Volume 20, Issue 6, June 2020, Page 75-77.

Decisions about continuing or terminating a pregnancy touch on profound, individualized questions about bodily integrity, reproductive autonomy, deeply held values regarding one's capacity for parenthood, and, in the case of a high-risk pregnancy, the risks one is willing to take to have a baby. So far as possible, reproductive decisions are made between a patient, in some cases her partner, and her medical provider. However, this standard framework cannot be applied if the patient lacks decision-making capacity. In this essay, we (...) discuss one such case that came before our clinical ethics team. We describe the challenges of respecting a patient's reproductive preferences when the patient cannot share what those preferences are, and we argue that decisions regarding reproductive health care should not be treated with exceptionalism. Rather, they should proceed under the normal processes of surrogate decision-making, including the application of substituted judgment. This approach enables us to take the patient's values into account when considering the questions implicated in reproductive health care, just as we do for other kinds of health care decisions in which a patient's deeply held values are salient. (shrink)

Volume 20, Issue 3, March 2020, Page 39-41.

With the increasing professionalization of clinical ethics, some hospitals and health systems utilize both ethics committees and professional clinical ethicists to address their ethics needs. Drawing upon historical critiques of ethics committees and their own experiences, the authors argue that, in ethics programs with one or more professional clinical ethicists, ethics committees should be dissolved when they fail to meet minimum standards of effectiveness. The authors outline several criteria for assessing effectiveness, describe the benefits of a model that places primary (...) responsibility for ethics work with professional clinical ethicists—the PCE-primary model, and offer suggestions for alternative ethics program structures that empower healthcare professionals to contribute to ethics work in ways more tailored to their strengths and skills while minimizing the shortcomings of ethics committees. (shrink)

Effective documentation is considered a core competency for clinical ethics consultation. Ethics consultants within the Cleveland Clinic in Cleveland, Ohio, observed variation in the formatting of ethics chart notes across consultants and realized that this formatting was based on their own views of effectiveness. To minimize variation and optimize the readability and understandability of ethics chart notes for end users, a team undertook a quality improvement project to assess the formatting preferences of healthcare professionals who rely on ethics consultation notes. (...) The team developed three sample templates and conducted interviews with stakeholders to understand their preferences. A single standardized template was developed based on the preferences that emerged, which all consultants on the ethics consultation service then utilized. In the first five months of implementation, the percentage of end user respondents marking the highest Likert scale option on a post-consultation survey regarding whether the ethics consultation service provided helpful documentation increased from 60 percent to 72 percent compared to the same five-month period in the year prior. (shrink)

Propelling Clinical Ethics Forward: A Working Unconference was held from 28-29 April 2022 in Atlanta, Georgia. The event, the third installment in an ongoing series of Clinical Ethics Unconferences, brought together 77 individuals from 40 institutions to exchange innovative practices and collaborate to address issues facing the field of clinical ethics. In this article the authors highlight the five major themes that emerged from the 2022 Unconference, including: (1) tackling new and old problems in clinical ethics practice; (2) evolving models (...) of clinical ethics structure and delivery; (3) defining the scope of clinical ethics work; (4) addressing racism, ableism, and underrepresentation in clinical ethics work; and (5) collecting and utilizing data effectively. The authors also reflect on what was learned from the first three Unconferences and offer suggestions for future Unconferences. (shrink)

In an effort to create new synergies to fill gaps in evaluation of value, assessment of quality, and definition of roles in clinical ethics programs we convened a meeting entitled Innovations in Clinical Ethics: A Working Un-Conference (the Un-Conference) in August 2018. The Un-Conference was conceived to be a working event aimed at promoting cross pollination and idea generation for innovative practices in clinical ethics. The event was attended by 95 individuals from 62 institutions, representing a wide diversity of healthcare (...) systems, who believed in the concept and brought their enthusiasm and expertise to share with others. As a product of the Un-Conference, whitepaper groups developed summaries and broad overviews of areas that need to be further addressed within our field. The whitepapers are being published in this issue of The Journal of Clinical Ethics. The first three whitepapers highlight the broad themes of demonstrating value to the institution, quality assessment, and emerging roles for clinical ethics programs and ethicists. The final whitepaper offers guidance to clinical ethicists engaged in pediatric ethics work and, in conversation with the emerging roles article, thoughtfully reflects on the role of pediatric ethicists. (shrink)

