This paper is the first of two in a series. In this paper, we identify mental health needs and challenges in the age of COVID-19 among Nepali-speaking, Bhutanese resettled refugees in the USA. We argue for a public health justice framework that looks critically at social determinants impacting mental health (SDIMH) barriers, which negatively impact our Bhutanese population, and serves as a theoretical foundation toward public policy and law that will inform healthcare decisions and fair treatment of resettled refugees at (...) the clinical bedside and in the community. We first describe our Bhutanese refugee population and the critical mental health issues that, for many, originated during political persecution and violent ethnic cleansing initiatives, or while living in refugee camps prior to resettlement to the USA. We present a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19, which are guided by the social determinants of economic stability; neighborhoods and physical environment; education; nutrition and exercise; community and social context; healthcare system; and legal system. We illustrate specific SDIMH of our resettled Bhutanese refugees during the pandemic, followed by a second paper that details recommendations for applying the SDIMH in a collective effort to address specific barriers to mental healthcare and support. (shrink)

This paper explores the vulnerability of Latin American human subjects, and how their vulnerability is ignored due to the complexities and inconsistencies of oversight committees and institutional policies. Secondly, the concept of apology is examined and its meaning to victims of past research abuses.

As much as we can be squeamish and angry over what was being done in these studies, they force us to consider how we tell these stories and the policy we make now, as so much of our research is global and the risks and benefits of experimentation always in need of recalibration.Susan M. ReverbyA growing distrust exists among Latin American populations as past abuses in medical research have rightly been publicized, and as researchers continue to intentionally and unintentionally circumvent (...) the systems of regulation and oversight. Beyond the cultural gaps between researcher and subject, the Latin American people have their own perspectives about responsible conduct of research formed by sociopolitical thought and familial and community identity, which may be overlooked or ignored by the U.S. and other foreign nations. Just as the Havasupai Tribe in Arizona have challenged us to think about the role of culture and the need for improved regulations and practices in conducting research within the United States, through past abuses in human experimentation and the emergence of discourse between our Latin American neighbors, similar challenges confront us. (shrink)

This paper is the second of two in a series. In our first paper, we presented a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19 and illustrated specific social determinants impacting mental health (SDIMH) of our resettled Bhutanese refugee population during the pandemic. This second paper details specific barriers to the SDIMH detrimental to the basic human rights and social justice of this population during this (...) pandemic. The SDIMH, as described, further informs the need for social justice measures and cultural humility in mental healthcare, public health, law, and community engagement. This work concludes with a proposed call to action toward mental health improvement and fair treatment for refugee populations in three core areas: communication and education, social stigma and discrimination, and accessibility and availability of resources. (shrink)

Volume 20, Issue 3, March 2020, Page 46-50.

In this case, Brian, a 42-year-old patient with decision-making capacity and a history of non-adherence to treatment, refuses to leave the hospital due to concerns about a bothersome rash on his ar...

In this mixed methods study we identify and assess ethical and pragmatic issues and dilemmas surrounding e-health technologies in the context of primary care, including what is already in the literature. We describe how primary healthcare professionals can access reliable and accurate data, improve the quality of care for patients, and lower costs while following institutional guidelines to protect patients. Using qualitative and quantitative methodologies we identify several underlying ethical and pragmatic burdens and benefits of e-health technologies. The 41 study (...) participants reported more burdens than benefits, and were generally ambivalent about their level of satisfaction with their institutions’ ehealth technologies, their general knowledge about the technologies, and whether e-health can improve team-based communication and collaboration. Participants provided recommendations to improve e-health technologies in primary care settings. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 44-46, December 2011.

Although bedbug infestation is not a new public health problem, it is one that is becoming more alarming among healthcare professionals, public health officials, and ethicists given the magnitude of patients who may be denied treatment, or who are unable to access treatment, especially those underserved populations living in low income housing. Efforts to quarantine and eradicate Cimicidae have been and should be made, but such efforts require costly interventions. The alternative, however, can further exacerbate the already growing problems of (...) injustice, i.e., unfair treatment of patients, inaccessibility of needed resources. In the following paper, I examine the ramifications of denying access to medical care, among other healthcare justice dilemmas surrounding bedbug infestations. I also explore the value of health, and how healthcare professionals and public officials often feel as though bedbugs are not a priority because they, themselves, are not diseases, regardless of the fact they cause physical and mental problems that affect a person’s health. I propose recommendations for improving the health and well-being of those vulnerable populations who are facing a difficult and growing public health problem that is currently being ignored in medical and public health ethics literature, regardless of increased media attention and unusual habitats of localized infestations, e.g., Statue of Liberty, New York City. (shrink)

