To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision‐making (...) and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. (shrink)

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool. ECQAT enables raters to assess the (...) quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation, established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT,.. (shrink)

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients and managers ; semi-structured interviews with managers, clinicians, and ethics committee chairpersons. Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on (...) patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

Our goal in producing this special issue is to encourage our colleagues to incorporate topics related to LGBT populations into bioethics curricula and scholarship. Bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities. This is an error on the part of bioethics. Medicine and law have served in the past as society's enforcement arm toward sexual minorities, in ways that robbed many people of their dignity. We feel that bioethics (...) has an obligation to discuss that history and to help us as a society take responsibility for it.We can address only a small number of topics in this special issue of the Hastings Center Report, and we selected topics we believe will stimulate discourse. Andrew Solomon offers an elegant overview of the challenges that bioethics faces in articulating a solid basis for LGBT rights. Timothy F. Murphy asks whether bioethics still faces issues related to lesbian, gay, and bisexual people, given the deletion of homosexuality as a disease and the progress toward same‐sex marriage. Jamie Lindemann Nelson's essay addresses the search for identity for transgender persons and the role of science in that search. Two articles, those by Brendan S. Abel and by Jack Drescher and Jack Pula, take up the complex issue of medical treatment for children who reject their assigned birth gender. Celia B. Fisher and Brian Mustanski address the special challenges of engaging LGBT youth in research, balancing the need for better information about this vulnerable group against the existing restrictions on research involving children. Tia Powell and Edward Stein consider the merits of legal bans on psychotherapies intended to change sexual orientation, particularly in the light of current research on orientation. Mary Beth Foglia and Karen I. Fredricksen‐Goldsen highlight health disparities and resilience among LGBT older adults and then discuss the role of nonconscious bias in perpetuating disparities. Stephan Davis and Nancy Berlinger assess the challenges of access to care and health policy for transgender persons. Edward J. Callahan et al. tackle the ways in which diverse aspects of medicine should change to better incorporate the needs of LGBT patients, including through use of the electronic medical record, education of health professionals, and recruitment efforts for LGBT health professionals. Virginia Ashby Sharpe and Uchenna S. Uchendu describe multifaceted efforts within Veterans Administration facilities to create change for LGBT veterans across the largest integrated health care network in the United States. Lance Wahlert and Autumn Fiester find a mixed record in the use of case studies in teaching about LGBT issues. (shrink)

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be able to reliably use (...) the tool.We developed a short course to train ethics consultants in using the ECQAT, and evaluated whether the participants (1) achieved an acceptable level of calibration in matching expert-established quality scores for a set of ethics consultations, and (2) were satisfied with the course. We recruited 28 ethics consultants to participate in a virtual, six-session course. At each session participants and faculty reviewed, rated, and discussed one to two ECRs. The participants’ calibration in matching expert-established quality scores improved with repeated exposure at all levels of ethics consultation quality. Participants were generally more accurate when assessing consultation quality at the dichotomous level of “acceptable” (scores of three or four) versus “unacceptable” (scores of one or two) than they were with a more specific score. Participants had higher rates of accuracy with the extreme ratings of “strong” (level four) or “poor” (level one). Although participants were highly satisfied with the course, only a minority of participants achieved the prespecified acceptable level of calibration (that is, 80 percent or greater accuracy between their score and expert-established scores). These results suggest that ECQAT training may require more sessions or need modification in the protocol to achieve higher reliability in scoring. Such trainings are an important next step in ensuring that the ECQAT is a tool that can be used to promote improvement in ethics consultation quality. (shrink)

Volume 20, Issue 7, July 2020, Page 145-147.

Richard Lennan’s Tilling the Church treats ecclesial conflict, the possibility of change, and the tensions involved. He acknowledges the resistance to development within the Church’s structures. This resistance helps to explain the church’s distrust of women, which frustrates many Catholics. Cornell philosopher Kate Manne puts resistance to change in context by describing the social expectations of women, by showing that those who resist change feel entitled to do so, and by revealing how victimization is legitimated. “Tilling the church” is an (...) apt metaphor for transformation that does not sufficiently appreciate socially-mediated systems of privilege and vulnerability. (shrink)

