BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

A recent article in this journal described practical and conceptual difficulties faced by public health researchers studying scabies outbreaks in British residential care facilities. Their study population was elderly, decisionally incapacitated residents, many of whom lacked a legally appropriate decision-maker for healthcare decisions. The researchers reported difficulties securing Research Ethics Committee approval. As practicing healthcare ethicists working in a large Canadian research hospital, we are familiar with this challenge and welcomed the authors’ invitation to join the discussion of the ‘outstanding (...) ambiguities and further questions’ that their experience uncovered. We propose a Power of Attorney for Research as one substantive solution to help address the problems they identified. Although we acknowledge the familiar shortcomings associated with Advance Directives in the clinical context, we believe that Powers of Attorney for Research Participation, accompanied by Advance Research Directives, may increase the likelihood of gaining deeper understandings of potential participant’s values and priorities and how they might apply to foreseeable research opportunities. (shrink)

I argue that it is possible to reframe the current debates over professionalization in a way that can account for disagreement without insisting that its advocates and opponents are adversaries. Giles Scofield, and critics like him, may be understood as engaging in the sort of theoretical disagreement that is an inescapable and vital part of our practice. The field could profit from the work of legal theorist Ronald Dworkin who has long argued that people of good will and great competence (...) need not share foundational assumptions. They may, instead, be advancing rival interpretations of what the practice of healthcare ethics (PHE) requires. (shrink)

The pervasive use of contracts in healthcare is a source of unease for many healthcare ethicists and patient advocates. This commentary examines the use of such contracts with individuals in rehabilitation settings who have complex medical and behavioural issues. The goals of this paper are to examine the many factors that can lead to contract use, to discuss some legal and ethical implications of contract use, and to assess contract use in light of concerns about health equity. The paper concludes (...) with some practical alternatives to the use of such contracts, and refers specifically to tools that might be borrowed from the field of behavioural therapy. (shrink)

The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp down (...) decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions. There are no data in this work. (shrink)

Currently, there is no authoritative credentialing process for individuals engaged in ethics practice, no accreditation system that sets minimum education standards for programs aiming to prepare these individuals for their work, and little evidence available that any particular training model is actually achieving its pedagogical goals. At the same time, a number of healthcare organizations and universities now routinely offer post-graduate programs, clinical fellowships and in-house training specifically devised to prepare graduates for ethics practice. However, while their numbers appear to (...) be growing, information about these programs is limited. In this paper, we describe the goals, content and strategies of three educational programs offered in Ontario, Canada. These case studies highlight the diversity of ethics education available to those who engage in ethics practice and underscore the need to take this variety into account in the development of future education standards that would specify minimally acceptable educational requirements. (shrink)

Background Immense volumes of personal health information are required to realize the anticipated benefits of artificial intelligence in clinical medicine. To maintain public trust in medical research, consent policies must evolve to reflect contemporary patient preferences. Methods Patients were invited to complete a 27-item survey focusing on: broad versus specific consent; opt-in versus opt-out approaches; comfort level sharing with different recipients; attitudes towards commercialization; and options to track PHI use and study results. Results 222 participants were included in the analysis; (...) 83% were comfortable sharing PHI with researchers at their own hospital, although younger patients were more uncomfortable than older patients. While 56% of patients preferred broad consent, 38% preferred specific consent; 6% preferred not sharing at all. The majority of patients preferred to be asked for permission before entry into a contact pool. Again, this trend was more pronounced for younger patients. Approximately half of patients were uncomfortable sharing PHI with commercial enterprises. Most patients preferred to track PHI usage, with the highest proportion once again reported by the youngest patients. A majority of patients also wished to be notified regarding study results. Conclusions While most patients were willing to share their PHI with researchers within their own institution, many preferred a transparent and reciprocal consent process. These data also suggest a generational shift, wherein younger patients preferred more specific consent options. Modernizing consent policies to reflect increased autonomy is crucial in fostering sustained public engagement with medical research. (shrink)

