In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. “Immersion” refers to a high-intensity clinical ethics experience in a (...) busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients’ charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations.Specific to this pilot, because participants’ evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics. (shrink)

This paper presents the behavioral interview model that we developed to formalize our hiring practices when we, most recently, needed to hire a new clinical ethicist to join our staff at the Center for Ethics at Washington Hospital Center.

This paper presents the behavioral interview model that we developed to formalize our hiring practices when we, most recently, needed to hire a new clinical ethicist to join our staff at the Center for Ethics at Washington Hospital Center.

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka (...) O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new “spaces” for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for “clinical ethics conflict coaching” can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new spaces for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for clinical ethics conflict coaching can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

The novel coronavirus of 2019 exposed, in an undeniable way, the severity of racial inequities in America’s healthcare system. As the urgency of the pandemic grew, administrators, clinicians, and ethicists became concerned with upholding the ethical principle of “most lives saved” by re-visiting crisis standards of care and triage protocols. Yet a colorblind, race-neutral approach to “most lives saved” is inherently inequitable because it reflects the normality and invisibility of ‘whiteness’ while simultaneously disregarding the burdens of ‘Blackness’. As written, the (...) crisis standards of care adopted by States are racist policies because they contribute to a history that treats Black Americans are inherently less than. This paper will unpack the idealized fairness and equity pursued by CSC, while also considering the use of modified Sequential Organ Failure Assessment as a measure of objective equality in the context of a healthcare system that is built on systemic racism and the potential dangers this can have on Black Americans with COVID-19. (shrink)

BackgroundRobust ethics consultation services cannot be sustained by all hospitals; consultative service from a high-volume center via teleconferencing is an attractive alternative. This pilot study was conceived to explore the feasibility and understand the practical implications of offering such a service.MethodsHigh-definition videoconferencing was used to provide real-time interaction between the rounding clinicians and a remote clinical ethicist. Data collection included: (1) evaluation of the hardware and software required for teleconferencing, and (2) comparison of ethics trigger counts between the remote and (...) on-site ethicist during rounds.ResultsIssues with audio represented the majority of technical problems. Once technical difficulties were addressed, the onsite ethicist’s count of “triggers” was not statistically different from the count of the remote ethicist.ConclusionRemote clinical ethics rounding is feasible when the equipment is optimized. Remote ethicists can identify similar numbers of “triggers” for possible ethical issues when compared to on-site ethicist numbers. (shrink)

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. “Immersion” refers to a high-intensity clinical ethics experience in a (...) busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients’ charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants’ evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

Philosophical theories of emotions, and to an extent some theories of scientific psychology, represent attempts to capture the essence of emotions basically as they are conceived in common sense psychology. Although there are problems, the success of explanations of our behavior in terms of believes, desires and emotions creates a presumption that, at some level of abstraction, they reflect important elements in our psychological nature. It is incumbent on a theory of emotions to provide an account of two salient facts (...) about emotions as conceived in common sense psychology. As intentional states, emotions have representational and rational properties: emotions represent states of affairs; and they are rationally related to other mental representations, figure in rational explanations of behavior, and are open to rational assessment. Emotions also have a close relationship to a range of non-intentional phenomena: in typical cases, emotions involve physiological changes, usually associated with the activation of the autonomic nervous system, which are proprioceptively experienced; and they often involve behavioral tendencies, as well. (shrink)

A review of deVries' and O'Shea's books, both titled "Wilfrid Sellars". By Jaroslav Peregrin.

Thomas Kuhn had little to say about scientific change in biological science, and biologists are ambivalent about how applicable his framework is for their disciplines. We apply Kuhn’s account of paradigm change to evolutionary microbiology, where key Darwinian tenets are being challenged by two decades of findings from molecular phylogenetics. The chief culprit is lateral gene transfer, which undermines the role of vertical descent and the representation of evolutionary history as a tree of life. To assess Kuhn’s relevance to this (...) controversy, we add a social analysis of the scientists involved to the historical and philosophical debates. We conclude that while Kuhn’s account may capture aspects of the pattern of an episode of scientific change, he has little to say about how the process of generating new understandings is occurring in evolutionary microbiology. Once Kuhn’s application is limited to that of an initial investigative probe into how scientific problem-solving occurs, his disciplinary scope becomes broader. (shrink)

It is common to regard love, friendship, and other associational ties to others as an important part of a happy or flourishing life. This would be easy enough to understand if we focused on friendships based on pleasure, or associations, such as business partnerships, predicated on mutual advantage. For then we could understand in a straightforward way how these interpersonal relationships would be valuable for someone involved in such relationships just insofar as they caused her pleasure or causally promoted her (...) own independent interests. But many who regard love, friendship, and other associational ties as an important part of a happy or flourishing life suppose that in many sorts of associations—especially intimate associations—the proper attitude among associates is concern for the other for the other's own sake, not just for the pleasure or benefits one can extract from one's associates. It is fairly clear how having friends of this sort is beneficial. What is less clear is how being a friend of this sort might contribute to one's own happiness or well-being. Even if we can explain this, it looks as if the contribution that friendship makes to one's happiness could not be the reason one has to care for friends, for that would seem to make one's concern for others instrumental, not a concern for the other for her own sake. (shrink)

