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)

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death (...) discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine. (shrink)

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)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (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)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Part III: Now presents solely, clinical ethics. --.

A caregiver from the dominant U.S. culture and a patient from a very different culture can resolve cross‐cultural disputes about treatment, not by compromising important values, but by focusing on the patient's goals.

The use of deception in medical care is highly suspect in this country. Yet there is one condition for which deception is often used as a diagnostic tool. Nonepileptic seizures, a psychiatric condition in which emotional or psychological conflicts manifest themselves unconsciously through bodily symptoms, are currently diagnosed by a procedure called “provocative saline infusion.” The test is fundamentally deceptive, requiring the physician to intentionally and directly lie to the patient, causing the patient to believe that the administered solution caused (...) his seizures. Without such deception, the test might be useless. (shrink)

Context: Although ethics consultation is commonplace in United States hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the “best informant” within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services were found in 81% of all general hospitals in the U.S., and in 100% (...) of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians, nurses, social workers, or chaplains. Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

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)

This book argues that the Russian-British philosopher Isaiah Berlin should primarily be understood through British idealism. Though he adopted Kantian methodology and a view of people as purposive beings, he rejected the Idealists' monism and theories of positive liberty. Robert A. Kocis demonstrates how, like Michael Oakeshott and R. G. Collingwood, Berlin can be seen as a 'post-Idealist' thinker, invested in the implications of that rich tradition.

The eminent and award-winning historian Robert A. Gross presents his long-awaited, immersive journey through Concord in the age of Emerson and Thoreau.

This is the prologue to a collection of essays on eugenics and psychiatry.

Punishment misunderstood -- The ratchet effect in theory -- The mixed signs in suffering -- The legal punishers -- The legally punished -- The punitive impulse in American society -- The law against itself -- Coda : the psychology of punishment.

God deserves obedience simply because he’s God—or does he? Inspired by a passion for biblical as well as constitutional scholarship, in this bold exploration Yale Law Professor Robert A. Burt conceptualizes the political theory of the Hebrew and Christian Bibles. God’s authority as expressed in these accounts is not a given. It is no less inherently problematic and in need of justification than the legitimacy of secular government. In recounting the rich narratives of key biblical figures—from Adam and Eve (...) to Noah, Cain, Abraham, Moses, Job, and Jesus—In the Whirlwind paints a surprising picture of the ambivalent, mutually dependent relationship between God and his peoples. Taking the Hebrew and Christian Bibles as a unified whole, Burt traces God’s relationship with humanity as it evolves from complete harmony at the outset to continual struggle. In almost every case, God insists on unconditional obedience, while humanity withholds submission and holds God accountable for his promises. Contemporary political theory aims for perfect justice. The Bible, Burt shows, does not make this assumption. Justice in the biblical account is an imperfect process grounded in human—and divine—limitation. Burt suggests that we consider the lessons of this tension as we try to negotiate the power struggles within secular governments, and also the conflicts roiling our public and private lives. (shrink)

This chapter examines traditionalists’ arguments why Dungeons Dragons (DD) is good for us first, and then discusses the cases where it could be bad for us. The irony for Christian critics of DD, such as Schnoebelen, is that the philosophical and theological arguments of Christian traditionalists, such as Thomas Aquinas and J.R.R. Tolkien, provide some of the strongest arguments in favor of DD role‐playing. However, to be fair, these same arguments can be used to argue that a particular DD game, (...) under certain circumstances, can be bad. “Postmodernists” refers loosely to a group of philosophers and thinkers who question, if not outright reject, the core tenets of the traditionalists. If the traditionalists have the correct metaphysics about the real world, then it follows that DD is good, but that care must be taken to make sure the game does not become morally objectionable. (shrink)

Miscreants, in the form of deviants and dark personalities, impact organizations more than we realize. Most management instruction on ethics issues focuses on helping students to understand how to evaluate difficult situations, make ethical decisions, and engage in ethical actions. While this approach works well for the individual decision maker, it fails to help students learn how to anticipate and proactively prevent the unethical actions of others. Using ethical codes as a backdrop, “Thinking Like a Bad Guy” is a provocative (...) classroom activity to elicit critical and creative thinking among business students. The goal of this exercise is to facilitate student learning so they can anticipate the behaviors of bad actors and alter organizational processes and procedures to mitigate the ability of others to violate organizational ethical standards. (shrink)

This is a bilingual edition of the selected peer-reviewed papers that were submitted for the International Symposium on Jesuit Studies on the thought of the Jesuit Francisco Suárez (1548-1617). The symposium was co-organized in Seville in 2018 by the Departamento de Humanidades y Filosofía at Universidad Loyola Andalucía and the Institute for Advanced Jesuit Studies at Boston College. Suárez was a theologian, philosopher and jurist who had a significant cultural impact on the development of modernity. Commemorating the four-hundredth anniversary of (...) his death, the symposium studied the work of Suárez and other Jesuits of his time in the context of diverse traditions that came together in Europe between the late Middle Ages, the Renaissance, and early modernity. (shrink)

An anthology of the life and teachings of Tsongkhapa that includes transcendental aspects of sutra, tantra, insight meditation, mystic conversations, spiritual songs, and a new introduction by Robert Thurman.