With a shift from genetics to genomics, the study of organisms in terms of their full DNA sequences, the resurgence of eugenics has taken on a new form. Following from this new form of eugenics, which I have termed "eugenomics", is a host of ethical and social dilemmas containing elements patterned from controversies over the eugenics movement throughout the 20th century. This paper identifies these ethical and social dilemmas, drawing upon an examination of why eugenics of the 20th century was (...) morally wrong. Though many eugenic programs of the early 20th century remain in the dark corners of our history and law books and scientific journals, not all of these programs have been, nor should be, forgotten. My aim is not to remind us of the social and ethical abuses from past eugenics programs, but to draw similarities and dissimilarities from what we commonly know of the past and identify areas where genomics may be eugenically beneficial and harmful to our global community. I show that our ethical and social concerns are not taken as seriously as they should be by the scientific community, political and legal communities, and by the international public; as eugenomics is quickly gaining control over our genetic futures, ethics, I argue, is lagging behind and going considerably unnoticed. In showing why ethics is lagging behind I propose a framework that can provide us with a better understanding of genomics with respect to our pluralistic, global values. (shrink)

This is a qualitative examination of ethics consultation requests, outcomes, and ethics committee recommendations at a tertiary/quaternary pediatric hospital in the U.S. The purpose of this review of consults over an 18-year period is to identify specific trends in the types of ethical dilemmas presented in our pediatric setting, the impact of consultation and committee development on the number and type of consults provided, and any clinical features and/or challenges that emerged and contributed to the nature of ethical situations and (...) dilemmas. Furthermore, in reviewing clinical ethics consultation trends for nearly two decades, we can identify topic areas for further ethics education and training for ethics consultants, ethics committee members, and pediatric healthcare teams and professionals based on our experiences. Our study with nearly two decades of data prior to the COVID-19 pandemic can serve as groundwork for future comparisons of consultation requests and ethics support for pediatric hospitals prior to, during, and following a pandemic. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the American (...) Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

We expand on the article “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force” to consider the ways in which rural...

Without a better understanding of mental disease, patients diagnosed with a mental disease may be mistreated clinically and/or socially, and caregivers and families may be wrongfully blamed for causing the disease and/or for not effectively helping and developing meaningful relationships with the patient as person. In trying to understand mental disease and why its various dimensions raise difficulties for our systems of classification and our medical models of diagnosis and treatment, a framework is required. This framework will connect metaphysical, epistemological, (...) and ethical considerations in ways that are mutually supportive and illuminating. This, in turn, will benefit those who are diseased and those persons who study, classify, diagnose, and treat disease. (shrink)

There is a critical need to establish a space to engage in careful deliberation amid exciting, important, necessary, and groundbreaking technological and clinical advances in pediatric medicine. Extracorporeal membrane oxygenation (ECMO) is one such technology that began in pediatric settings nearly 50 years ago. And while not void of medical and ethical examination, both the symbolic progression of medicine that ECMO embodies and its multidimensional challenges to patient care require more than an intellectual exercise. What we illustrate, then, is a (...) person-centered framework that incorporates the philosophy and practice of palliative care and care-based ethical approaches. This person-centered framework is valuable for identifying and understanding challenges central to ECMO, guides collaborative decision-making, and recognizes the value of relationships within and between patients, families, healthcare teams, and others who impact and are impacted by ECMO. Specifically, this person-centered approach enables caregivers to provide compassionate and effective support in critical, and often urgent, situations where conflicts may emerge among healthcare team members, families, and other decision makers. By reflecting on three cases based on actual situations, we apply our person-centered framework and identify those aspects that were utilized in and informed this project. We aim to fill a current gap in the pediatric ECMO literature by presenting a person-centered framework that promotes caregiving relationships among hospitalized critically ill children, families, and the healthcare team and is supported through the philosophy and practice of palliative care and clinical ethics. (shrink)

Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Julie Houts has cultivated a devoted following as "Instagram's favourite illustrator" (Vogue) by lampooning the conflicting messages and images women consume and share with the world every day. A collection of darkly comic illustrated essays, Literally Me chronicles the daily exploits of "slightly antisocial heroines" (Refinery29) in vivid, excruciatingly funny detail, including: -The beauty routine of a deranged bride who aspires to be "truly without flaws" on her wedding day -What happens when Kylie Jenner has an existential crisis and (...) can no longer "step out" -A journey to Coachella by the Four Horsewomen of the Apocalypse -The true dating confessions of a fembot -The terrifying description for Alice Staunch's book How to be the Perfect Feminist -The diary of Fiddle Ficus, a tree that lives inside a CÉLINE store, and much more. Literally Me marks the launch of a brilliant new social satirist. Julie's singular voice and beautiful illustrations reveal the truth about the absurdity of life in the social media age: the line between becoming a total `Girlboss' and a 21st-century American Psycho is razor-thin."--Dust jacket. (shrink)