Consequentialism is often criticized for failing to accommodate impersonal constraints and personal options. A common consequentialist response is to acknowledge the anticonsequentialist intuitions but to argue either that the consequentialist can, after all, accommodate the allegedly recalcitrant intuitions or that, where accommodation is impossible, the recalcitrant intuition can be dismissed for want of an adequate philosophical rationale. Whereas these consequentialist responses have some plausibility, associational duties represent a somewhat different challenge to consequentialism, inasmuch as they embody neither impersonal constraints nor (...) personal options, but rather personal constraints. Our intuitions about associational duties resist capture within the intellectual net of consequentialism, and such duties do admit of a philosophical rationale at least as plausible as anything the consequentialist has to offer. (shrink)

This study explores consumer expectations and attitudes related to gender-based price discrimination. Although much research has focused on pay inequalities and gender diversity, considerably less attention has been focused on situations in which men and women are charged different prices based on gender. In two studies, expectations and attitudes toward gender-based price discrimination are examined. In Study 1, two scenarios related to prices at hair salon and dry cleaning services were manipulated to measure expectations and attitudes toward gender-based price discrimination. (...) We found that the nature of the service results in expectations of price differences between men and women. We also found men expect gender-based pricing more than women. In Study 2, qualitative research was conducted to reveal the cognitions that men and women experience when exposed to gender-based price discrimination. (shrink)

Here we prove the existence of sheaf cohomology theory in arbitrary o-minimal structures.

Recent discoveries of geographical patterns in microbial distribution are undermining microbiology’s exclusively ecological explanations of biogeography and their fundamental assumption that ‘everything is everywhere: but the environment selects’. This statement was generally promulgated by Dutch microbiologist Martinus Wilhelm Beijerinck early in the twentieth century and specifically articulated in 1934 by his compatriot, Lourens G. M. Baas Becking. The persistence of this precept throughout twentieth-century microbiology raises a number of issues in relation to its formulation and widespread acceptance. This paper will (...) trace the conceptual history of Beijerinck’s claim that ‘everything is everywhere’ in relation to a more general account of its theoretical, experimental and institutional context. His principle also needs to be situated in relationship to plant and animal biogeography, which, this paper will argue, forms a continuum of thought with microbial biogeography. Finally, a brief overview of the contemporary microbiological research challenging ‘everything is everywhere’ reveals that philosophical issues from Beijerinck’s era of microbiology still provoke intense discussion in twenty-first century investigations of microbial biogeography. (shrink)

In this paper, I aim to clarify the role of ‘wonder’ in education. Most of us who work in education want to provide valuable experiences for our students, and we want them to be driven by intrinsic values such as truth and recognition of the dignity of human existence. However, whilst I echo many of the sentiments espoused by advocates of the utility and ethical significance of wonder, I contend that some recent developments—and in particular, Schinkel’s argument that ‘deep’ (‘contemplative’ (...) or ‘cosmic’) wonder has a ‘fundamental’ role in education—are misconceived. This is, I argue, because any concept deployable within educational spaces (whether formal or informal) must pay due regard to the conceptual constraints of the concept of ‘education’; that is, attention must be paid to the role of ‘learning’. Schinkel’s proposals are, I suggest, vulnerable to a critique of sentimentalism and excessive romanticism. As such, they offer little in terms of practical import for educators. As I will propose, if we are to take ‘wonder’ seriously in educational contexts, we must pay attention to the purpose of wonder as an epistemic emotion; namely, aiming for knowledge and understanding, and getting there requires sensitivity to practical know-how and conceptual competence. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S24-S29, March‐April 2022.

Rather surprisingly, T.H.Green's ideas on women and the family are as neglected today as they were immediately after his death in 1882, when his thought was first interpreted for a wider public by his colleagues and friends.1 Silence on such matters in the 1880s is not remarkable. It is odd, however, that it persists today, despite recent intense concern with the history of women and the family, including their place in political thought, and despite reviving philosophical interest in the British (...) Idealists and readiness to credit them with a significant impact on politics, education and social work. It has often been remarked that Green's political ideas have much in common superficially with those of John Stuart Mill, since their values and precepts are very similar, although the substructure of their thought is utterly different. Nevertheless it has altogether escaped notice that this is equally true of their ideas on women, marriage and family relationships. Today Mill's fabled feminism easily appears limited and imperceptive, and the priority he gave to the parliamentary vote strangely simplistic. Did Green show any greater realism and understanding? Did he practise as well as preach real equality between men and women, in private as well as public life? In short, what precisely was Green's position on 'the woman question'�? (shrink)

The relation between the digital and the collective has become an urgent contemporary question. These collected essays explore the implications of this relation, around the theme of #NousSommes. This hashtag marks the point where the «personal» modalities of social media have become embroiled in collective expressions of unity, solidarity and resistance. As this volume demonstrates, the impact of this cannot be isolated to the internet, but affect philosophy, literature, cinema, politics and the public space itself. The contributors approach the issue (...) of #NousSommes from a diverse range of disciplines and methodologies, bringing out both the continuity and discontinuity with other forms of collective expression. Important contemporary philosophers such as Nancy, Derrida and Deleuze are engaged here, as are issues of ecology, community, automation, postcolonial identity and addiction. Featuring eight academic essays and an interview, this volume testifies to the importance of French philosophy and culture in understanding the digital and the collective today. (shrink)