This book exploits the power of phenomenological methods to access and describe lived moral experiences of pain and suffering for patients, their families and the wider community. Creating new fields of communication for patients, their family members and health professionals in shared decision making processes, this book builds on knowledge about suffering to help and guide correct action in preventing and relieving chronic pain and improving systems of care. It offers a new phenomenology for understanding moral experience in serious illness (...) and suffering, and its implication for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present some areas of ethical inquiry, including: pain and suffering maternal care ethics evaluation and moral deliberation about treatment options decision-making and moral agency end-of-life experiences of care. Exploring how moral phenomenology could provide fruitful alternatives to traditional frameworks in bioethics, this is an important addition to the literature. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services. (shrink)

Franciscan commitments -- Creation: a metaphysics of the particular -- Cognition, language, and reality -- Divine existence and perfections -- What is theology? -- Freedom and the will -- Moral goodness and beauty -- Practical wisdom and discernment -- Creation, incarnation, and divine desire.

This chapter first distinguishes between originality and creativity. True originality is rare, whether in art, science, or LEGO, because to be truly original means to have done something that no one has ever done before, and that no one could have anticipated. Most LEGO creations will not meet that condition, for with the exception of serious hobbyists who undertake massive builds, most players who make original creations are making creations that are commonplace. Painting or remolding or placing stickers on the (...) bricks counts against the spirit of LEGO creation. The chapter then discusses The LEGO Movie embodies the paradox that presents three conflicting models of creative LEGO play, illustrated by the Master Builders, Finn's father, and Emmet. The movie's creators were deliberately playing around with conflicting popular conceptions of creativity: creativity as madness, creativity as thinking outside the box, and creativity as vision. (shrink)

This chapter contains sections titled: The “Symptoms” of Love What is Love The Biology of Romantic Love Rejection in Love Conclusion.

This book explores the “new normal” for teaching, learning, and leadership in higher education. Emphasis is placed on welcoming growth and change and being curious to the transformative opportunities that exist for today’s students so that the next generation is prepared to solve the world’s most pressing issues.

The #metoo movement has forced many fans to consider what they should do when they learn that a beloved artist has acted immorally. One natural thought is that fans ought to give up the artworks of immoral artists. In Why It's OK to Enjoy the Work of Immoral Artists, Mary Beth Willard argues for a more nuanced view. Enjoying art is part of a well-lived life, so we need good reasons to give it up. And it turns out (...) good reasons are hard to find. Willard show that it's reasonable to believe that most boycotts of artists won't succeed, so most of the time there's no ethical reason to join in. Someone who manages to separate the art from the artist isn't making an ethical mistake by buying and enjoying their art. She then considers the ethical dimensions of canceling artists and so-called "cancel culture," arguing that canceling is ethically risky because it encourages moral grandstanding. Willard concludes by arguing that the popular debate has overlooked the power of art to change our lives for the good. It's of course OK to decide to give up the artwork of immoral artists, but--as Willard shows in this provocative little volume--it's OK to continue to enjoy their art, as well. Key Features Offers accessible discussions of complicated philosophical topics like aesthetic value, collective action problems, and epistemic justice Provides a unique perspective and underexplored argument on the popular issue of cancellation Explores the role of aesthetic value in our lives, including its relation to our ethical decisions and our well being. (shrink)

Governance theories impact how corporations are run, which in turn impacts societal well-being. This dynamic is commonly accepted, as evidenced by the flood of articles exploring the links between corporate governance and corporate social responsibility (e.g., Hong et al. in J Bus Ethics 136:199–213, 2016). This article supplements current corporate governance theories with Catholic social thought (CST) to address burgeoning societal issues such as the increasing trust gap, income inequality (the compensation gap), and an overemphasis on financial compensation as the (...) primary way to motivate senior managers. The authors propose a shift away from agency theory and stakeholder theory, both of which, with their limited depictions of the motivations of managers, have contributed to excessive executive compensation. Instead, the authors develop an alternative—justice stewardship theory—which integrates organizational justice theory, the principles of stewardship theory, and the insights of 150 years of CST. (shrink)

Erich Hatala Matthes’s (2021)Drawing the Line is about what we ought to do when we discover that an artist whom we love has committed a great moral wrong. As it turns out, Matthes and I agree almost entirely on the moral obligations of the individual consumer. We both agree that it is necessary to ascertain whether the life of the artist affects the aesthetic quality of their work, and that we should attend to how continuing to engage with their work (...) publicly expresses our ethical values. Both of us wind up with a morally permissive stance, according to which individuals can, in some contexts, continue to engage with the artwork of immoral artists.There is one distinct difference in how we approached the problem. Matthes took up the question of the role and responsibility of institutions in his third chapter, a question I set aside almost entirely. In this article, I want to delve more deeply into the question of art institutions and their responsibilities to reform themselves. I will argue that the nature of aesthetic practice means that it is harder for an institution to tread the desirable middle ground between uncritically endorsing an immoral artist and cancelling them. (shrink)

From the title, Interpreting Duns Scotus, one would expect to find in this volume a type of meta-study. By this I mean that each article would reveal as much about the author as about the subject,...

