For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Campbell, Ulrich, and Grady (2016) should be commended for attempting to contribute to the discussion of what many believe is currently a messy concept. They propose that a broader definition of mo...

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

The target article by Grady and colleagues (2008) is a valuable and exciting contribution to the debate about the importance of ethics education for nurses. The findings indicated that ethics educa...

A recent Carnegie Report on Nursing Education – Educating Nurses: A Call for Radical Transformation challenges the nursing profession to embrace an education model that integrates knowledge, skilled know how and ethical comportment. Placing ethics in such a prominent position in nursing education is a radical transformation. Teaching ethics must be intentional and it is integral to the development of individual nurses and the profession as a whole. The development of moral imagination has a prominent place in this new education (...) model. The moral imagination is the ability to ponder and wonder about the inherent rightness or wrongness of decisions, choices and behaviors. This paper will review some key issues relevant to teaching ethics and then explore what nurturing the moral imagination could do for nurses as they learn to apply abstract ethics concepts to their clinical practice. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

The article “Moral distress: What are we measuring?” by Kolbe and de Melo-Martin (2023) is an important contribution both to the literature and research agenda for the complicated construct of mora...

The idea of a role in nursing that includes expertise in ethics has been around for more than 30 years. Whether or not one subscribes to the idea that nursing ethics is separate and distinct from bioethics, nursing practice has much to contribute to the ethical practice of healthcare, and with the strong grounding in ethics and aspiration for social justice considerations in nursing, there is no wonder that the specific role of the nurse ethicist has emerged. Nurse ethicists, expert (...) in nursing practice and the application of ethical theories and concepts, are well positioned to guide nurses through complex ethical challenges. However, there is limited discussion within the field regarding the specific job responsibilities that the nurse ethicist ought to have. The recent appearance of job postings with the title “nurse ethicist” suggest that some healthcare institutions have identified the value of a nurse in the practice of ethics and are actively recruiting. Discomfort about the possibility of others defining the role of the nurse ethicist inspired this paper (and special issue). If the nurse ethicist is to be seen as an integral part of addressing ethical dilemmas and ethical conflicts that arise in healthcare, then nurse ethicists ought to be at the forefront of defining this role. In this paper, we draw upon our own experiences as nurse ethicists in large academic healthcare systems to describe the essential elements that ought to be addressed in a job description for a nurse ethicist practicing in a clinical setting linked to academic programs. Drawing upon our experience and the literature, we describe how we perceive the nurse ethicist adds value to healthcare organizations and teams of professional ethicists. (shrink)

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of (...) the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model of moral reasoning along with tenets of the International Council of Nursing’s (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action. (shrink)

AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

IntroductionIn this study we compared the effects of a mindfulness-based intervention with a story reading intervention on the executive functions and psychological profile of children in two different public schools in São Paulo, Brazil.MethodsIn this controlled clinical trial, 207 children aged 8 to 9 years old responded to the Five-Digit Test, stress levels, depression, anxiety, positive and negative affect, at baseline and 8 weeks later. From T0 to T1, school 1 participated in MBI classes and school 2 in IS classes.ResultsIn (...) school 1, children improved their scores on all tests except reading and counting compared with school 2. No differences were observed between groups in terms of emotional health.ConclusionIt is feasible to implement MBI or SI in Brazilian public schools. Students in the MBI group presented broader effects in executive functions, while students in the SI group showed a trend toward reduced negative affect and depression symptoms. (shrink)

Ethics consultation is a service provided to patients, families, and clinicians to support decisions during ethical dilemmas. This study is a secondary qualitative analysis of 48 interviews from clinicians involved in an ethics consultation at a large academic health center. An inductive secondary analysis of this data set led to the emergence of one key theme, the apparent perspective the clinicians adopted as they recalled a specific ethics case. This article presents a qualitative analysis of the propensity of clinicians involved (...) in an ethics consultation to adopt the subjective viewpoints of their team, their patient, or both simultaneously. Clinicians demonstrated an ability to take the patient perspective (42%), the clinician perspective (31%), or the clinician-patient perspective (25%). Our analysis suggests the potential for narrative medicine to build the empathy and moral imagination necessary to bridge the gap in perspectives between key stakeholders. (shrink)

Hastings Center Report, Volume 52, Issue 5, Page 46-47, September–October 2022.

