A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

Postmodernism and poststructuralism challenge fundamental positions in social theory. This book sets out some of the components of a postmodern social theory of health and healing, deriving from theorists including Derrida, Deleuze and Guattari, Foucault, Cixous and Kristeva. Nicholas J. Fox observes that the knowledge of the medical profession about the body, illness and health supplies the basis for medical dominance. The body of the patient is inscribed by discourses of professional `care,' an interaction which subjectifies the patient. Fox explores (...) the character of this power - and how it may be, and is, resisted. The book illustrates with detailed examples how the organization of health care and the caring relationship itself are sites for this contestation of power. Elements of feminist theory, and Derridean concepts of diffrance and intertextuality, supply the framework for the politics and ethics of the postmodern position on health. Deleuze and Guattari's radical challenge to psychoanalysis and familial repetitions within the healer/patient contact allows a re-reading of central ideas in medical sociology. While focusing upon the possibilities of postmodern social theory, the book demands a reappraisal of issues of structure, identity and knowledge in modernist medical sociology. Modernist sociology, Fox suggests, has been complicit in the creation of `the patient,' and of 'health' and 'illness.' Written with an emphasis on accessibility, this book explores the practical consequences of postmodern theory as well as familiarizing the reader with the concepts of postmodernism. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

The success or failure of an ineffective assistance of counsel claim turns largely on the testimony of trial counsel. It is therefore common for the government to communicate ex parte with trial co...

In this book Fox and Miller define public administration theory and public management doctrine as an orthodoxy that is intellectually bankrupt and democratically unacceptable. Constitutionalism and communitarianism get similar treatment. Next, the authors construct a new theoretical position defined as constructivism and based on critical theory, phenomenology and structuration theory.

Background: Hypothalamic-pituitary-adrenal (HPA) system activation is adaptive in response to stress, and HPA dysregulation occurs in stress-related psychopathology. It is important to understand the mechanisms that modulate HPA output, yet few studies have addressed the neural circuitry associated with HPA regulation in primates and humans. Using high-resolution F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in rhesus monkeys, we assessed the relation between individual differences in brain activity and HPA function across multiple contexts that varied in stressfulness.

This is a critical introduction to modern French philosophy, commissioned from one of the liveliest contemporary practitioners and intended for an English-speaking readership. The dominant 'Anglo-Saxon' reaction to philosophical development in France has for some decades been one of suspicion, occasionally tempered by curiosity but more often hardening into dismissive rejection. But there are signs now of a more sympathetic interest and an increasing readiness to admit and explore shared concerns, even if these are still expressed in a very different (...) idiom and intellectual context. Vincent Descombes offers here a personal guide to the main movements and figures of the last forty-five years. He traces over this period the evolution of thought from a generation preoccupied with the 'three H's' - Hegel, Husserl and Heidegger, to a generation influenced since about 1960 by the 'three masters of suspicion' - Marx, Nietzsche and Freud. In this framework he deals in turn with the thought of Sartre, Merleau-Ponty, the early structuralists, Foucault, Althusser, Serres, Derrida, and finally Deleuze and Lyotard. The 'internal' intellectual history of the period is related to its institutional setting and the wider cultural and political context which has given French philosophy so much of its distinctive character. (shrink)

This article reports a content analysis of advertisements for household goods appearing in Ladies Home Journal between 1909-1910 and 1980, with the aim of understanding the ideological campaign that characterized the years in which households were mechanized and women's domestic labor transformed in the United States. More Journal ads featured directives about housework than descriptions of the product; they emphasized work performance far more frequently than liberation from housework, and they also promoted service to family. These findings supplement other evidence (...) that advertisers' efforts to create a market for household appliances and other means of domestic labor involved promotion of an ideology about housework that reinforced women's dedication to it. (shrink)

Fox writes about the nomadic project for people with bodies wherever they live, in what turned out not quite to be the planned sequel to his Postmodernism, Sociology, and Health (1993), but a treatment of the very practical issue of embodiment. Aspiring to transcend the conceptualization of embodiment by modern medicine, the caring professions, and other institutions, he suggests that it is possible to have a non-essentialist yet becoming body, not a being-body, not to be trammelled by notions of health (...) and illness. Distributed in the US by ISBS. Annotation copyrighted by Book News, Inc., Portland, OR. (shrink)

Whether or not youth work should professionalise and to what degree governments should regulate youth work services have been a widely debated topic within the Australian youth sector in recent tim...