In this much-anticipated work, distinguished authors Mary Beth Ingham and Mechthild Dreyer present an accessible introduction to the philosophy of the thirteenth century Franciscan John Duns Scotus.

To the person unfamiliar with the wide variety of street art, the term “street artist” conjures a young man furtively sneaking around a decaying city block at night, spray paint in hand, defacing concrete structures, ears pricked for police sirens. The possibility of the ethical criticism of street art on such a conception seems hardly worth the time. This has to be an easy question. Street art is vandalism; vandalism is causing the intentional damage or destruction of someone else’s property; (...) causing destruction or damage is wrong. The only remaining question is which of two coarse-grained models of ethical criticism we choose. The ethicist model holds that a work of art that exhibits ethically bad properties is a work that is thereby aesthetically flawed. That is, the work is flawed as a work of art just because of its ethical flaws. Bad ethics make art worse than it otherwise would have been, although it may be aesthetically successful otherwise. The autonomist model, by contrast, holds that the ethical properties of a work of art have no bearing at all on its aesthetic success. One might suppose, therefore, that on either model, a criticism of street art would be relatively easy to undertake. In defacing public property, some street art exhibits and endorses ethically bad attitudes. On the ethicist model, such a work is thereby pro tanto aesthetically flawed because in the process of creating such works, they violate ethical norms concerning the use of public spaces; on the autonomous model, any ethical criticism of the aesthetics of street art would need to be set aside entirely in favor of criticism that focused purely on the aesthetic properties of street art. I will argue in this paper that neither the ethicist nor the autonomist model adequately captures the moral landscape of street art. Street art may indeed be criticized productively on aesthetic grounds for the destruction it does to public spaces, but the existing models of ethical criticism overlook the complex ethical landscape of street art that results from its use of public spaces. In the interplay of various forms of street art we can see the emergence of an ethical criticism of art that is accomplished by the material properties of related artwork, and consists in the creation of a dialogue over the proper use of contested public spaces. (shrink)

This article examines the claim that Duns Scotus’s position on the will’s freedom changed between his early Lectura teaching to his late Reportatio lectures on Distinction 25 of Book II of the Sentences. Stephen Dumont in “Did Duns Scotus Change His Mind on the Will?” suggests that Scotus moves closer to the position of Henry of Ghent on the will. The Franciscan had criticized that position in his earlier teaching. In order to demonstrate that Scotus’s voluntarism continues to be moderate, (...) the author first explicates the notion of a rational will in Scotist thought, by means of the two affections of the will and the position outlined in Scotus’s Questions on the Metaphysics of Aristotle Book IX, Q. 15. Following this, a textual comparison of Lectura II, D. 25 with Reportatio II, D. 25 shows that there is indeed a shift, but not toward a more exaggerated form of voluntarism. Rather, close reading of these texts reveals that, in his early teaching, Scotus did not think the will was the rational potency, and did not identify its freedom with rationality. In the later Parisian teaching he presents the will as the sole rational potency, thereby diminishing the role of the intellect, but not that of rationality. The textual evidence of Ordinatio II, D. 6, Questions on the Metaphysics, Lectura II, D. 25 and Reportatio II, D. 25 show that Scotus’s final teaching on the will integrates rationality into the functioning of freedom, and does not align him with Henry’s position, despite similarity of language. (shrink)

Medical ethics committees are increasingly called on to assist doctors, patients, and families in resolving difficult ethics issues. Although committees are becoming more sophisticated in the substance of medical ethics, little attention has been given to the processes these committees use to facilitate decision-making. In 1990, the National Institute for Dispute Resolution in Washington, D.C., provided a planning grant from its Innovation Fund to the Institute of Public Law of the University of New Mexico School of Law to look at (...) what ethics committees can learn from facilitation and mediation techniques. The study's thesis was that, if adapted for use by medical ethics committees, facilitation and mediation techniques can be helpful to those bodies in case review consultations and in other internal committee processes. This article reports on that project. (shrink)