Given a space in an elementary submodel M of H, define XM to be X∩M with the topology generated by . It is established, using anti-large-cardinals assumptions, that if XM is compact and its regular open algebra is isomorphic to that of a continuous image of some power of the two-point discrete space, then X=XM. Assuming in addition, the result holds for any compact XM satisfying the countable chain condition.

The text focuses on the status of sciences, starting from the psychiatric discipline, related to the crisis that from the 60s to today has threatened his epistemological presuppositions. Not otherwise, the other sciences, on the the wave of progress and technological development, end up reaching increasingly important results, paying the price of losing the condition and the aim of research and knowledge.

Online crowdsourcing platforms have rapidly become a popular source of data collection. Despite the various advantages these platforms offer, there are substantial concerns regarding not only data validity issues, but also the ethical, societal, and global ramifications arising from the prevalent use of online crowdsourcing platforms. This paper seeks to expand the dialogue by examining both the “internal” aspects of crowdsourcing research practices, such as data quality issues, reporting transparency, and fair compensation, and the “external” aspects, in terms of how (...) the widespread use of crowdsourcing data collection shapes the nature of scientific communities and our society in general. Online participants in research studies are informal workers who provide labor in exchange for remuneration. The paper thus highlights the need for researchers to consider the markedly different political, economic, and socio-cultural characteristics of the Global North and the Global South when undertaking crowdsourcing research involving an international sample; such consideration is crucial for both increasing research validity and mitigating societal inequities. We encourage researchers to scrutinize the value systems underlying this popular data collection research method and its associated ethical, societal, and global ramifications, as well as provide a set of recommendations regarding the use of crowdsourcing platforms. (shrink)

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to (...) patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain. (shrink)

In The Oxford Handbook of Philosophy in Music Education, editors Wayne D. Bowman and Ana Lucia Frega have drawn together a variety of philosophical perspectives from the profession's most exciting scholars from all over the world. Rather than relegating philosophical inquiry to moot questions and abstract situations, the contributors to this volume address everyday concerns faced by music educators everywhere. Emphasizing clarity, fairness, rigour, and utility above all, The Oxford Handbook of Philosophy in Music Education will challenge music educators (...) all over the world to make their own decisions and ultimately contribute to the conversation themselves. (shrink)

This study examined linguistic patterns in mothers’ reports about their toddlers’ involvement in everyday household work, as a way to understand the parental ethnotheories that may guide children’s prosocial helping and development. Mothers from two cultural groups – US Mexican-heritage families with backgrounds in indigenous American communities and middle-class European American families – were interviewed regarding how their 2- to 3-year-old toddler gets involved in help with everyday household work. The study’s analytic focus was mothers’ responses to interview questions asking (...) about the child’s efforts to help with a variety of everyday household work tasks. Results showed that mothers responded with linguistic patterns that were indicative of ethnotheoretical assumptions regarding children’s agency and children’s prosocial intentions, with notable contrasts between the two cultural groups. Nearly all US Mexican-heritage mothers reported children’s contributions and participation using linguistic forms that centered children’s agency and prosocial initiative, which corresponds with extensive evidence suggesting the centrality of both children’s autonomy and supportive prosocial expectations in how children’s helpfulness is supported in this and similar cultural communities. By contrast, middle-class European American mothers frequently responded to questions about their child’s efforts to help with linguistic forms that “pivoted” to either the mother as the focal agent in the child’s prosocial engagement or to reframing the child’s involvement to emphasize non-help activities. Correspondence between cultural differences in the linguistic findings and existing literature on socialization of children’s prosocial helping is discussed. Also discussed is the analytic approach of the study, uncommon in developmental psychology research, and the significance of the linguistic findings for understanding parental ethnotheories in each community. (shrink)

Estudos indicam que o estresse altera o sistema imune e pode influir na etiologia, progressão e severidade de doenças. A resiliência pode ser definida como a capacidade que algumas pessoas desenvolvem e as ajudam a passar por situações adversas na vida, a superá-las, e ainda a saírem fortalecidas ou..