Background:In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.Objectives:We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to (...) be made.Research design:This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.Participants and research context:We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.Ethical considerations:The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.Findings:As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.Discussion:We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care.Conclusions:One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

Background Rapid ethical access to personal health information to support research is extremely important during pandemics, yet little is known regarding patient preferences for consent during such crises. This follow-up study sought to ascertain whether there were differences in consent preferences between pre-pandemic times compared to during Wave 1 of the COVID-19 global pandemic, and to better understand the reasons behind these preferences. Methods A total of 183 patients in the pandemic cohort completed the survey via email, and responses were (...) compared to the distinct pre-pandemic cohort ; all were patients of a large Canadian cancer center. The survey covered broad versus study-specific consent; opt-in versus opt-out contact approach; levels of comfort sharing with different recipients; perceptions of commercialization; and options to track use of information and be notified of results. Four focus groups were subsequently conducted to elucidate reasons motivating dominant preferences. Results Patients in the pandemic cohort were significantly more comfortable with sharing all information and biological samples, sharing information with the health care institution, sharing information with researchers at other hospitals, sharing PHI provincially, nationally and internationally compared to the pre-pandemic cohort. Discomfort with sharing information with commercial companies remained unchanged between the two cohorts. Significantly more pandemic cohort patients expressed a wish to track use of PHI, and to be notified of results. Thematic analysis uncovered that transparency was strongly desired on outside PHI use, particularly when commercialization was involved. Conclusions In pandemic times, patients were more comfortable sharing information with all parties, except with commercial entities, where levels of discomfort remained unchanged. Focus groups identified that the ability to track and receive results of studies using one’s PHI is an important way to reduce discomfort and increase trust. These findings meaningfully inform wider discussions on the use of personal health information for research during global crises. (shrink)

We agree with White, Jankowski, and Shelton (2014) that professionalization of health care ethics practice requires serious consideration of a written examination to assess core knowledge competenc...

Dans la genese de sa constitution, la philosophie n'a pu faire l'economie d'une confrontation avec la musique qui fournissait aux anciens Grecs les schemes fondamentaux de la culture. De cette confrontation Platon est le temoin. Scindant la musique, il privilegie l'Harmonique, qui en est la partie theorique, sans toutefois lui reconnaitre la titre de science supreme. Correlativement, il condamne comme dysharmonie, tumulte fracassant et perturbateur de l'ordre cosmique, l'harmonie chromaticiste dont il s'emploie, non sans paradoxe, a decrire le detail. Par (...) cette lecture en filigrane des Dialogues de Platon, l'auteur se propose de reconstruire la pensee qui procede de l'harmonie chromaticiste et de montrer son importance dans l'elaboration de la philosophie fondatrice. Au carrefour des disciplines du savoir antique, ce livre s'adresse non seulement aux philosophes, mais aussi a tous ceux qui, musiciens ou stylisticiens, s'interessent a la forme musicale. (shrink)

AbstractWhen considering the manner of death, two categories can be distinguished, namely natural death and unnatural death. Though most physicians think that the distinction between the two is evident, this is not the case.When comparing the Netherlands, Belgium, England and Germany it is noticed that the terms natural and unnatural might be used in law but are not defined by law. In practice, the term unnatural death is used when there is an external cause of death, but even that turns (...) out to not be sufficient in making an obvious difference between the two terms. Different countries may even label the same death differently. A, at times philosophical and semantic, discussion shows that when it comes to causes of death a very large grey area exists between natural and unnatural causes of death. The Netherlands, Belgium and Germany even have the possibility to label a death as natural without actually knowing the cause of death.In conclusion, we recommend a new system in which the circumstances surrounding a death are properly investigated. This should lead to a report to an independent legal expert, who is able to decide if and what conclusion can be drawn, from a judicial and a public point of view, thereby, making the distinction and the use of the terms natural and unnatural/nonnatural obsolete. (shrink)

