As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities has published core knowledge (...) competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent (...) that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (shrink)

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)

Benchmarks against which healthcare ethics consultation (HCEC) services can assess their performance are needed. As first-generation benchmarks continue to be developed, it is the obligation of the field to continually evaluate how these measures reflect the performance of any single HCEC service. This will be possible only with widespread reporting of standardized data points. In their article in this issue of The Journal of Clinical Ethics, Glover and colleagues provide a valuable preliminary approach for assessing appropriate consult volumes for a (...) HCEC service. The limitations of their study read as a call to action for the field of clinical ethics to expand and standardize data reporting so that more robust metrics can be developed. In response to this call by Glover and colleagues, the Cleveland Clinic HCEC service provides consult data from 2015 through 2019 for one of its medical centers, and offers an additional volumebased metric, consult-to-ICU-to-bed ratio (CiBR), that may add nuance to any normative assessment of HCEC service consult volume. Given that volume-based metrics are the native language of the clinical environment, efforts to improve such metrics in the field through transparency and standardization are warranted. However, the expositive power of volume-based metrics is limited; additional domains related to quality and outcomes are needed. (shrink)

This paper discusses the ethical issues related to hemicorporectomy surgery, a radical procedure that removes the lower half of the body in order to prolong life. The literature on hemicorporectomy (HC), also called translumbar amputation, has been nearly silent on the ethical considerations relevant to this rare procedure. We explore five aspects of the complex landscape of hemicorporectomy to illustrate the broader ethical questions related to this extraordinary procedure: benefits, risks, informed consent, resource allocation and justice, and loss and the (...) lived body. (shrink)

This article presents the case of a mother who is planning a home birth with a midwife with the shared knowledge that the fetus would have congenital anomalies of unknown severity. We discuss the right of women to choose home birth, the caregivers’ duty to the infant, and the careproviders’ dilemma about how to respond to this request. The ethical duties of concerned careproviders are explored and reframed as professional obligations to the mother, infant, and their profession at large. Recommendations (...) are offered based on this case in order to clarify the considerations surrounding not only home birth of a fetus with anticipated anomalies, but also to address the ethical obligations of caregivers who must navigate the unique tension between respecting the mother’s wishes and the duty of the careproviders to deliver optimal care. (shrink)

The nurse asks the ethics consultant what can be done to stop the patient’s blogging. R.J.’s messages on the public forum are taking their toll on the care environment and the health care providers...

For Lack of a Better Plan: A Framework for Ethical, Legal, and Clinical Challenges in Complex Inpatient Discharge Planning Content Type Journal Article Pages 311-326 DOI 10.1007/s10730-009-9117-6 Authors Jane Jankowski, Albany Medical Center Albany NY 12208 USA Terese Seastrum, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Robert N. Swidler, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Wayne Shelton, Alden March Bioethics Institute, Albany Medical College 47 New Scotland Avenue, MC 153 Albany NY 12208-3478 USA (...) Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Volume 20, Issue 3, March 2020, Page 21-24.

The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

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

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)

Colleges and universities exist within a political arena where external demands for accountability materialize within a market-driven environment. As a result, government agencies pressure colleges and universities to rely on assessment and transparent reporting to become more market-driven assuming that the competition within the market, led by public choice and institutional selection, will drive improvements in learning and will also self-govern the institutions. This article explores how Foucault informs our conception of neoliberal governmentality through political rationality and technologies of self-governance (...) in order to inform our understanding of accountability in higher education and to challenge institutions to develop a counter dialogue which meets institutional obligations to the public and market. (shrink)

The Emergence of Word-Meaning in Early China makes an innovative contribution to studies of language by historicizing the Chinese notion that words have "meaning" (content independent of instances of use). Rather than presuming that the concept of word-meaning had always existed, Jane Geaney explains how and why it arose in China. To account for why a normative term (yi, "duty, morality, appropriateness") came to be used for "meanings" found in dictionaries, Geaney examines interrelated patterns of word usage threading through (...) and across a wide range of genres. These patterns show that by the first millennium, as textual production exploded—and as radically different writing forms (in Buddhist sutras) were encountered—yi already functioned as an externally accessible "model" for semantic interpretation of texts and sayings. The book has far-reaching implications. Because the idea of word-meaning is fundamental to theorizing, the book illuminates not only semantic ideas and the normativity of language in Early China, but also aspects of early Chinese philosophy and intellectual history. As the internet supplants one form of media (print), thereby reducing knowledge to vast digital databases, so too, this book explains, two thousand years ago a culture that prized oral and visual balance became an "empire of the text.". (shrink)