This important new book provides a multidisciplinary overview on different discourses and practices, exploring cutting-edge questions from the burgeoning field of artistic research.

Motivated by a desire to narrate and contextualize the deluge of "French theory," After the Deluege showcases recent work by today's brightest scholars of French intellectual history that historicizes key debates, figures, and turning points in the postwar era of French thought.

BackgroundInformation and communication technology solutions have the potential to support active and healthy aging and improve monitoring and treatment outcomes. To make such solutions acceptable, all stakeholders must be involved in the requirements elicitation process. Due to the COVID-19 situation, alternative approaches to commonly used face-to-face methods must often be used. One aim of the current article is to share a unique experience from the Pharaon project where due to the COVID-19 outbreak alternative elicitation methods were used. In addition, an (...) overview of common functional, quality, and emotional goals identified by six pilot sites is presented to complement the knowledge about the needs of older adults.MethodsOriginally planned face-to-face co-creation seminars were impossible to carry out, and all pilot sites chose alternative requirements elicitation methods that were most suitable in their situation. The elicited requirements were presented in the form of goal models. In one summary goal model, we provide an overview of common functional, quality, and emotional goals.ResultsDifferent elicitation methods were combined based on the digital literacy of the target group and their access to digital tools. Methods applied without digital technologies were phone interviews, reviews of literature and previous projects, while by means of digital technologies online interviews, online questionnaires, and virtual co-creation seminars were conducted. The combination of the methods allowed to involve all planned stakeholders. Virtual and semi-virtual co-creation seminars created collaborative environment comparable to face-to-face situations, while online participation helped to save the time of the participants. The most prevalent functional goals elicited were “Monitor health,” “Receive advice,” “Receive information.” “Easy to use/comfortable,” “personalized/tailored,” “automatic/smart” were identified as most prevalent quality goals. Most frequently occurring emotional goals were “involved,” “empowered,” and “informed.”ConclusionThere are alternative methods to face-to-face co-creation seminars, which effectively involve older adults and other stakeholders in the requirements elicitation process. Despite the used elicitation method, the requirements can be easily transformed into goal models to present the results in a uniform way. The common requirements across different pilots provided a strong foundation for representing detailed requirements and input for further software development processes. (shrink)

Riassunto : L’obiettivo di questo lavoro è di analizzare le prime riflessioni di Merleau-Ponty sul tema dell'animalità, in riferimento particolare alla sua prima opera, La struttura del comportamento. L'articolo – attraverso un’ampia introduzione sulla rielaborazione merleau-pontyana delle nozioni di “comportamento” e di “gestalt”, seguita da un’analisi specifica della tripartizione delle forme di comportamento animale – farà emergere la ricchezza e insieme l’ambiguità del primo lavoro di Merleau-Ponty: se da una parte il fenomenologo francese rintraccia fin da subito una continuità ontologica (...) tra animale e umano, d'altra parte essa rimane ancorata in una visione “privativa” dell’animalità. Parole chiave : Maurice Merleau-Ponty; Animalità; Comportamento; Gestalt; Relazioni uomo/animale Une signification nouvelle. Merleau-Ponty's Early Analysis on Animality: The purpose of this article is to examine Merleau-Ponty’s early analysis on animality, particularly referring to his first work The Structure of Behaviour. The article focuses on the review of notions like “behaviour” and “gestalt” and on the analysis of the tripartition of the forms of animal behaviour. It will be underlined both the richness and the ambiguity of Merleau-Ponty’s first reflection. Indeed on the one hand, the French philosopher immediately discovers an ontological continuity between animals and humans but, on the other hand, his point of view on animality is still “privative”. Keywords : Maurice Merleau-Ponty; Animality; Behaviour; Gestalt; Human/Animal Relationships. (shrink)