In this paper, I take a critical look at Sartorio’s book Causation and Free Will (2016). Sartorio offers a rich defence of an actual-sequence view of freedom, which pays close attention to issues in the philosophy of causation and how they relate to freedom. I argue that although this focus on causation is illuminating, Sartorio’s project nevertheless runs into some serious difficulties. Perhaps most worrying amongst them is whether the agent-based reason-sensitivity account, offered by Sartorio, is consistent with Frankfurt-style cases (...) – the very cases which are provided as the sole reason to endorse an actual-sequence view of freedom. I suggest that given that powers and causation are so intimately bound together, the debate is skewed somewhat by thinking of these as rivals. (shrink)

_A portion of the revenue from this book’s sales will be donated to Doctors Without Borders to assist the humanitarian work of nurses, doctors, and other health care providers in the fight against COVID-19 and beyond._ _Concepts and Cases in Nursing Ethics_ is an introduction to contemporary ethical issues in health care, designed especially for Canadian audiences. The book is organized around six key concepts: beneficence, autonomy, truth-telling, confidentiality, justice, and integrity. Each of these concepts is explained and discussed with (...) reference to professional and legal norms. The discussion is then supplemented by case studies that exemplify the relevant concepts and show how each applies in health care and nursing practice. This new fourth edition includes an added chapter on end-of-life issues, and it is revised throughout to reflect the latest developments on topics such as global health ethics, cultural competence, social media, and palliative sedation, as well as ethical issues relating to COVID-19. (shrink)

Concepts and Cases in Nursing Ethics maps the ethical landscape of contemporary nursing. The book is the product of a collaboration between philosopher-ethicist Michael Yeo, nurse-ethicist Anne Moorhouse, and six representatives of various areas of professional nursing. It thus combines philosophical and ethical analysis with nursing knowledge and experience in a manner that is both understandable and relevant. The book is organized around six main concepts in nursing ethics: beneficence, autonomy, confidentiality, truth-telling, justice, and integrity. A chapter is devoted to (...) the elucidation of each of these concepts. In each chapter, historical background and conceptual analysis are supplemented by case studies that exemplify issues and show how the concept applies in nursing practice. In this new edition, the materials in each chapter have been updated to reflect recent developments in nursing and more generally in health care. In addition, a totally new chapter on ethical theory has been added. Complete with bibliographies and study questions for further analysis of cases, this book is ideally suited for textbook use. It will help both practitioners and students to deal better with the clinical problems and issues that are encountered in the field. However, it's simple prose and clear exposition of complex issues will make Concepts and Cases in Nursing Ethics attractive to anyone concerned about health care. (shrink)

This long-awaited two-volume set constitutes the definitive presentation of the system of classifying moral judgment built up by Lawrence Kohlberg and his associates over a period of twenty years. Researchers in child development and education around the world, many of whom have worked with interim versions of the system, indeed, all those seriously interested in understanding the problem of moral judgment, will find it an indispensable resource. Volume I reviews Kohlberg's stage theory, and the by-now large body of research on (...) the significance and utility of his moral stages. Issues of reliability and validity are addressed. The volume ends with detailed instructions for using the forms in Volume 2. Volume 2, in a specially-designed, user-friendly format, includes three alternative functionally-equivalent forms of the scoring system. (shrink)

Some theories of goodness are descriptively rich: they have much to say about what makes things good. Neo-Aristotelian accounts, for instance, detail the various features that make a human being, a dog, a bee good relative to facts about those forms of life. Famously, such theories of relative goodness tend to be comparatively poor: they have little or nothing to say about what makes one kind of being better than another kind. Other theories of goodness—those that take there to be (...) absolute goodness—are comparatively rich: they offer grounds for judging some types of things better than others because they have more absolute goodness. Moorean accounts, for example, can tell us that humans and human experiences are superior to bees and blades of grass. But such theories tend to be descriptively poor: they struggle to tell us in virtue of what this is so. In this essay we motivate and flesh out a view that splits the difference between accounts of goodness as relative and accounts of goodness as absolute. Such a view holds promise only if the mechanics of this kind of metaphysics of goodness can be worked out. Here we present a view on which the paradigm for absolute goodness is God and the paradigm for each kind of relative goodness is a divine idea. (shrink)

This book is an intercultural exploration of the full scope of evil. The problems of evil have beset humanity throughout the ages and continue to trouble us. The studies here examine evil in Asian thought, in Western theory, in the cosmic order, in human psychology, and in social practice. Insights are added to the philosophical discussions from religion, culture, history, law, technology, and literature.