In this close analysis of Immanuel Kant’s aesthetics in his Critique of Judgment, Dr. Julie N. Books, explains why Kant fails to provide a convincing basis for his desired necessity and universality of our aesthetic judgments about beauty. Drawing upon her extensive background in the visual arts, art history, and philosophy, Dr. Books provides a unique discussion of Kant’s supersensible, illuminating how it cannot justify his a priori nature of our aesthetic judgments about beauty. She uses examples from the (...) history of art, including paintings by Michelangelo, Caravaggio, Rubens, and Constable, to support her views. This book will make a significant addition to courses on the philosophy of Kant, aesthetics, philosophy of art, metaphysics, the history of Western philosophy, ethics, psychology, and art history. (shrink)

God -- God is holy -- Sin -- God's holiness is important -- Sin brings separation -- Confession -- Forgiveness -- Special God -- Salvation -- Consequences -- Jesus -- Punishments -- Jesus instead of you -- Jesus was crucified -- Jesus was resurrected -- Jesus is really God's son -- God can really forgive sin -- Jesus defeated death -- Physical and spiritual -- Mystery -- Eternal life -- Heaven -- Grace and faith -- Becoming a Christian -- Following (...) Jesus. (shrink)

"J’étais morte, mais pas enterrée, et c’est la philosophie qui m’a ramenée à la vie. Comme une mère, elle m’a non seulement donné la vie en me donnant accès à ma vie intérieure par l’élargissement de ma conscience, mais elle m’a également appris à vivre, c’est-à-dire comment agir au mieux dans la vie quotidienne. Tout au long de ses réflexions et de son témoignage, l’auteure affirme haut et fort que la philosophie peut sauver des vies, car elle rend possibles la (...) conversion du regard et la prise en charge de sa propre liberté."--Résumé de l'éditeur. (shrink)

Self-deception may be a natural consequence of active goal operation instead of an adaptation for negotiating the social world. We argue that because autonomous goal programs likely drove human judgment and behavior prior to evolution of a central executive or “self,” these goal programs can operate independently to attain their desired end states and thereby produce outcomes that “deceive” the individual.

Reveals how our survival depends on embracing complexity consciousness and relating to nature and all life as sacred.

The importance of voice and myth of the 'voiceless' -- Community pespective, experience and voice -- Glebelands Hostel, Durban -- Xolobeni, Eastern Cape -- Thembelihle community, Johannesburg -- Dominant media telling and elite communication -- The polical economy of dominant power and storytelling -- media diversity and voices(s) -- Rethinking media freedom, revamping media ethics -- Planting the seeds of change.

This book offers a radical alternative to the positive orientation of popular psychology. This positive orientation has been criticized numerous times. However, there has yet to be a coherent alternative proposed. We all know today that life hurts and that there is no ultimate remedy to this pain. The positive approach feels to us as dishonest and irrelevant. We require a new, more negative, perspective and practice, one that is honest and does not pretend to offer an escape from the (...) agonies of the world. This book offers in three main chapters a ‘depressive realist’ perspective that explores the structural role of negativity and tragedy in relation to the individual psyche, society, and nature. It explores the possibility of ‘negative psychoanalysis’ which takes into account the tragedy of human existence instead of adopting escapist positions. (shrink)

This article discusses what is involved in having full moral status, as opposed to a lesser degree of moral status and surveys different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

La defense d'un profond humanisme dont les racines puisent dans la Renaissance ainsi que le souci permanent d'une pedagogie exemplaire ont guide Genevieve Giudicelli-Delage durant toute sa carriere. Professeur emerite de l'Universite Paris 1 Pantheon-Sorbonne, ou elle a notamment dirige pendant de nombreuses annees le DEA devenu Master II de droit penal et politique criminelle en Europe, redactrice en chef de la Revue de science criminelle et de droit penal compare pour les editions Dalloz, presidente de l'Association de recherches penales (...) europeennes (ARPE), directrice de l'Ecole du Centre Ouest des avocats a Poitiers, Genevieve Giudicelli-Delage n'a cesse d'oeuvrer pour un depassement des frontieres disciplinaires et geographiques dans l'approche du phenomene criminel, ce dont temoignent en particulier son engagement en faveur du developpement du droit compare et son attachement a repousser les lignes d'horizons juridiques. Son regard sur le droit penal a profondement marque des generations d'etudiants et de doctorants. Par ses recherches individuelles, comme par les recherches collectives qu'elle mene admirablement, elle a egalement contribue au rayonnement doctrinal du droit penal en general, et de certaines de ses disciplines telles que le droit penal des affaires, le droit international penal, le droit penal europeen ou la procedure penale. C'est donc au chercheur comme au pedagogue que nous avons souhaite rendre hommage par ces Melanges regroupant une soixantaine d'auteurs, anciens eleves/collegues/amis, universitaires et/ou praticiens reunis autour du theme Humanisme et justice, que le Professeur Giudicelli-Delage a, par un soin constant, nourri et questionne durant toutes ses annees d'exercice. (shrink)

The ambition of the "ethical anthropology" established by the author is to think about ethics as a process of becoming by way of a new and precise reading of Spinoza and to give a significant place to affects, desire, imagination, personal history, and encounters.

A practical guide to stop searching for meaning by creating meaning from within"--Provided by publisher.