Volume 20, Issue 7, July 2020, Page 6-8.

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including (...) residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

usually brings to mind images of picket signs held by laborers striking for better wages and benefits. Collective action, however, need not be limited to the withholding of labor. Nor need it involve only the working or middle classes, as airline pilots have recently demonstrated. Finally, collective action need not have as its only purpose the self-interest of the group. Collective action does, however, always involve a joining together of individuals united by common goals or interests in order to consolidate (...) power for the purpose of negotiating with another group or entity. Examples of collective action obviously include striking, other withholding labor actions, and slowdowns, but can also include many other activities. for example, have been threatened or used by house officer organizations in the past. In a paper strike, patient care continues but without documentation, and thus, the institution suffers from absent or delayed financial remuneration. (shrink)

Though trust is essential to relationships between people, including that between patient and clinician, its role in organizational ethics is largely unexplored. Nonetheless, trust is also ideally a part of the relationship between patient and health care institution, both because it is desirable in and of itself, and because it makes for better medical care.

Those who advocate higher out-of-pocket spending, especially high deductibles, to keep health care costs better controlled without losing quality use market language to talk about how people should think about health care. Consumers—that is, patients—should hunt for bargains. Clip coupons. Shop around. Patients need to have more “skin in the game.” Consumer-patients will then choose more carefully and prudently and use less unnecessary health care. Unfailingly, “skin” refers to having money at stake. Usually, those arguing for high deductibles express dismay (...) or frustration that patients do not face the full cost of the health services they receive. Unfortunately, a lack of price transparency, the need to unbundle bundled groups of services to discover total price, and the challenge of validly and reliably measuring and disclosing quality make shopping for health care a challenge for even the savviest patient. Urgency, fear, and sickness that impairs peak cognitive function and other aspects of emotionally laden decision-making, even when “shared” with a physician, add obstacles to coupon clipping and tire kicking. Who has more at stake in health decisions than patients? Whose flesh is literally, not just figuratively, at risk? (shrink)

Health care and public health programs increasingly rely on, and often even require, organizational action, which is facilitated, if not dependent on, trust. Case examples in this essay highlight trust, trustworthiness, and distrust in public and private organizations, providing insights into how trust in health‐related organizations can be betrayed, earned, and justified and into the consequences of organizational trust and trustworthiness for the health of individuals and communities. These examples demonstrate the need for holistic assessments of trust in clinicians and (...) trust in organizations and for organizations, public health, and the medical profession to address questions concerning their own trustworthiness. Normative and empirical assessments of trust and trustworthiness that capture the experiences of those treated within the walls of a health care organization, as well as the care of those outside, will contribute to more trustworthy systems of care. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 62-63, August 2011.

The American Journal of Bioethics, Volume 11, Issue 7, Page 1-2, July 2011.

The American Journal of Bioethics, Volume 11, Issue 12, Page 13-16, December 2011.

Volume 19, Issue 12, December 2019, Page 57-60.

Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need (...) for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness, while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government. (shrink)

Jecker makes three major points in her article, “A Broader View of Justice” (2008). First, she argues that justice in healthcare relates to justice in the broader social conditions of society as th...

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of (...) six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors’empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners. (shrink)

Polygamy, forced marriage, female genital mutilation, punishing women for being raped, differential access for men and women to health care and education, unequal rights of ownership, assembly, and political participation, unequal vulnerability to violence. These practices and conditions are standard in some parts of the world. Do demands for multiculturalism — and certain minority group rights in particular — make them more likely to continue and to spread to liberal democracies? Are there fundamental conflicts between our commitment to gender equity (...) and our increasing desire to respect the customs of minority cultures or religions? In this book, the eminent feminist Susan Moller Okin and fifteen of the world’s leading thinkers about feminism and multiculturalism explore these unsettling questions in a provocative, passionate, and illuminating debate. Okin opens by arguing that some group rights can, in fact, endanger women. She points, for example, to the French government’s giving thousands of male immigrants special permission to bring multiple wives into the country, despite French laws against polygamy and the wives’ own bitter opposition to the practice. Okin argues that if we agree that women should not be disadvantaged because of their sex, we should not accept group rights that permit oppressive practices on the grounds that they are fundamental to minority cultures whose existence may otherwise be threatened. In reply, some respondents reject Okin’s position outright, contending that her views are rooted in a moral universalism that is blind to cultural difference. Others quarrel with Okin’s focus on gender, or argue that we should be careful about which group rights we permit, but not reject the category of group rights altogether. Okin concludes with a rebuttal, clarifying, adjusting, and extending her original position. These incisive and accessible essays — expanded from their original publication in Boston Review and including four new contributions — are indispensable reading for anyone interested in one of the most contentious social and political issues today. The diverse contributors, in addition to Okin, are Azizah al-Hibri, Abdullahi An-Na’im, Homi Bhabha, Sander Gilman, Janet Halley, Bonnie Honig, Will Kymlicka, Martha Nussbaum, Bhikhu Parekh, Katha Pollitt, Robert Post, Joseph Raz, Saskia Sassen, Cass Sunstein, and Yael Tamir. (shrink)

(From the book cover in 2007) The Blackwell Companion to Consciousness is the most thorough and comprehensive survey of contemporary scientific research and philosophical thought on consciousness currently available. Its 55 newly commissioned, peer-reviewed chapters combine state-of-the-art surveys with cutting edge research. Taken as a whole, these essays by leading lights in the philosophy and science of consciousness create an engaging dialog and unparalleled source of information regarding this most fascinating and mysterious subject.

An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for (...) AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support. (shrink)

We develop a Bayesian framework for thinking about the way evidence about the here and now can bear on hypotheses about the qualitative character of the world as a whole, including hypotheses according to which the total population of the world is infinite. We show how this framework makes sense of the practice cosmologists have recently adopted in their reasoning about such hypotheses.

This chapter discusses the two general kinds of uploading scenarios and given our response to Chalmers' objections, let us summarize where things stand. First, there is considerable reason to be pessimistic about instantaneous destructive uploading's ability to preserve identity or to produce continuations of the original person. Second, there is also good reason to be pessimistic about gradual destructive uploading's ability to preserve identity or produce continuations, since exactly the same issues arise in the context of gradual uploading. The chapter (...) introduces issues from the field of metaphysics that are key to determining whether you could survive uploading. The author argues that it is plausible, given these background metaphysical issues, that you will not survive uploading. The chapter considers David Chalmers' objections to our position, as stated in a recent paper of his. (shrink)

William of Ockham (d. 1347) is well known for his commitment to parsimony and for his so-called ‘razor’ principle. But little is known about attempts among his own contemporaries to deflect his use of the razor. In this paper, I explore one such attempt. In particular, I consider a clever challenge that Ockham’s younger contemporary, Walter Chatton (d. 1343) deploys against the razor. The challenge involves a kind of dilemma for Ockham. Depending on how Ockham responds to this dilemma, his (...) razor will, Chatton argues, either prove unacceptably dull when it comes to determining ontological commitment or prove unacceptably sharp when it comes to determining commitments entailed by certain theological doctrines. While Chatton’s objection is subtle and interesting in its own right, the broader significance of the debate between these thinkers lies in the light it sheds on medieval approaches to issues surrounding metaphysical methodology. (shrink)

Background:Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.Objectives:An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.Review Methods:This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.Results:Synthesis of the scientific literature revealed (...) inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.Conclusion:Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (shrink)