La 4ème de couverture indique : "Cet ouvrage, qui réunit juristes, sociologues, anthropologue et psychanalyste, se propose de saisir la place du genre en bioéthique à l'heure de questions sociétales liées tant aux progrès de la médecine reproductive qu'aux rôles assignés aux femmes et aux hommes à l'intérieur de la famille ou en dehors de celle-ci. Il s'agit, au travers de regards croisés, d'éclairer le débat du genre au sein de la sphère bioéthique en identifiant, au sein et au-delà des (...) thèmes de la procréation, de la parentalité et du patrimoine, les questions juridiques qui peuvent naître de la rencontre de la bioéthique et du genre. Les sujets sont nombreux, regroupés autour d'interrogations telles que : le genre est-il reçu dans le droit du vivant? Que font les lois bioéthique au genre? Y a-t-il un âge pour procréer? Existe-t-il une égalité entre les femmes et les hommes en termes d'accès aux soins? Assiste-t-on à une désexualisation du couple? Peut-on parler de patrimoine sexuel?... Éventail d'interrogations, diversité des opinions : les meilleurs spécialistes de chaque question abordée y analysent les réponses fournies par le droit en livrant des pistes de réflexion sur le traitement des inégalités ou des différences existant entre hommes et femmes dans l'exercice, parfois l'existence, des droits et libertés qui sont les leurs en ce domaine.". (shrink)

The meaning of life and man's alienation from himself and his natural environment is examined in brief selections, illustrated with photographs, from the works of Albert Schweitzer.

Pionnière dans la pénalisation du viol en 1980, la France a été en eurocrime qu’aurait entraîné l’unanimité dans l’acceptation de la nouvelle définition proposée par la Commission européenne. L’absence de consentement devient finalement pour tous le critère principal, et de nombreux pays ont aligné récemment leur législation avec la directive européenne. Sur le droit à l’avortement, la convergence est moins sensible, plusieurs pays mettent d’importantes restrictions. La constitutionnalisation de la liberté d’avorter et de sa garantie en France va peut-être conduire (...) à son inscription dans les droits humains. (shrink)

ZusammenfassungDer Beitrag fragt nach dem Stellenwert des Normalitätsbegriffs im Diskurs der Behinderung. Ausgangspunkt ist die These, dass Normalität und Normativität analytisch voneinander getrennt werden müssen. In der heutigen Normalisierungsgesellschaft existieren sowohl wertbezogene, präskriptive ("normative") als auch statistisch fundierte, deskriptive ("normalistische") Normen. Außerdem lassen sich zwei Normalisierungsstrategien kennzeichnen: ein starr ausgrenzender, normierender Ansatz ("Protonormalismus") und eine flexible, normalisierende Strategie ("flexibler Normalismus"). Auf dieser theoretischen Folie wird diskutiert, ob sich im behindertenpolitischen Diskurs und in sozialpolitischen Konzepten Tendenzen der flexiblen Normalisierung auffinden lassen. (...) Der Schwerpunkt des Beitrags liegt auf einer normalitätstheoretischen Analyse der beiden Klassifikationsmodelle der Weltgesundheitsorganisation. Die "International Classification of Impairments, Disabilities and Handicaps" (ICIDH 1980) blieb noch der wertbezogenen Normativität verhaftet. Dagegen stellt die "International Classification of Functioning, Disability and Health" (ICF 2001) die normalistische (Vergleichs-)Norm ins Zentrum und formuliert das Gebot der Selbstnormalisierung. (shrink)

Was passiert, wenn die Bevölkerung die Möglichkeit erhält, sich ungeschminkt und ungefiltert zu bioethischen Problemstellungen zu äußern?

