This paper explores the relationship between teaching and consulting in clinical ethics teaching and the role of the ethics teacher in clinical decision-making. Three roles of the clinical ethics teacher are discussed and illustrated with examples from the authors' experience. Two models of the ethics consultant are contrasted, with an argument presented for the ethics consultant as decision facilitator. A concluding section points to some of the challenges of clinical ethics teaching.

In lieu of an abstract, here is a brief excerpt of the content:Bedside VoicesJacqueline J. GloverThis issue of Narrative Inquiry in Bioethics features ten stories of Certified Nursing Assistants (CNAs) who work primarily in long-term care. This is a voice of direct care at the bedside that is not often heard. The addition of these stories in the literature is long overdue and I am honored to be asked to comment. There is much to learn from these bedside caregivers. All (...) of these stories reflect the deep struggle to be respected as a member of the health care team. But I also hear the pain of being caught in the tension between the desire to be skilled, qualified, and professional and the desire to be present in a way that emphasizes service, caring and common human touch. My commentary is informed by my experience in Rural Bioethics and my work at the Center for Bioethics and Humanities at the University of Colorado which has a commitment to Interprofessional Education. The CNAs' stories reveal much that they share with other health care professionals, but also some unique features that can teach us much.CommonalitiesSelf Care and Being Cared ForThe voice of the CNA is a voice that is echoed in a way by all health care professionals. Each of the stories bears witness to the need to take care of yourself and to be cared for in order to be able to continue to care for others. Leilani Roseberry writes "This unresolved grief and constant exposure to dying and death had me looking at every day, even every moment, through the eyes of a dying person. This is an emotion that is very difficult to put into words." She continues elsewhere, "I believe that if I had grief support opportunities available to me in my professional life, my level of care and compassion would have been much more resilient from the very beginning of my work as a CNA. Instead, only after sorting through emotions affecting my personal life and learning they were a compilation of what I experienced professionally, only then have I become much more resilient in the face of grief and mourning." Danny Reed writes, "Caregivers benefit from the same thing patients and residents do: genuine kindness. Take care of the caregivers because one day they will be all you have left in the world." And from James Bradley, "The work itself can be very draining, but to beat the stress of it, you can follow all the usual stuff like going for walks, playing with your kids, watch TV etc. The best advice though is to, as far as possible, leave the work behind when you walk off at the end of your shift. That may be the hardest thing to do but it is the only way to retain the correct professional approach."Self care can certainly be about boundaries and stress management. Health care institutions, including professional schools, increasingly have wellness programs (Johnson, 2000). It was once thought that [End Page 159] professional and emotional distance was necessary to maintain healthy relationships and avoid burn out. But current thinking seems to indicate the opposite. If a health care professional views his or her work only in terms of tasks to be performed without some connection to the meaning of what he or she is doing for the patient as a human being, that person is more likely to burn out (Halpern, 2003). Bradley's use of "correct professional approach" prompted me to think beyond wellness and health to the need to nurture meaning in one's work. The CNAs' essays are filled with the call to recognize the deeper meaning of their work. Tracy Dudzinski writes, "Most people think anyone can do this job. I thought that myself, twelve years ago. But now I know that it takes someone special. Direct care workers do not do this work because they are getting rich. They do it because they love the work and because it is the right thing to do. This is the hardest job I have ever done but it is also the most rewarding job I have ever done."There is increasing attention to the use of reflective writing in... (shrink)

Medical decision making on behalf of unrepresented patients is one of the most challenging ethical issues faced in clinical practice. The legal environment surrounding these patients is equally complex. This article describes the efforts of a small coalition of interested healthcare professionals to address the issue in Colorado. A brief history of the effort is presented, along with discussion of the legal, ethical, practical, and political dimensions that arose in Colorado’s effort to address decision making for unrepresented patients through an (...) extension of the existing Colorado Medical Treatment Decision Act (CRS 15-18). A discussion of lessons learned in the process is included. (shrink)

Volume 19, Issue 7, July 2019, Page 66-67.

The case of a dying baby with is one of the most difficult in pediatric ethics. I have been involved in several such cases and they are extremely challenging for all parties, especially the parents. With the luxury of being an I will comment on this case from the perspective of when it first began and at the end point described in the narrative.