The authors present a case study involving truth telling responsibilities in the setting of nonepileptic seizures. Specifically, over the course of several suspected nonepileptic seizures, a patient’s seizures stopped after he received a saline flush meant to precede the administration of anti-seizure medication. The patient and his surrogate believed he had received the medication each time, and the team wondered whether they should disclose the truth. Some worried that disclosure would reinforce the suspected psychogenic behavior, exacerbating the patient’s condition. In (...) this way, the case study presents a twist on the traditional truth telling archetype. While most truth telling cases center on navigating cultural differences or worries about emotional harm, this case presented concerns about medical harm in the form of exacerbating the patient’s condition. The authors describe the complex patient-family-team dynamic that preceded this ethical dilemma, describe the case, analyze the ethical issue, and describe the outcome. (shrink)

Background: Nurses face ethical issues and experience moral distress in their everyday work. A nursing ethics champion program was developed at a hospital in the United States. Methods: As part of a quality improvement project, pre- and post-training surveys were developed to assess whether the program was feasible and sustainable, enhanced nurse confidence in recognizing and addressing ethical issues and moral distress, and increased nurse knowledge of institutional resources for addressing the same. Qualitative and quantitative analyses were performed. Results: Thirteen (...) nurses from both the critical care and medical/surgical settings participated in the program. The program proved feasible. Attrition after the educational sessions raised concerns about sustainability. Survey results suggest an association between participating in the program’s educational sessions and increased nurse confidence in recognizing and addressing ethical issues and moral distress, as well as identifying institutional resources that can assist nurses with the same. Discussion: Opportunities for future nursing ethics champion programs include increasing the interactivity and duration of educational sessions, making programs multidisciplinary, and creating materials for nurses to more easily share with colleagues. It would be valuable for future research to measure the impact of nursing ethics champion programs on nursing turnover. Implications: A nursing ethics champion program has the potential to help nurses feel better equipped to navigate ethical issues and moral distress in their everyday work. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Despite an abundance of academic conferences, clinical ethicists lacked a forum to share innovative practices with peers and to generate solutions to common challenges. Organizers of the first Clinical Ethics Un-Conference developed a working event centered on active participation and problem solving through peer learning, with the goal of improving realworld practice. Registrants included 95 individuals from 64 institutions. Attendees were surveyed immediately after the Un-Conference, and again eight months later. After eight months, 85 percent (n = 33/39) of the (...) survey respondents reported that they found the event “highly impactful” or “some-what impactful” to their clinical practice, and 23 attendees reported that they had implemented ideas or projects inspired by the event. Three sets of best practice guidelines and four white papers were published from the event. As the field of clinical ethics continues to advance and evolve, this working event format offers an innovative, disruptive alternative to a traditional conference format and may serve as a model for future efforts aimed at improving real-world clinical ethics practice. (shrink)

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

Noninvasive prenatal testing (NIPT) has become widely available in recent years. While initially used to screen for trisomies 21, 18, and 13, the test has expanded to include a range of other conditions and will likely expand further. This paper addresses the ethical issues that arise from one particularly controversial potential use of NIPT: screening for adult‐onset conditions (AOCs). We report data from our quantitative survey of Australian NIPT users' views on the ethical issues raised by NIPT for AOCs. The (...) survey ascertained support for NIPT for several traits and conditions including AOCs. Participants were then asked about their level of concern around implications of screening for AOCs for the future child and parent(s). Descriptive and comparative data analyses were conducted. In total, 109 respondents were included in data analysis. The majority of respondents expressed support for NIPT screening for preventable (70.9%) and nonpreventable AOCs (80.8%). Most respondents indicated concern around potential harmful impacts associated with NIPT for AOCs, including the psychological impact on the future child and on the parent(s). Despite this, the majority of participants thought that continuation of a pregnancy known to be predisposed to an AOC is ethically acceptable. The implications of these data are critically discussed and used to inform the normative claim that prospective parents should be given access to NIPT for AOCs. The study contributes to a body of research debating the ethical acceptability and regulation of various applications of NIPT as screening panels expand. (shrink)