La dépression hante notre contemporanéité. « Mal du siècle », elle envahit notamment les lieux de consultation et services hospitaliers accueillant les bébés et leurs parents. Les recherches montrent les impacts de la dépression maternelle sur le développement de l’enfant et la nécessité d’accompagner le processus de parentalité dans ce cas de figure. Après quelques repères théoriques autour de la dépression maternelle et/ou conjointe, l’article propose une thérapeutique qui s’est révélée efficace. Il s’agit d’Accordanse : un dispositif de soin et (...) de recherche accueillant des mères et leurs bébés en souffrance psychique centré sur la danse. Quelques séquences cliniques permettront de mieux mesurer dans quelle mesure la danse soutient la construction d’une chorégraphie des interactions harmonieusement accordée lorsque celle-ci est « empêchée » par la lourdeur de la dépression. (shrink)

The structure as well as the themes of theSymposiumsuggest that Eryximachus’ speech plays a fundamental role in the dialogue. The problem is that what he says in praise of love is far from clear and continues to be a subject of debate. The aim of our article is to re-examine this speech to clarify its meaning and determine its contribution to Plato’s theory of love. First, we will analyse thetextof theSymposium, then we will investigate itsmedicalback-ground, and finally we will evaluate (...) itsphilosophicalimpact. We will argue that Eryximachus’ speech, which draws inspiration from the Hippocratic Collection and the Pre-Socratic thought, is based on the concept of ‘harmony’: a balanced and organised unity of opposites. According to Eryximachus, love – conceived of as harmony – is the key to thehealthand thevirtueof human beings, as well as to the cosmic order and justice. Thereby the specificity of Eryximachus’ speech will become clear: Plato tries to combinescienceandmoralityby proposing, among other things, some considerations onbioethics. (shrink)

This paper aims to explore the cartographical method as a political option able to destroy the linguistic and semiotic empire of sense. Starting from the difference between map and tracing, Deleuze and Guattari understood the power of a rhizomatic expression, commonly represented by the obsessive and compulsive gesture of autistics, or their impossibility of speaking correctly. This phenomenon has been deeply analysed by Fernand Deligny through his experience in the Cévennes, where he inaugurated his personal anti-psychoanalytic and anti-linguistic method. During (...) this collective living, the wanderings of the autistic children, called Lignes d’erre, were traced and gathered in a cartography in which action overtakes word and speech, and human gestures are reterritorialized. Characterized by movement without finality, life in Cévennes becomes a “life raft”, where the raft is no more the shipwreck of humanity, but the shelter for no- speakers. Therefore, a new spatial configuration is given, where the bonds between people and with objects exist exactly as the pieces of wood in the raft: namely slacken, rhizomatic. (shrink)

A single case study of a patient, D.M., with a lesion in the region of the right occipito-temporal gyrus is presented. D.M. had well-preserved language and general cognitive abilities. Colour discrimination, contrast sensitivity, gross depth perception, spatial localization, and motion appreciation were within normal limits.On the evaluation of perceptual abilities, he failed to identify two-dimensional shapes from stereoscopic vision, motion, and texture although in all cases he was able to identify the rough area subtended by the shape. These findings are (...) considered in relation to the current anatomical-physiological functional models of vision and it is suggested that D.M. 's deficits provide evidence for the existence in man of a functional pathway involved in the computation of texture and fine aspects of shape, which is distinct from the pathways involved in motion and stereopsis processing on one hand and colour and coarse aspects of form on the other hand. (shrink)

Le but de cette étude est de démontrer que Columelle, un agronome romain, nous restitue un texte d’Héraclite inconnu par ailleurs. Ce témoignage nous conduit à réfuter les interprétations moraliste et relativiste du « pur » et de l’« impur » et à proposer une nouvelle interprétation, physiologique, de la conception héraclitéenne du « propre » et du « sale ». Columelle permet ainsi de mieux connaître la théorie d’Héraclite et de la distinguer de celle de Démocrite : en identifiant (...) et en opposant les cochons et les poules, d’une part, la boue et la poussière, d’autre part, Héraclite nous a fourni une double illustration, à la fois physique et logique, de l’unité des contraires. (shrink)