Character structures underlie everyone’s personality. When rigidly defended, they limit us; yet as they become more flexible, they can reveal sources of animation, renewal and authenticity. _The Matrix and Meaning of Character_ guides the reader into an awareness of the archetypal depths that underlie character structures, presenting an original developmental model in which current analytic theories are synthesised. The authors examine nine character structures, animating them with fairy tales, mythic images and case material, creating a bridge between the traditional language (...) of psychopathology and the universal realm of image and symbol. This book will appeal to all analytical psychologists, psychoanalysts and psychotherapists who want to strengthen their clinical expertise. It will help clinicians to extend their clinical insights beyond a strictly behavioural, medical or cognitive approach, revealing the potential of the human spirit. (shrink)

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that i...

In 2016, the Colorado legislature passed an amendment to Colorado’s medical proxy law that established a process for the appointment of a physician to act as proxy decision maker of last resort for an unrepresented patient (Colorado HB 16-1101: Medical Decisions For Unrepresented Patients). The legislative process brought together a diverse set of stakeholders, not all of whom supported the legislation. Following passage of the statutory amendment, the Colorado Collaborative for Unrepresented Patients (CCUP), a group of advocates responsible for initiating (...) the legislative process, coordinated a unique effort to engage these stakeholders in the creation of a set of voluntary guidelines to assist facilities and individual careproviders in the implementation of policies and procedures enabled by the statute. This article delineates the questions and concerns of stakeholders, describes how those issues were addressed within the guidelines, and proposes additional opportunities for research to assess the impact of the legislation in Colorado. (shrink)

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...) to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)

The idea of the Internet as Gutenberg 2.0—a true revolution in disseminating information—is now a routine part of how bioethics education works. The Internet has become indispensable as a channel for sharing teaching materials and connecting learners with a central platform that houses materials to support an online or hybrid curriculum or a traditional course. A newer idea in bioethics education reflects developments in web-based medical education more broadly and draws on design principles developed for the Internet. This approach to (...) online bioethics education requires thinking about web-based learning as an engaging, potentially immersive experience, about learners' expectations concerning web-based learning, and about differences between self-directed learning and teaching to support group learning. In clinician education in bioethics, the interrelated goals of ethical reflection and practice for professionals and of continuous quality improvement in health care are supported by a focus on real-world challenges and by encouraging the habits of self-directed learning. In this paper, we describe how an international, interdisciplinary team used a web-based framework to develop a health care ethics casebook whose content, design, and pedagogy were tailored to the needs and expectations of health care professionals and other audiences in Singapore; we also explain how they used this framework to make the casebook accessible nationwide and to support cross-cultural learning. (shrink)

Introduction to Kristeva -- Horror/basic concepts: the abject and its varieties -- Horror/specifying the circumstances -- Strangers/basic concepts: strangers without and within -- Strangers/expansions: the stranger's story -- Love/basic concepts -- Love/basic concepts the text of society and history -- Love/ Expansions: Old and new discourses -- The text of society and history -- Women and social change.

Despite a growing body of literature focused on understanding experiences of workplace dignity, attention has centered almost exclusively on employees with lower-level jobs. As a result, little is known about how workplace dignity and indignity are experienced by employees with middle- and upper-level jobs and how their experiences differ from those with lower-level jobs. We address these absences by interviewing employees from a diversity of lower-, middle-, and upper-level jobs about their experiences of indignity at work. We outline common dignity (...) threats, along with typical emotional responses and recourses employees use at each level. We find lower-level employees experience chronic dignity threats from being disrespected, devalued, demeaned, and dehumanized, to which their most typical response is endurance. Middle-level employees experience periodic dignity threats due to undermining of their work, confidence, and reputation. For them, the typical response is strategizing. Finally, on the rare occasions upper-level employees experience dignity threats, it usually is due to a disregard of their special expertise or denial of special rights, to which they respond by rising above. (shrink)