In _Vibrant Matter_ the political theorist Jane Bennett, renowned for her work on nature, ethics, and affect, shifts her focus from the human experience of things to things themselves. Bennett argues that political theory needs to do a better job of recognizing the active participation of nonhuman forces in events. Toward that end, she theorizes a “vital materiality” that runs through and across bodies, both human and nonhuman. Bennett explores how political analyses of public events might change were we (...) to acknowledge that agency always emerges as the_ _effect of ad hoc configurations of human and nonhuman forces. She suggests that recognizing that agency is distributed this way, and is not solely the province of humans, might spur the cultivation of a more responsible, ecologically sound politics: a politics less devoted to blaming and condemning individuals than to discerning the web of forces affecting situations and events. Bennett examines the political and theoretical implications of vital materialism through extended discussions of commonplace things and physical phenomena including stem cells, fish oils, electricity, metal, and trash. She reflects on the vital power of material formations such as landfills, which generate lively streams of chemicals, and omega-3 fatty acids, which can transform brain chemistry and mood. Along the way, she engages with the concepts and claims of Spinoza, Nietzsche, Thoreau, Darwin, Adorno, and Deleuze, disclosing a long history of thinking about vibrant matter in Western philosophy, including attempts by Kant, Bergson, and the embryologist Hans Driesch to name the “vital force” inherent in material forms. Bennett concludes by sketching the contours of a “green materialist” ecophilosophy. (shrink)

Firms and industries increasingly subscribe to voluntary codes of conduct. These self-regulatory governance systems can be effective in establishing a more sustainable and inclusive global economy. However, these codes can also be largely symbolic, reactive measures to quell public criticism. Cross-sector alliances (between for-profit and nonprofit actors) present a learning platform for infusing participants with greater incentives to be socially responsible. They can provide multinationals new capabilities that allow them to more closely ally social responsibility with economic performance. This paper (...) examines learning facilitators in cross-sector alliances that enrich corporate understanding of stakeholder concerns. It suggests that these organizational learning experiments can translate into globally responsible practices and processes that improve the content and effectiveness of voluntary corporate codes. (shrink)

"It is well to remind ourselves, from time to time, that "Ethics" is but another word for "righteousness," that for which many men and women of every generation have hungered and thirsted, and without which life becomes meaningless. Certain forms of personal righteousness have become to a majority of the community almost automatic. But we all know that each generation has its own test, the contemporaneous and current standard by which alone it can adequately judge of its own moral achievements. (...) To attain individual morality in an age demanding social morality, to pride one's self on the results of personal effort when the time demands social adjustment, is utterly to fail to apprehend the situation. This book is a study of various types and groups who are being impelled by the newer conception of Democracy to an acceptance of social obligations involving in each instance a new line of conduct."--. (shrink)

The Aesthetics of Design offers the first full treatment of design in the field of philosophical aesthetics, challenging the discipline to broaden its scope to include the quotidian objects and experiences of our everyday lives and concerns ...

This is part of a complete set of Jane Austen's novels collating the editions published during the author's lifetime and previously unpublished manuscripts. The books are illustrated with 19th century plates and incorporate revisions by experts in the light of subsequent research.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Women Philosophers of the Seventeenth Century, and: Anne Conway: A Woman PhilosopherJane DuranWomen Philosophers of the Seventeenth Century, by Jacqueline Broad; 204 pp. Cambridge: Cambridge University Press, 2002. $65.00. Anne Conway: A Woman Philosopher, by Sarah Hutton; 280 pp. Cambridge: Cambridge University Press, 2004. $75.00.Recent work on women philosophers has, in general, approached the topic from two vantage points: on the one hand, a number of anthologies have (...) been published, wherein commentators present a small portion of the woman thinker's work, often without the background necessary for a fuller understanding. On the other hand, some few women philosophers have been the subject of full-length works, but these have tended, by and large, to be women thinkers of the twentieth century, with whose work we are already familiar. Two recent books, one by Jacqueline Broad and the other by Sarah Hutton, go a long way toward improving the situation.Work by Eileen O'Neill, Sarah Hutton and Margaret Atherton, among others, has helped familiarize us with the notion that the seventeenth century—that era so commonly associated with Descartes and the rise of modern philosophy—was also a time of rich theorizing by women philosophers. Jacqueline Broad's book possesses many virtues: it has the finely-tuned style of the careful historian, while at the same time not failing to demonstrate acquaintance with a range of contemporary feminist commentary. Part of the problem in addressing women thinkers of the past is another version of what we are now tempted to call the essentialism problem: does it make sense to think that there is a style that might be demarcated as "feminine," or that might, in some way, pertain uniquely to women theorists? These are difficult issues, but a partial response to the question is to try to remember that it is not for no reason that women thinkers have, indeed, been left out of the canon. As Broad herself says, women philosophers "are now mere footnotes to the standard historical-intellectual accounts of the early modern period" (p. 1).Broad does a superb job of navigating between the need to set out the plain tenets of the thinker's philosophy, and the desire to try to tie it into these larger questions. In six chapters, she addresses the work of Elizabeth of Bohemia, [End Page 200] Margaret Cavendish, Anne Conway, Mary Astell, Damaris Masham and Catharine Trotter Cockburn The chapters on Elizabeth, Margaret Cavendish and Mary Astell are particularly strong—here part of the difficulty is that we do have familiar commentaries addressing the work of these women, and it is hard to try to see them in a new light. We are accustomed, for example, to think of Elizabeth merely as Descartes's correspondent. As is the case with information that is currently coming to bear on the question of Harriet Taylor Mill's input into the work of John Stuart Mill, it is difficult for us to see Elizabeth as a thinker in her own right, or, indeed, to give her the credit that Descartes himself gave her; as Broad notes, he had described her as "the only person I have so far found who has completely understood all my previous works" (p. 13). Margaret Cavendish's reputation has suffered from the somewhat scattered approach of her writings, and Broad cites her "reputation for eccentricity" (p. 38). Nevertheless, the sheer volume of her work and its allusion to the problems addressed by the Cambridge Platonists (areas also worked on by Anne Conway) demands that she be taken far more seriously than she has in the past. Astell has become known largely for her more overtly feminist works, such as A Serious Proposal to the Ladies, but she was also the author of several other pieces addressing issues in metaphysics, and again the amount of her work and its citation during her own time would militate against the notion that it should not receive thorough examination.Broad does a wonderful job of setting out the main philosophical questions found in these theorists' works, and she excels at pitting their views against those of the various male philosophers whose work—according to... (shrink)