Compiling empirical work from management and social science disciplines, the Research Companion to Ethical Behavior in Organizations provides an entry point for academic researchers and compliance officers interested in measuring the moral dimensions of individuals. Accessible to newcomers but geared toward academics, this detailed book catalogs the varied and nuanced constructs used in behavioral ethics, along with measures that assess those constructs. With its cross-disciplinary focus and expert commentary, a varied collection of learned scholars bring essential studies into one volume, (...) creating a resource that promises to enhance the burgeoning field of behavioral ethics"--Publisher's web site. (shrink)

The Coalition of Immokalee Workers (CIW) has successfully combated modern-day slavery by transforming the ways that over a dozen major brands, including Taco Bell, Subway, and Wal-Mart, manage their supply chains. The CIW’s efforts over more than 20 years have effectively stopped enslavement practices, including abuses such as wage theft and peonage indebtedness. We conducted a field ethnography, interviews, and archival analyses to understand this success. We find that the CIW employs a decentered, egalitarian, and ensemble approach to their multiplicities (...) of alliances by collectively “animating” themselves and their partners through ensemble leadership. This combination of alliances, along with worker-driven monitoring, brings life to the CIW motto “We are all leaders.” Translating this motto into daily practice is how the CIW virtually eradicates enslavement practices in corporate supply chains. (shrink)

In 1922 Skolem delivered an address before the Fifth Congress of Scandinavian Mathematicians in which he pointed out what he called a "relativity of set-theoretic notions". This "relativity" has frequently been regarded as paradoxical; but today, although one hears the expression "the Lowenheim-Skolem Paradox", it seems to be thought of as only an apparent paradox, something the cognoscenti enjoy but are not seriously troubled by. Thus van Heijenoort writes, "The existence of such a 'relativity' is sometimes referred to as the (...) Lowenheim-Skolem Paradox. (shrink)

Hilary Putnam deals in this book with some of the most fundamental persistent problems in philosophy: the nature of truth, knowledge and rationality. His aim is to break down the fixed categories of thought which have always appeared to define and constrain the permissible solutions to these problems.

Hilary Putnam deals in this book with some of the most fundamental persistent problems in philosophy: the nature of truth, knowledge and rationality. His aim is to break down the fixed categories of thought which have always appeared to define and constrain the permissible solutions to these problems.

First published in 1971, Professor Putnam's essay concerns itself with the ontological problem in the philosophy of logic and mathematics - that is, the issue of whether the abstract entities spoken of in logic and mathematics really exist. He also deals with the question of whether or not reference to these abstract entities is really indispensible in logic and whether it is necessary in physical science in general.

The final published book by Nobel Prize-winning author and philosopher Henri Bergson (1859-1941), La pensée et le mouvant (translated here as The Creative Mind), is a masterly autobiography of his philosophical method. Through essays and lectures written between 1903 and 1923, Bergson retraces how and why he became a philosopher, and crafts a fascinating critique of philosophy itself. Until it leaves its false paths, he demonstrates, philosophy will remain only a wordy dialectic that surmounts false problems. With masterful skill and (...) intensity, Bergson shows that metaphysics and science must be rooted in experience for philosophy to become a genuine search for truth. And in the quest for unanswered questions, the spiritual dimension of human life and the importance of intuition must be emphasized. A source of inspiration for physicists as well as philosophers, Bergson's introduction to metaphysics reveals a philosophy that is always on the move, blending man's spiritual drive with his mastery of the material world. (shrink)

Professor Hilary Putnam has been one of the most influential and sharply original of recent American philosophers in a whole range of fields. His most important published work is collected here, together with several new and substantial studies, in two volumes. The first deals with the philosophy of mathematics and of science and the nature of philosophical and scientific enquiry; the second deals with the philosophy of language and mind. Volume one is now issued in a new edition, including (...) an essay on the philosophy of logic first published in 1971. (shrink)

Mabel Cooper and Gloria Ferris lived in St Lawrence's Hospital one of the large learning disability institutions which were built round the edges of London. In this paper, Mabel and Gloria share their memories of three nurses at St Lawrence's, supported by Jane Abraham and in this process reveal a number of ethical issues that remain relevant today.