Background: Personal genomic testing (PGT) offers individuals genetic information about relationships, wellness, sporting ability, and health. PGT is increasingly accessible online, including in emerging markets such as Australia. Little is known about what consumers expect from these tests and whether their reflections on testing resonate with bioethics concepts such as autonomy. Methods: We report findings from focus groups and semi-structured interviews that explored attitudes to and experiences of PGT. Focus group participants had little experience with PGT, while interview participants had (...) undergone testing. Recordings were transcribed and analyzed using thematic analysis. Findings were critically interpreted with reference to bioethics scholarship on autonomy. Results: Fifty-six members of the public participated in seven focus groups, and 40 individuals were interviewed separately. Both groups valued the choice of PGT, and believed that it could motivate relevant actions. Focus group themes centered on the perceived value of choices, knowledge enabling action and knowledge about the self. Interview themes suggest that participants reflexively engage with their PGT information to make meaning, and that some appreciate its shortcomings. Critical interpretation of findings shows that while consumers of PGT are able to exercise a degree of autonomy in choosing, they may not be able to achieve a substantive conceptualization of autonomy, one that promotes alignment with higher-order desires. Conclusions: PGT consumers can critically reason about testing. However, they may uncritically accept test results, may not appreciate drawbacks of increased choice, or may overestimate the potential for information to motivate behavioral change. While consumers appear to be capable of substantive autonomy, they do so without ongoing support from companies. PGT companies promote a problematic (“default”) account of autonomy, reliant on empowerment rhetoric. This leaves consumers vulnerable to making decisions inconsistent with their higher-order desires. As PGT expands, claims about its power and value need to be carefully drawn. (shrink)

Introdução a Levinas a partir da discussão sobre a problemática da subjetividade.

The western-based leadership and ethics literatures were reviewed to identify the key characteristics that conceptually define what it means to be an ethical leader. Data from the Global Leadership and Organizational Effectiveness (GLOBE) project were then used to analyze the degree to which four aspects of ethical leadership – Character/Integrity, Altruism, Collective Motivation, and Encouragement – were endorsed as important for effective leadership across cultures. First, using multi-group confirmatory factor analyses measurement equivalence of the ethical leadership scales was found, which (...) provides indication that the four dimensions have similar meaning across cultures. Then, using analysis of variance (ANOVA) tests each of the four dimensions were found to be universally endorsed as important for effective leadership. However, cultures also varied significantly in the degree of endorsement for each dimension. In the increasingly global business environment, these findings have implications for organizations implementing ethics programs across cultures and preparing leaders for expatriate assignments. (shrink)

Technologic advances mean automated, wearable cameras are now feasible for investigating health behaviors in a public health context. This paper attempts to identify and discuss the ethical implications of such research, in relation to existing guidelines for ethical research in traditional visual methodologies. Research using automated, wearable cameras can be very intrusive, generating unprecedented levels of image data, some of it potentially unflattering or unwanted. Participants and third parties they encounter may feel uncomfortable or that their privacy has been affected (...) negatively. This paper attempts to formalize the protection of all according to best ethical principles through the development of an ethical framework. Respect for autonomy, through appropriate approaches to informed consent and adequate privacy and confidentiality controls, allows for ethical research, which has the potential to confer substantial benefits on the field of health behavior research. (shrink)

Chief Executive Officers and other organizational leaders can affect how corporate social responsibility initiatives are perceived in their organizations. However, in order to be successful with regard to promoting CSR, leaders need to have strong network competencies and to move beyond charismatic leadership. In this paper we offer a critique of charismatic leadership as it relates to CSR, posit that the intellectual stimulation brought about by transformational leadership is more important in this regard, propose that internal and networking is a (...) leadership competence highly relevant to CSR, and emphasize the importance of working through highly credible opinion leaders in promoting CSR. (shrink)

Participatory action research (PAR) is a form of community-driven qualitative research which aims to collaboratively take action to improve participants’ lives. This is generally achieved through cognitive, reflexive learning cycles, whereby people ultimately enhance their wellbeing. This approach builds on two assumptions: (1) participants are able to reflect on and prioritize difficulties they face; (2) collective impetus and action are progressively achieved, ultimately leading to increased wellbeing. This article complicates these assumptions by analyzing a two-year PAR project with mothers of (...) disabled children from a South African urban settlement. Participant observation notes, interviews, and a group discussion served as primary data. We found that mothers’ severe psychological stress and the strong intersectionality of their daily challenges hampered participation. Consequently, mothers considered the project ‘inactionable’. Yet, many women quickly started expressing important individual and collective wellbeing transformations. To understand these ‘unlikely’ transformations, a feminist relational account, in particular, that of relational wellbeing, proves essential. We reflect on the consequences of these findings for the dominant PAR methodology and operationalization, and propose to sensitize future PAR with marginalized women by employing relational wellbeing as an overarching ontological awareness. (shrink)

