Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed (...) in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. (shrink)

In this issue, Ellen Fox and colleagues report on their national study on ethics consultation in U.S. hospitals, following up on the previous 1999–2000 landmark study. Th...

Volume 20, Issue 3, March 2020, Page 1-5.

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and (...) Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and (...) Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

I am grateful to Felicia Cohn for saying that my commentary “miss[ed] the real role credentialing has in professionalization”, and hope that I can rectify the situation by including...

Bioethicists function in an environment in which their peers - healthcare executives, lawyers, nurses, physicians - assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts (...) that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists. (shrink)

Visual narratives like comics involve a range of complex cognitive operations in order to be understood. The Parallel Interfacing Narrative‐Semantics (PINS) Model integrates an emerging literature showing that comprehension of wordless image sequences balances two representational levels of semantic and narrative structure. The neurocognitive mechanisms that guide these processes are argued to overlap with other domains, such as language and music.

Narratives are an integral part of human expression. In the graphic form, they range from cave paintings to Egyptian hieroglyphics, from the Bayeux Tapestry to modern day comic books (Kunzle, 1973; McCloud, 1993). Yet not much research has addressed the structure and comprehension of narrative images, for example, how do people create meaning out of sequential images? This piece helps fill the gap by presenting a theory of Narrative Grammar. We describe the basic narrative categories and their relationship to a (...) canonical narrative arc, followed by a discussion of complex structures that extend beyond the canonical schema. This demands that the canonical arc be reconsidered as a generative schema whereby any narrative category can be expanded into a node in a tree structure. Narrative “pacing” is interpreted as a reflection of various patterns of this embedding: conjunction, left-branching trees, center-embedded constituencies, and others. Following this, diagnostic methods are proposed for testing narrative categories and constituency. Finally, we outline the applicability of this theory beyond sequential images, such as to film and verbal discourse, and compare this theory with previous approaches to narrative and discourse. (shrink)

The practice of using race or ethnic origin as a distinguishing feature of populations or individuals seeking health care is a universal and well-accepted custom in medicine. Although the origin of this practice may, in part, reflect past prejudicial attitudes, its use today can certainly be defended as a useful means of improving diagnostic and therapeutic efforts. Indeed, the tradition of dividing populations by some racial distinction in clinical research has nearly always revealed differences in mechanisms of disease and disease (...) frequency that can enhance diagnostic and therapeutic precision.At the conference occasioning this symposium, Professors Duster and Rotimi provided persuasive evidence that so-called race is not an accurate way to distinguish populations and that identification by race has led to serious prejudice. Professor Cho pleaded that race should never be used to characterize population differences. (shrink)

Much attention has been given to determining whether an adolescent patient has the capacity to consent to research. This study explores the factors that influence adolescents' decisions to participate in a research study about youth violence and to determine positive or negative feelings elicited by being a research subject. The majority of subjects perceived their decision to participate to be free of coercion, and few felt badly about having participated. However, adolescents who were alone in the room during the assent (...) process were more likely to report that they chose freely to be a research subject. This study may influence the ways physicians communicate with adolescent patients around research assent within a clinical care environment. 1This article was presented at the Annual Meetings of The Pediatric Academic Societies in Baltimore, MD and The Society for Academic Emergency Medicine in Atlanta, GA in May, 2001. (shrink)

Growing attention is being paid to the importance of trust, and its corollaries such as mistrust and distrust, in health service and the central place they have in assessments of quality of care. Although initially focussing on doctor-patient relationships, more recent literature has broadened its remit to include trust held in more abstract entities, such as organisations and institutions. There has consequently been growing interest to develop rigorous and universal measures of trust.

Morin argues that ideographies are limited because graphic codes lack a capacity for proliferating standardization. However, natural graphic systems display rich standardization and can be placed in sequences using complex combinatorial structures. In contrast, ideographies are not natural, and their limitations lie in their attempts to artificially force a graphic system to behave like a writing system.

This paper describes the topological aspect of a logic-based, artificial intelligence approach to formalising the qualitative description of spatial properties and relations, and reasoning about those properties and relations. This approach, known as RCC theory, has been under development for several years at the University of Leeds. The main rationale for this project is that qualitative descriptions of spatial properties and relationships, and qualitative spatial reasoning, are of fundamental importance in human thinking about the world: even where quantitative spatial data (...) are most important, they must be attached to the components of a perceived spatial structure if we are to make use of them. RCC theory covers other qualitative aspects of spatial description and reasoning, but the topological properties and relations of spatially extended entities are fundamental to our work. The topological formalisms used by mathematicians are, in general, not well suited to the task of formalising the kinds of ‘common-sense’ or ‘everyday’ qualitative spatial description and reasoning which are our primary interest. Nevertheless, we must come to grips with the concepts of topology as practised by mathematicians if we are not to risk constantly ‘reinventing wheels’. (shrink)

Still Life: Suspended Development in the Victorian Novel rethinks the nineteenth-century aesthetics of agency through the Victorian novel's fascination with states of reverie, trance, and sleep. These states challenge contemporary scientific and philosophical accounts of the perfectibility of the self, which privileged reflective self-awareness. In dialogue with the field of literature and science studies and affect studies, this book shows how Victorian writers used narrative form to respond to the analytical practices and knowledge production of those other disciplines. Drawing upon (...) canonical texts--by Charlotte Brontë, George Eliot, George Meredith, and Thomas Hardy--Still Life contends that depictions of non-purposive perceptual experience suspend the processes of self-cultivation central to Victorian aesthetics, science, psychology, and political theory, as well as most critical accounts of the novel form. Departing from the values of individual cultivation and moral revelation associated with the genre, these writers offer an affective framework for understanding the subtly non-instrumental powers of narrative. Victorian novels ostensibly working within the parameters of the Bildungsroman are suspended by moments of "still life": a decentered lyricism associated with states of diminished consciousness. They use this style to narrate what should be unnarratable: experiences not dependent on reflective consciousness, which express a distinctive ambivalence toward dominant developmental frameworks of individual self-culture. (shrink)