Not all public art is bad art, but when public art is bad, it tends to be bad in an identifiable way. In this paper, I develop a Waltonian theory of the category of public art, according to which public art standardly is both accessible to the public and minimally site-specific. When a work lacks the standard features of the category to which it belongs, appreciators tend to perceive the work as aesthetically flawed. I then compare and contrast cases of (...) successful and unsuccessful public art to show that accessibility and site-specificity are features which tend to preclude the other. It is difficult, although hardly impossible, for a site-specific work to remain accessible, and difficult for an accessible work to engage adequately with the site on which it is situated. As a result, while not all public art is bad, the features peculiar to public work encourage a latent tendency toward badness. (shrink)

This analysis explores the phenomenology of suffering and temporal, genetic and social developmental aspects of suffering for seriously ill older adults. A phenomenological account of suffering is advanced using oral history data from in-depth interviews with a seriously ill, frail elderly woman. The analysis evaluates how a phenomenological account of suffering may inform ethics in end-of-life decision making, and may provide a further basis for an integrated ethical and gerontological response to suffering in palliative social work practice with seriously ill (...) older adults at the end of life. Levinas’s ethical philosophy and conceptualizations of the non-totalizing relation of self to other, disinterest, and radical passivity are employed to help reframe an approach to the ethical relation and the nature of obligation in end-of-life care, expanding consciousness of suffering and its meanings in an intersubjectively experienced world. Differences in Husserl’s account of the other and the concept of alterity in Levinas’s ethics are explored in the context of phenomenology as a descriptive science that respond directly to the pragmatic concerns of the analysis. (shrink)

The physical sciences include highly developed fields that investigate intensities in the form of intensive quantities like speeds, temperatures, pressures and altitudes. Some contemporary readers of Deleuze interested in the physical sciences at times attribute to Deleuze a common, contemporary scientific concept of intensive magnitude. These readings identify Deleuze's philosophical conception of intensity with an existing scientific conception of intensity. The essay argues that Deleuze does not in fact lift a conception of intensity from the physical sciences to embed it (...) as the fundamental term in his differential ontology. (shrink)

Demonstrates the dramatic interplay of elements that comprise the concepts of norm, bisexuality, and development.

Teenagers enjoy better physical and mental health when they avoid early sexual debut and reserve the sexual act for marriage. Teens who initiate sexual relations outside of marriage risk contracting sexually transmitted diseases, and those who also use hormonal contraception to avoid pregnancy often suffer unwanted physical and emotional side effects. Teens who have multiple partners may have later attachment or bonding difficulties. The consequences of an unintended pregnancy after a casual sexual relationship are often abortion or single motherhood and (...) an increased likelihood of poverty. Teenagers who save sexual relations for marriage experience freedom from these negative consequences and are more likely, in marriage, to experience the beauty of self-giving love. (shrink)

This analysis explores the phenomenology of suffering and temporal, genetic and social developmental aspects of suffering for seriously ill older adults. A phenomenological account of suffering is advanced using oral history data from in-depth interviews with a seriously ill, frail elderly woman. The analysis evaluates how a phenomenological account of suffering may inform ethics in end-of-life decision making, and may provide a further basis for an integrated ethical and gerontological response to suffering in palliative social work practice with seriously ill (...) older adults at the end of life. Levinas’s ethical philosophy and conceptualizations of the non-totalizing relation of self to other, disinterest, and radical passivity are employed to help reframe an approach to the ethical relation and the nature of obligation in end-of-life care, expanding consciousness of suffering and its meanings in an intersubjectively experienced world. Differences in Husserl’s account of the other and the concept of alterity in Levinas’s ethics are explored in the context of phenomenology as a descriptive science that respond directly to the pragmatic concerns of the analysis. (shrink)

While much has been published on the philosophical and theological positions of John Duns Scotus, the univocal concept of being continues to be a source of debate and, for some, condemnation. In this ambitious study, LaZella investigates how central the labor of division can be in order to “cut the univocal concept of being at its joints”. Throughout, LaZella engages with classic and contemporary scholarship to achieve a twofold end. First, he clearly shows how, for Scotus, the univocal concept of (...) being does not fall victim to the stereotypical renderings of some proponents of analogy. Second, he analyzes how the univocal concept of being is differentiated. Here is revealed “ultimate... (shrink)