Anne Margaret Baxley offers a systematic interpretation of Kant's theory of virtue, whose most distinctive features have not been properly understood. She explores the rich moral psychology in Kant's later and less widely read works on ethics, and argues that the key to understanding his account of virtue is the concept of autocracy, a form of moral self-government in which reason rules over sensibility. Although certain aspects of Kant's theory bear comparison to more familiar Aristotelian claims about virtue, Baxley contends (...) that its most important aspects combine to produce something different - a distinctively modern, egalitarian conception of virtue which is an important and overlooked alternative to the more traditional Greek views which have dominated contemporary virtue ethics. (shrink)

Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in (...) the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patients self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality. (shrink)

_Examines how violence has been conceptually and rhetorically put to use in continental social theory._.

Introduction The mainstream view in philosophy of language is that sentence meaning determines truth-conditions. A corollary is that the truth or falsity of an utterance depends only on what words mean and how the world is arranged. Although several prominent philosophers (Searle, Travis, Recanati, Moravcsik) have challenged this view, it has proven hard to dislodge. The alternative view holds that meaning underdetermines truth-conditions. What is expressed by the utterance of a sentence in a context goes beyond what is encoded in (...) the sentence itself. Truth-conditional content depends on an indefinite number of unstated background assumptions, not all of which can be made explicit. A change in background assumptions can change truth-conditions, even bracketing disambiguation and reference assignment. That is, even after disambiguating any ambiguous words in a sentence and assigning semantic values to any indexical expressions in the sentence, truth-conditions may vary with variations in the background. (shrink)

_This illuminating account of contemporary American Buddhism shows the remarkable ways the tradition has changed over the past generation_ The past couple of decades have witnessed Buddhist communities both continuing the modernization of Buddhism and questioning some of its limitations. In this fascinating portrait of a rapidly changing religious landscape, Ann Gleig illuminates the aspirations and struggles of younger North American Buddhists during a period she identifies as a distinct stage in the assimilation of Buddhism to the West. She observes (...) both the emergence of new innovative forms of deinstitutionalized Buddhism that blur the boundaries between the religious and secular, and a revalorization of traditional elements of Buddhism, such as ethics and community, that were discarded in the modernization process. Based on extensive ethnographic and textual research, the book ranges from mindfulness debates in the Vipassana network to the sex scandals in American Zen, while exploring issues around racial diversity and social justice, the impact of new technologies, and generational differences between baby boomer, Gen X, and millennial teachers. (shrink)

Anne Conway was an extraordinary figure in a remarkable age. Her mastery of the intricate doctrines of the Lurianic Kabbalah, her authorship of a treatise criticising the philosophy of Descartes, Hobbes, and Spinoza, and her scandalous conversion to the despised sect of Quakers indicate a strength of character and independence of mind wholly unexpected (and unwanted) in a woman at the time. Translated for the first time into modern English, her Principles of the Most Ancient and Modern Philosophy is the (...) most interesting and original philosophical work written by a woman in the seventeenth century. Her radical and unorthodox ideas are important not only because they anticipated the more tolerant, ecumenical, and optimistic philosophy of the Enlightenment, but also because of their influence on Leibniz. This fully annotated edition includes an introduction which places Conway in her historical and philosophical contexts, together with a chronology of her life and a bibliography. (shrink)

Examines how violence has been conceptually and rhetorically put to use in continental social theory.

Table of Contents: Illustrations Acknowledgments Conventions Introduction 3 Ch. 1 Kinds of Natural Philosophy 14 Ch. 2 Methods of Bookishness 49 Ch. 3 Modes of Argument 82 Ch. 4 Bodin’s Philosophy of Nature 116 Ch. 5 Theatrical Metaphors 153 Ch. 6 The Reception of the Theatrum 180 Epilogue: The Legacies of the Theatrum 225 Notes 233 Bibliography 331 Index 369.