge discourse’ argue that nurses should drop the ‘virtue script’ and focus on the scientific and technical aspects of their work. On the other hand, proponents of the ‘caring discourse’ promote a view of nursing that embodies humanistic qualities such as compassion, empathy and mutuality. In view of this, we suggest a way to reconcile both discourses despite (...) the fact that they appear to be at odds theoretically and practically. To that end, we argue that nursing theory must give a prominent role to the Aristotelian conception of virtue, and we offer an account that includes both character and intellectual virtues. This account allows for a focus on moral competence but also accommodates the demands for discipline‐specific knowledge. Our account incorporates the caring discourse by suggesting a way for individuals to cultivate the conditions within themselves that make ‘caring in nursing’ possible, while the knowledge discourse is accommodated via the acquisition of the intellectual virtues. The process for achieving both these ends is the same: an intention to consistently develop, hone and exercise certain character traits over time. (shrink)

We defend Jaegwon Kim’s ‘causal inheritance’ principle from an objection raised by Jurgen Schröder. The objection is that the principle is inconsistent with a view about mental properties assumed by Kim, namely, that they are second-order properties. We argue that Schröder misconstrues the notion of second-order property. We distinguish three notions of second-order property and highlight their problems and virtues. Finally, we examine the consequence of Kim’s principle and discuss the issue of whether Kim’s ‘supervenience argument’ generalizes to all special (...) sciences or not. (shrink)

We evaluate the scope of Jaegwon Kim's “supervenience argument” for reduction. Does its conclusion apply only to psychology, or does it generalize to all the special sciences? The claim that the supervenience argument generalizes to all the special sciences if it goes through for psychology is often raised as an objection to the supervenience argument. We argue that this objection is ambiguous. We distinguish three readings of it and suggest that some of them make it a plausible claim, whereas other (...) readings make it implausible. We suggest that this ambiguity is the result of picturing the world as being hierarchically organized in levels, with the domain of physics at the bottom and the domains of the social sciences at the top. The plausibility of the objection depends on how we think of this picture. This popular picture, we suggest, involves three different dimensions along which reduction may occur. (shrink)

(No abstract is available for this citation).

Typically, the determination of death by neurological criteria follows a very specific protocol. An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to “say goodbye,” and at such a time to permit organ retrieval (with authorization of the patient or consent of the next of kin). Such a process maximizes transparency and ensures generalizability. In exceptional circumstances, however, it may be necessary (...) to deviate from this protocol in order to spare family members unnecessary suffering and to reduce moral distress felt by clinical staff. It may also be appropriate, we argue, to refrain from even inquiring about organ donation when the next-of-kin is not only certain to refuse, but lacks the decision-making capacity to potentially consent. The case described in this article calls into question generally reliable assumptions about determination of death by neurological criteria, where the best the clinical team could do for the patient and his family was “the least bad option.”. (shrink)