AbstractDuring the Covid-19 pandemic, ethicists and researchers proposed human challenge studies as a way to speed development of a vaccine that could prevent disease and end the global public health crisis. The risks to healthy volunteers of being deliberately infected with a deadly and novel pathogen were not low, but the benefits could have been immense. This essay is a history of the three major efforts to set up a challenge model and run challenge studies in 2020 and 2021. The (...) pharmaceutical company Johnson and Johnson, the National Institutes of Health in the United States, and a private-public partnership of industry, university, and government partners in Britain all undertook preparations. The United Kingdom’s consortium began their Human Challenge Programme in March of 2021.Beyond documenting each effort, the essay puts these scientific and ethical debates in dialogue with the social, epidemiological, and institutional conditions of the pandemic as well as the commercial, intellectual, and political systems in which medical research and Covid-19 challenge studies operated. It shows how different institutions understood risk, benefit, and social value depending on their specific contexts. Ultimately the example of Covid-19 challenge studies highlights the constructedness of such assessments and reveals the utility of deconstructing them retrospectively so as to better understand the interplay of medical research and research ethics with larger social systems and historical contexts. (shrink)

Hilary Putnam, who may have been the first philosopher to advance the notion that the computer is an apt model for the mind, takes a radically new view of his...

In this festschrift for the eminent philosopher Hilary Putnam, a team of distinguished philosophers write on a broad range of topics and thus reflect the remarkably fertile and provocative research of Putnam himself. The volume is not merely a celebration of a man, but also a report on the state of philosophy in a number of significant areas. The essays fall naturally into three groups: a central core on the theme of conventionality and content in the philosophy of mind, (...) language, and science, and two smaller sections on the relationship of ethics and language, and on the philosophy of logic and aesthetics.In this festschrift for the eminent philosopher Hilary Putnam, a team of distinguished philosophers write on a broad range of topics and thus reflect the remarkably fertile and provocative research of Putnam himself. The volume is not merely a celebration of a man, but also a report on the state of philosophy in a number of significant areas. The essays fall naturally into three groups: a central core on the theme of conventionality and content in the philosophy of mind, language, and science, and two smaller sections on the relationship of ethics and language, and on the philosophy of logic and aesthetics. (shrink)

Hilary Kornblith argues for a naturalistic approach to investigating knowledge. Knowledge, he explains, is a feature of the natural world, and so should be investigated using scientific methods. He offers an account of knowledge derived from the science of animal behavior, and defends this against its philosophical rivals. This controversial and refreshingly original book offers philosophers a new way to do epistemology.

Drawing on the pragmatic turn in contemporary social theory, we explore how corporate elites accused of corruption in the context of weak institutions engage in their justification works. Empirically, we focus on three high-profile corruption scandals that shook Ghana between 2010 and 2020 and inspired widespread public condemnation. Publicly accessible archival documents, such as court reporting, newspaper stories, press conferences, and the digital footprints of corporate elites implicated in the scandals provide data for our inquiry. Focussing on the juxtaposition of (...) ‘sayings’ and ‘doings’, the findings show justification as performative, and rooted in contextual pragmatism that acknowledges the plurality of logics situated between self-interest and folk-logic. Within this framework, the domestic and civic orders of worth emerge as most prominent, with the justification processes manifesting through _victimising, scapegoating,_ and _crusading_. Building on these insights, we develop a framework that highlights how the use of justifications serves as a critique of the inadequacies within climates of weak institutional frameworks consequently fostering an atmosphere conducive to framing unethical conducts as morally acceptable. (shrink)

This is the third volume of Hilary Putnam's philosophical papers, published in paperback for the first time. The volume contains his major essays from 1975 to 1982, which reveal a large shift in emphasis in the 'realist'_position developed in his earlier work. While not renouncing those views, Professor Putnam has continued to explore their epistemological consequences and conceptual history. He now, crucially, sees theories of truth and of meaning that derive from a firm notion of reference as inadequate.

Can we reconcile the idea that we are free and responsible agents with the idea that what we do is determined according to natural laws? For centuries, philosophers have tried in different ways to show that we can. This text seeks to show that the two ideas are compatible by drawing on the distinction between practical and theoretical reasoning.

Por un lado, el libro aborda la problemática educativa que enfrentan estudiantes mexicanos indocumentados en las universidades de los Estados Unidos. Por el otro lado, se aborda la atención específica (escolar, académica y administrativa) que la Universidad de Guadalajara (México), ofrece a los estudiantes migrantes retornados de los Estados Unidos.

Presentación del Dossier: Feminismos y posthumanismo.