In the article Privacy and Health Practices in the Digital Age, the authors describe current privacy challenges for digital health data and review the theoretical framework on privacy in the contex...

The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be able to reliably use (...) the tool.We developed a short course to train ethics consultants in using the ECQAT, and evaluated whether the participants (1) achieved an acceptable level of calibration in matching expert-established quality scores for a set of ethics consultations, and (2) were satisfied with the course. We recruited 28 ethics consultants to participate in a virtual, six-session course. At each session participants and faculty reviewed, rated, and discussed one to two ECRs. The participants’ calibration in matching expert-established quality scores improved with repeated exposure at all levels of ethics consultation quality. Participants were generally more accurate when assessing consultation quality at the dichotomous level of “acceptable” (scores of three or four) versus “unacceptable” (scores of one or two) than they were with a more specific score. Participants had higher rates of accuracy with the extreme ratings of “strong” (level four) or “poor” (level one). Although participants were highly satisfied with the course, only a minority of participants achieved the prespecified acceptable level of calibration (that is, 80 percent or greater accuracy between their score and expert-established scores). These results suggest that ECQAT training may require more sessions or need modification in the protocol to achieve higher reliability in scoring. Such trainings are an important next step in ensuring that the ECQAT is a tool that can be used to promote improvement in ethics consultation quality. (shrink)

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool. ECQAT enables raters to assess the (...) quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation, established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT,.. (shrink)

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)

Volume 20, Issue 7, July 2020, Page 145-147.

The field of clinical ethics consultation has matured into a multidisciplinary profession, with clinical ethics consultants (CECs) being trained in bioethics, philosophy, theology, law, medicine, n...

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

The argument in this paper is that the exclusion of empirical research has led to a deficiency in the Positivist model; the neglect of conflict in the form of the trouble-case. In the attempt to define law in a relatively narrow way Positivists have avoided important knowledge about social behavior. In addition the analytical method of Positivism has been connected with a value-position which tends to exaggerate the extent to which law functions within social structures as an orderly system. One (...) consequence of this perspective is that the role of conflict in the law process is hardly appreciated. Studies of law in some primitive societies suggest that although social behavior generally is not regulated in rule-terms, conflict often is institutionalized in a manner capable of providing norms appropriate to new situations. It is suggested that the focus upon the trouble-case is more likely to develop our understanding of conflict as a dynamic element in the law process. (shrink)

Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about (...) autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

The Eurozone crisis has triggered profound political and economic changes across the debtor member states. This article shows how the crisis and the imposition of austerity policies by the Troika have forced Spain to pursue internal devaluation as a means of economic adjustment through the reduction of real wages, increased pressure for liberalizing labor market institutions, and given Spain’s conservative government the opportunity and cover to pursue radical neoliberal labor law reforms. Spain’s 2012 labor law reforms went well beyond external (...) demands. The crisis and the Troika’s policy demands generated mass unemployment, devastated Spain’s Socialist Party, and created the enabling conditions for economic reforms. But domestic partisan considerations led the conservative People’s Party to commandeer the crisis to weaken unions as the electoral and organizational base of the center-left opposition. The PP channeled reform into an attack on labor that decisively shifted power to employers. As organized labor relations were reduced to concession bargaining, real wages have plummeted for the vast majority of Spaniards, even as mass unemployment and economic stagnation persist. Analysis suggests the emergence of a winner-take-all economy that will have lasting consequences for the Eurozone and the European Union. (shrink)

This paper discusses the role of religious speech in the public square and the common school. It argues for more openness to political theology than many liberals are willing to grant and for an educational strategy of engagement over one of avoidance. The paper argues that the exclusion of religious debate from the public square has dysfunctional consequences. It discusses Rawls’s more recent views on public reason and claims that, while they are not altogether adequate, they are consistent with engagement. (...) The outcome of these arguments is applied to three ‘hot button’ issues in US education: creationism, an issue of gay rights, and teaching the Bible in schools. (shrink)

This paper examines two questions. The first is what it would mean for schools to be communities. This question is pursued by examining four metaphors for community: families, congregations, guilds, and democratic polities. Three models of school communities are then sketched. The second question is whether schools that are communities are inherently illiberal. The paper distinguishes between a liberal interpretation of schools as communities, where schools are viewed as limited-purpose free associations, and a communitarian interpretation where community and polity are (...) not adequately distinguished. I argue that, within a framework of liberal pluralism, schools can be communities without being illiberal. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

Translations and commentaries on Greek philosophy.