In the second edition of this groundbreaking text in non-Western philosophy, sixteen experts introduce some of the great philosophical traditions in the world. The essays unveil exciting, sophisticated philosophical traditions that are too often neglected in the western world. The contributors include the leading scholars in their fields, but they write for students coming to these concepts for the first time. Building on revisions and updates to the original, this new edition also considers three philosophical traditions for the first time—Jewish, (...) Buddhist, and South Pacific philosophy. (shrink)

This study investigates the role of “moral” emotional traits—guilt proneness, shame proneness, empathic concern, and perspective taking—as predictors of workplace bullying perpetration. We also test and find support for a model derived from moral emotions literature and the sociometer theory of self-esteem in which the tendency to take reparative action following interpersonal transgressions mediates the buffering effect of guilt proneness on bullying. Data were obtained from working MBA students and advanced undergraduates during 2 survey sessions, 4 to 6 weeks apart. (...) Findings indicate that moral emotional traits may be useful to consider in personnel selection as a means to reduce workplace bullying. (shrink)

Cancer cells seem to exploit mechanisms that evolve as part of physiological tolerance, which is a complementary and often beneficial form of defense. The study of physiological systems of tolerance can therefore provide insights into the development of a state of host tolerance of cancer, and how to break it. Analysis of these models has the potential to improve our understanding of existing immunological therapeutic targets, and help to identify future targets and rational therapeutic combinations. The treatment of cancer with (...) immune checkpoint inhibitors aims to reverse the progression to tolerance of cancer, and achieve an immunogenic, rather than tolerogenic, homeostasis. Broadening the efficacy and durability of checkpoint inhibitors focuses on reversing tolerance and stimulating immunogenicity in the cancer, host, and environment. Two examples of important physiological states of tolerance that may inform tolerance of cancer are microbial infection and placental reproduction. These states of tolerance result from bilateral shaping of host and non‐self, akin to immunoediting in cancer, and offer reliable models to study the immune tolerance paradigm. (shrink)

A role of perirhinal cortex (PrC) in recognition memory for objects has been well established. Contributions of parahippocampal cortex (PhC) to this function, while documented, remain less well understood. Here, we used fMRI to examine whether the organization of item-based recognition memory signals across these two structures is shaped by object category, independent of any difference in representing episodic context. Guided by research suggesting that PhC plays a critical role in processing landmarks, we focused on three categories of objects that (...) differ from each other in their landmark suitability as confirmed with behavioral ratings (buildings > trees > aircraft). Participants made item-based recognition-memory decisions for novel and previously studied objects from these categories, which were matched in accuracy. Multi-voxel pattern classification revealed category-specific item-recognition memory signals along the long axis of PrC and PhC, with no sharp functional boundaries between these structures. Memory signals for buildings were observed in the mid to posterior extent of PhC, signals for trees in anterior to posterior segments of PhC, and signals for aircraft in mid to posterior aspects of PrC and the anterior extent of PhC. Notably, item-based memory signals for the category with highest landmark suitability ratings were observed only in those posterior segments of PhC that also allowed for classification of landmark suitability of objects when memory status was held constant. These findings provide new evidence in support of the notion that item-based memory signals for objects are not limited to PrC, and that the organization of these signals along the longitudinal axis that crosses PrC and PhC can be captured with reference to landmark suitability. (shrink)

Several recent studies devote themselves to Mary Astell's feminist theory of virtue—her ‘serious proposal to the ladies’ to help women obtain wisdom, equality, and happiness, despite the prejudices of seventeenth-century custom. But there has been little scholarship on Astell's conception of heroic virtues, those exceptional character traits that raise their bearers above the ordinary course of nature. Astell's appropriation of heroic virtue poses a number of philosophical difficulties for her feminist ethics—heroic virtues are characteristically masculine, exceptional, and individualistic, ill-suited to (...) a community-oriented feminism aimed at ordinary women. In this paper, we seek to investigate—and then dispel—these key difficulties. Our intention is to generate a new understanding of Astell's theory of virtue as a unique and sophisticated theory that equalizes and naturalizes heroic virtue for women. (shrink)