For several decades, international law has recognized certain norms such as the prohibitions against genocide, slavery, and military aggression as "jus cogens"- peremptory law which supersedes conflicting international treaties and customs. Despite widespread acceptance of the jus cogens concept, legal theorists continue to debate whether peremptory norms derive their legal authority from state consent, natural law, or the demands of international public order. Anxiety over peremptory norms' legal basis has frustrated efforts to clarify the scope and content of jus cogens, (...) as well as placing peremptory norms on a collision course with inherited notions of state sovereignty. Drawing on Immanuel Kant 's conception of fiduciary relations, this Article develops a new theory of jus cogens based on the idea that states are fiduciaries of their people. According to the fiduciary theory, peremptory norms do not stand in opposition to state sovereignty; rather, they are constitutive of state sovereign authority because all states owe their subjects a fiduciary obligation to comply with such norms. The fiduciary model of the state resolves the longstanding tension in international legal theory between peremptory norms and state sovereignty and points to discrete formal and substantive criteria for identifying peremptory norms. (shrink)

This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King’s College London, with endorsement from the British Transplantation Society (BTS), and the European Society of Organ Transplantation (ESOT), brought together a group of experts in xenotransplantation science, ethics and law to discuss the ethical, regulatory and technical challenges surrounding translating xenotransplantation into the clinical setting. The symposium was the first of its kind in the UK for 20 years. This paper (...) summarises the content of the expert lectures showcasing the progress which has been made in xenotransplantation including—the history of xenotransplantation, advances in gene edited animals and progress towards clinical xenotransplantation. We then set out the ethical and legal issues still to be resolved. Finally, we report the themes of the roundtable discussion highlighting areas of consensus and controversy. While the detail of the legal discussion was directed towards the UK, the principles and summary reported here are intended to be applicable to any jurisdiction seeking to implement clinical xenotransplantation. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining and multi-level (...) models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

Ethical guidance from the British Medical Association about treating doctor–patients is compared and contrasted with evidence from a qualitative study of general practitioners who have been patients. Semistructured interviews were conducted with 17 GPs who had experienced a significant illness. Their experiences were discussed and issues about both being and treating doctor–patients were revealed. Interpretative phenomenological analysis was used to evaluate the data. In this article data extracts are used to illustrate and discuss three key points that summarise the BMA (...) ethical guidance, in order to develop a picture of how far experiences map onto guidance. The data illustrate and extend the complexities of the issues outlined by the BMA document. In particular, differences between experienced GPs and those who have recently completed their training are identified. This analysis will be useful for medical professionals both when they themselves are unwell and when they treat doctor–patients. It will also inform recommendations for professionals who educate medical students or trainees. (shrink)

The distribution of voting rights in the UK is an artefact of history rather than a product of clear legal or philosophical principles. Consequently, some resident aliens have the right to vote in all UK elections; others can vote in local elections but are excluded from national elections; still others are excluded from all elections. In England and Wales alone, roughly 2.3 million immigrants are excluded from voting in national elections. This exclusion is inconsistent with the founding principle of democracy (...) and distorts political discourse. What if all immigrants could vote in national elections? We estimate that up to ninety-five parliamentary seats could have been won by a different party in the 2015 general election. More substantially, enfranchising all immigrants would require re-drawing UK constituency boundaries. The new electoral map would increase the relative power of urban constituencies and would incentivise some political entrepreneurs and parties to temper anti-immigration rhetoric. (shrink)

This collection of papers is the fourth in a series of volumes on the work of the Comparative Austronesian Project. Each paper describes a specific Austronesian locality and offers an ethnographic account of the way in which social knowledge is vested, maintained and transformed in a particular landscape. The intention of the volume is to consider common patterns in the representation of place among Austronesian-speaking populations.

Constantine, the first Christian Emperor, bequeathed war against Persia to his son Constantius, a legacy which haunted the next two decades, culminating in Julian′s debacle in 363. Much has been written on the timing, motives, and strategy of these campaigns but the same role model appears at their beginning and end: Alexander the Great. Here, I wish to re-examine the evidence for his presence: recent scholarship has minimized it at one end and maximized at the other.

We argue that human rights are best conceived as norms arising from a fiduciary relationship that exists between states and the citizens and noncitizens subject to their power. These norms draw on a Kantian conception of moral personhood, protecting agents from instrumentalization and domination. They do not, however, exist in the abstract as timeless natural rights. Instead, they are correlates of the state's fiduciary duty to provide equal security under the rule of law, a duty that flows from the state's (...) institutional assumption of irresistible sovereign powers. (shrink)

In international law, the term "jus cogens" refers to norms that are considered peremptory in the sense that they are mandatory and do not admit derogation. Although the jus cogens concept has achieved widespread acceptance, international legal theory has yet to furnish a satisfying account of jus cogens's legal basis. We argue that peremptory norms are inextricably linked to the sovereign powers assumed by all states. The key to understanding international jus cogens lies in Immanuel Kant 's discussion of the (...) innate right of children to their parents' care. Drawing on Kant 's account, our theory of jus cogens posits that states exercise sovereign authority as fiduciaries of the people subject to their power. An immanent feature of this state-subject fiduciary relationship is that the state must comply with jus cogens. The fiduciary theory clarifies jus cogens's content by generating discrete criteria for identifying peremptory norms. (shrink)

High-spin states have been studied in Pr-135(59), populated through the Cd-116(Na-23,4n) reaction at 115 MeV, using the Gammasphere gamma-ray spectrometer. The negative-parity yrast band has been significantly extended to spin similar to 45 (h) over bar and excitation energy 21.5 MeV, showing evidence for several rotational alignments. The positive-parity yrast band of Ce-135(58), populated through the p4n channel of this reaction, was also populated to spin similar to 38 (h) over bar and excitation energy 18 MeV. Cranking calculations indicate that (...) these nuclei are soft with respect to the triaxiality parameter gamma and that several competing nuclear shapes occur at high spin. (shrink)