This essay some first steps toward the naturalization of what I call rational intentionality or alternatively type II intentionality. By rational or type II intentionality, I mean that full combination of rational powers and content-bearing states that is paradigmatically enjoyed by mature intact human beings. The problem I set myself is to determine the extent to which the only currently extant approach to the naturalization of the intentional that has the singular virtue of not being a non-starter can be aggregated (...) up into an account of rational intentionality. I have in mind a broadly defined family of accounts whose main members are the indicator/information-theoretic approach of Dretske (1988), the asymmetric dependence theory of Jerry Fodor (1987, 1990, 1994) and the teleo-semantics of Ruth Millikan (1984, 1993). Somewhat inaccurately, I will call this family of approaches the information-theoretic family. To be sure, there is only a rough family resemblance among the members of the information-theoretic family. Indeed, several intense quarrels divide the members of that family one from another, but the precise outcome of those internecine struggles is not directly relevant to the aims of this essay. ² Taken collectively, the information-theoretic family yields a compelling picture of the place of at least a crude form of intentionality -- what I call frog-like or type I intentionality -- in the natural order. Though frog-like or type I intentionality is, I think, a genuine species of intentionality, it may subsist in the absence of rational powers. It is that species of intentionality enjoyed by irritable creatures who, following Brandom (1994). (shrink)

The primary psychological process leading aggressive children to grow into dysfunctional adults is a defensive mindset, which encompasses a pattern of deviant social information processing steps, including hypervigilance to threat; hostile attributional biases; psychophysiological reactivity, experience of rage and testosterone release (in males); aggressive problem-solving styles; aggressogenic decision-making biases; and deficient behavioral skills. These processes are acquired in childhood and predict adult maladjustment outcomes, including incarceration and premature death. The antecedents of defensive mindset lie in early childhood experiences of trauma (...) and threat. The Fast Track (FT) intervention was designed to improve social competence in aggressive children. A randomized controlled trial demonstrated that FT is effective in preventing externalizing psychopathology; the primary mediating factor is the reduction of defensive mindset processes. This Element concludes with insights that defensive mindset might also explain dysfunction in other realms, including school culture, parenting, marriage, the workplace, intergroup relationships, politics, and international relations. (shrink)

A meta-analytic review of studies that experimentally elicited awe and compared the emotion to other conditions (84; 487 effects; 17,801 participants) examined the degree to which experimentally elicited awe (1) affects outcomes relative to other positive emotions (2) affects experience, judgment, behaviour, and physiology, and (3) differs in its effects if the awe state was elicited through positive or threatening contexts. The efficacy of methods that have been used to experimentally elicit awe and the possibility of assessing changes in the (...) state of the self with experimental awe elicitations were also examined. Meta-analyses with robust variance estimation revealed that awe affected outcomes compared to other positive emotions and control conditions; affected experience, judgment, and behaviour; and had similar effects if elicited through positive or threatening contexts. The ability to compare awe to negative emotion states and its effects on physiology was limited by a small number of available effects. Images, videos, autobiographical recall, and naturalistic exposure were effective in eliciting awe. Exploratory analyses suggested that some processes involved in changes in the self can be related to experimental awe elicitations. These findings suggest awe is a discrete emotion and identifies areas for future investigation. (shrink)

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

Michelle Garcia Winner’s Social Thinking Curriculum is widely used by schools across the USA and has garnered attention internationally. The curriculum addresses social language and behavior deficits among those on the autism spectrum. Although many embrace this curriculum without reservation, the emphasis on social conformity, including avoiding behaviors that make others uncomfortable, merits scrutiny. Individuals who have difficulty understanding social cues and conventions can derive tremendous benefit from learning to fit in, for example, or learning what is likely to make (...) others uncomfortable and why. However, too much emphasis on pleasing others can reinforce undesirable tendencies. For example, autism is already linked to avoidant personality disorder. An emphasis on avoiding making others uncomfortable may also inhibit the development of principled ethical thinking and action. Reframing social thinking to treat it not (or not only) as an end in itself, but as a way to achieve a variety of social and personal goals would go a long way toward addressing the weaknesses of the Social Thinking Curriculum. (shrink)

This paper examines two questions. The first is what it would mean for schools to be communities. This question is pursued by examining four metaphors for community: families, congregations, guilds, and democratic polities. Three models of school communities are then sketched. The second question is whether schools that are communities are inherently illiberal. The paper distinguishes between a liberal interpretation of schools as communities, where schools are viewed as limited-purpose free associations, and a communitarian interpretation where community and polity are (...) not adequately distinguished. I argue that, within a framework of liberal pluralism, schools can be communities without being illiberal. (shrink)

This paper addresses the question of whether the interest liberal societies have in producing liberal citizens gives liberal societies the right to regulate the affairs of illiberal groups. It claims that attempts by Rawls and Galston to make liberalism more “pluralism friendly” by reducing the demands for liberal citizenship fail, and it explores arguments by Amy Gutmann, Susan Moller Okin, Eamonn Callan and Will Kymlicka that support a stronger interest in regulating the socialization practices of illiberal groups. The main conclusion (...) of the article is that we must seek for a context-sensitive balance between the need to produce liberal citizens and other liberal values such as freedom of conscience. (shrink)

This paper responds to Goodwin Liu's argument in Volume II of this Journal that a pedagogy must be supported by an appropriate theory of knowledge, and that the epistemology which best supports the service-learning pedagogy is anti-foundational pragmatism. The author shows that Liu's characterization of the pragmatist model of knowledge does not avoid the dualism which he sees as a fault of the traditional epistemology. After suggesting a remedy to this, the author then extends Liu's argument by indicating the limits (...) to what the appropriately modified epistemological support will sanction. These limits are shown to be more restrictive than Liu suggests. The result is an improved philosophical justification of the service-learning pedagogy and some suggestions for evaluating proposed curriculum. (shrink)