This paper sets out to launch a challenge to the usual ‘modernist’ view of the relationship between ecology and ethics. Two ‘post-modern’ interpretations of this relationship are considered. The first ‘deep’ interpretation holds that ecology reveals that nature has intrinsic value. The second interpretation derives from the work of Michel Foucault. The aim of his critique is to reveal how certain values are taken for granted by the acceptance of certain scientific models, and how the acceptance of those models as (...) true makes it impossible to articulate alternative values. I end by suggesting, contra Foucault, that phenomenological enquiry could serve to articulate alternative and perhaps more eco-friendly values. (shrink)

It is a commonplace that the modern world cannot be experienced as enchanted--that the very concept of enchantment belongs to past ages of superstition. Jane Bennett challenges that view. She seeks to rehabilitate enchantment, showing not only how it is still possible to experience genuine wonder, but how such experience is crucial to motivating ethical behavior. A creative blend of political theory, philosophy, and literary studies, this book is a powerful and innovative contribution to an emerging interdisciplinary conversation about (...) the deep connections between ethics, aesthetics, and politics. As Bennett describes it, enchantment is a sense of openness to the unusual, the captivating, and the disturbing in everyday life. She guides us through a wide and often surprising range of sources of enchantment, showing that we can still find enchantment in nature, for example, but also in such unexpected places as modern technology, advertising, and even bureaucracy. She then explains how everyday moments of enchantment can be cultivated to build an ethics of generosity, stimulating the emotional energy and honing the perceptual refinement necessary to follow moral codes. Throughout, Bennett draws on thinkers and writers as diverse as Kant, Schiller, Thoreau, Kafka, Marx, Weber, Adorno, and Deleuze. With its range and daring, The Enchantment of Modern Life is a provocative challenge to the centuries-old ''narrative of disenchantment,'' one that presents a new ''alter-tale'' that discloses our profound attachment to the human and nonhuman world. (shrink)

When discussing the problem of evil, philosophers often distinguish between physical evil (harm caused within the natural world such as natural disasters, disease, and the like), and moral evil (harm caused by human agency). Mapping this traditional distinction is mapped onto the third section of Fichte’s The Vocation of Man would at first seem fairly straightforward: for Fichte, evil arising from nature occurs through “blind mechanism” and is unfree; in contrast, evil done by human beings arises out of free agency. (...) The answer may be more complicated, however, in two different ways. First, Fichte holds that nature is to be cultivated and controlled by human beings so that it is no longer a source of harm; this may imply that the continuing harm done by nature is the result of humans’ failure to have sufficiently tamed nature. In that case, some of the harm caused by nature may be attributable to free human causality and thus no longer be a clearcut instance of natural evil. Second, Fichte repeatedly states that those who fail to act morally and who fail to conform their wills to the moral law are still be in the power of the mechanisms of nature. Even though we must think of them as free, Fichte compares their actions to the operation of nature and its mechanism of necessity. By presenting a careful and nuanced Fichtean account of the traditional distinction between physical and moral evil, we can better appreciate how Fichte understood the meaning and scope of human responsibility. (shrink)

Overviews -- Hildegard of Bingen -- Anne Conway -- Mary Astell -- Mary Wollstonecraft -- Harriet Taylor Mill -- Edith Stein -- Simone Weil -- Simone de Beauvoir -- Conclusions.

In _influx & efflux_ Jane Bennett pursues a question that was bracketed in her book _Vibrant Matter_: how to think about human agency in a world teeming with powerful nonhuman influences? “Influx _& _efflux”—a phrase borrowed from Whitman's "Song of Myself"—refers to everyday movements whereby outside influences enter bodies, infuse and confuse their organization, and then exit, themselves having been transformed into something new. How to describe the human efforts involved in that process? What kinds of “I” and “we” (...) can live well and act effectively in a world of so many other lively materialities? Drawing upon Whitman, Thoreau, Caillois, Whitehead, and other poetic writers, Bennett links a nonanthropocentric model of self to a radically egalitarian pluralism and also to a syntax and style of writing appropriate to the entangled world in which we live. The book tries to enact the uncanny process by which we “write up” influences that pervade, enable, and disrupt us. (shrink)

Clicks, comments, transactions, and physical movements are being increasingly recorded and analyzed by Big Data processors who use this information to trace the sentiment and activities of markets and voters. While the benefits of Big Data have received considerable attention, it is the potential social costs of practices associated with Big Data that are of interest to us in this paper. Prior research has investigated the impact of Big Data on individual privacy rights, however, there is also growing recognition of (...) its capacity to be mobilized for surveillance purposes. Our paper delineates the underlying issues of privacy and surveillance and presents them as in tension with one another. We postulate that efforts at controlling Big Data may create a trade-off of risks rather than an overall improvement in data protection. We explore this idea in relation to the principles of the European Union’s General Data Protection Regulation as it arguably embodies the new ‘gold standard’ of cyber-laws. We posit that safeguards advocated by the law, anonymization and pseudonymization, while representing effective counter measures to privacy concerns, also incentivize the use, collection, and trade of behavioral and other forms of de-identified data. We consider the legal status of these ownerless forms of data, arguing that data protection techniques such as anonymization and pseudonymization raise significant concerns over the ownership of behavioral data and its potential use in the large-scale modification of activities and choices made both on and offline. (shrink)

"It is well to remind ourselves, from time to time, that "Ethics" is but another word for "righteousness," that for which many men and women of every generation have hungered and thirsted, and without which life becomes meaningless. Certain forms of personal righteousness have become to a majority of the community almost automatic. But we all know that each generation has its own test, the contemporaneous and current standard by which alone it can adequately judge of its own moral achievements. (...) To attain individual morality in an age demanding social morality, to pride one's self on the results of personal effort when the time demands social adjustment, is utterly to fail to apprehend the situation. This book is a study of various types and groups who are being impelled by the newer conception of Democracy to an acceptance of social obligations involving in each instance a new line of conduct."--. (shrink)

Effective corporate social responsibility policies are a requirement for today's companies. Policies have not only to be formulated, they also have to be delivered by corporate employees. This paper uses existing research findings to identify two types of factors that may impact on employee motivation and commitment to CSR ‘buy-in’. The first of these is contextual: employee attitudes and behaviours will be affected by organizational culture and climate, by whether CSR policies are couched in terms of compliance or in terms (...) of values, and by whether such policies are integrated into business processes or simply an ‘add-on’ that serves as window-dressing. The second set of factors is perceptual. Motivation and commitment will be affected by the extent to which they can align personal identity and image with that of the organization, by their perceptions of justice and fairness both in general and in terms of how CSR performance is rewarded, and by their impressions concerning the attitude of top management to CSR issues and performance. (shrink)

The article presents the results of research on relationships between types of social participation and emotion regulation. In the study, Gratz’ and Roemer’s perspective on emotion regulation and Reinders’ and Butz’s concept of types of social participation were applied. Participants were 1151 students from three types of vocational schools: basic vocational school, technical upper secondary school, and specialized upper secondary school. The results of studies conducted with the use of Difficulties in Emotion Regulation Scale and Social Participation Questionnaire indicate that (...) there are small, however, significant, differences in the levels of social participation dimensions and the frequency of particular types of social participation between students from the three investigated types of vocational schools. The level of transitive orientation turned out to be higher among students from the basic vocational schools than among students from the specialized upper secondary schools and the technical upper secondary schools. In each educational group, the level of transitive orientation was significantly higher than the level of moratorium orientation. The hypothesis about the relationship between dimensions of emotion regulation and types of social participation, particularly with respect to the dimension of “lack of emotional awareness”, was confirmed. The most effective style in terms of emotion regulation turned out to be the assimilation type. The highest level of emotion dysregulation proved to be connected with the segregation type. (shrink)