Critically examines and revises many of Freud's seminal ideas about culture from the perspective of contemporary anthropology, psychoanalysis, evolutionary theory, and literature and the arts.

It is widely recognized that Immanuel Kant was one of Karl Barth's most important intellectual influences, but how and to what extent this is the case remains an open question. In Presupposing God, Robert Hand demonstrates a deep consistency between Kant's and Barth's theological epistemologies, with this issue in mind. After arguing for a number of positive emphases in Kant's critical philosophy and religious epistemology in conversation with modern Kant scholarship, Presupposing God demonstrates how these emphases were obscured in (...) Kant's reception in the decades between Kant and Barth, and then explores the intellectual conditions under which Barth first encountered Kant. The argument proceeds to show how Barth wrestled with these varying interpretations and continued to utilize Kant with increased sophistication as his thought developed across the Romans commentaries, Anselm, and the Church Dogmatics. Presupposing God suggests that Kant can be an asset to theology, rather than the liability he is often taken to be, and that Barth is one of the better available examples of this in practice. (shrink)

This film is a 44-minute documentary film based around the stories of five eugenics survivor from the province of Alberta, Canada, made as part of the Living Archives on Eugenics in Western Canada project.

Matteo Ricci (1552-1610) was an Italian Jesuit and one of the first Christian missionaries to China in the modern era. He was a genuine polymath—a translator, cartographer, mathematician, astronomer, and musician. Above all, Ricci was a missionary for the gospel. As we briefly examine his 1603 seminal work, The True Meaning of the Lord of Heaven, our hope is that we, as evangelical educators, will perceive some of the deeper principles necessary for our own missionary work among unreached people.

Where does the mind begin and end? Most philosophers and cognitive scientists take the view that the mind is bounded by the skull or skin of the individual. Robert Wilson, in this provocative and challenging 2004 book, provides the foundations for the view that the mind extends beyond the boundary of the individual. The approach adopted offers a unique blend of traditional philosophical analysis, cognitive science, and the history of psychology and the human sciences. The companion volume, Genes and (...) the Agents of Life, explores the theme in the biological sciences. Written with verve and clarity, this ambitious book will appeal to a broad swathe of professionals and students in philosophy, psychology, cognitive science, and the history of the behavioural and human sciences. You can download the table of contents here. (shrink)

Stakeholder theory has become a central issue in the literature on business ethics / business and society. There are, however, a number of problems with stakeholder theory as currently understood. Among these are: 1) the lack of a coherent justificatory framework, 2) the problem of adjudicating between stakeholders, and 3) the problem of stakeholder identification. In this essay, I propose that a possible source of obligations to stakeholders is the principle of fairness (or fair play) as discussed in the political (...) philosophic literature of Rawls, Simmons, and Cullity among others. The principle of fairness states that, “Whenever persons or groups of persons voluntarily accept the benefits of a mutually beneficial scheme of co-operation requiring sacrifice or contribution on the parts of the participants and there exists the possibility of free-riding, there exist obligations of fairness on the part of these persons or groups to co-operate in proportion to the benefits accepted.” In this essay I discuss the gaps in the current stakeholder literature, elucidate and defend a principle of fairness that fills the gap, compare the fairness model to other similar models of business ethics, and draw some conclusions for the future of stakeholder theory. (shrink)

This is an introductory article on sociobiology, particularly its relationship to eugenics. Sociobiology developed in the 1960s as a field within evolutionary biology to explain human social traits and behaviours. Although sociobiology has few direct connections to eugenics, it shares eugenics’ optimistic enthusiasm for extending biological science into the human domain, often with reckless sensationalism. Sociobiology's critics have argued that sociobiology also propagates a kind of genetic determinism and represents the zealous misapplication of science beyond its proper reach that characterized (...) the eugenics movement. More recently, evolutionary psychology represents a sophistication of sociobiology that attends to the mind as the "missing link" between evolution and behaviour (Cosmides and Tooby 1992, Pinker 1997). (shrink)

1. The Situation in Cognition 2. Situated Cognition: A Potted Recent History 3. Extensions in Biology, Computation, and Cognition 4. Articulating the Idea of Cognitive Extension 5. Are Some Resources Intrinsically Non-Cognitive? 6. Is Cognition Extended or Only Embedded? 7. Letting Nature Take Its Course.

Written by the preeminent democratic theorist of our time, this book explains the nature, value, and mechanics of democracy. In a new introduction to this Veritas edition, Ian Shapiro considers how Dahl would respond to the ongoing challenges democracy faces in the modern world. “Within the liberal democratic camp there is considerable controversy about exactly how to define democracy. Probably the most influential voice among contemporary political scientists in this debate has been that of Robert Dahl.”—Marc Plattner, _New York (...) Times_ “An excellent introduction for novices, as well as a trusty handbook for experts and political science mavens.”—_Publishers Weekly_. (shrink)

This engaging and informative text will hold the attention of students and scholars as they take a journey through time to understand the role that history and philosophy have played in shaping the course of sport and physical education in Western and selected non-Western civilizations. Using appropriate theoretical and interpretive frameworks, students will investigate topics such as the historical relationship between mind and body; what philosophers and intellectuals have said about the body as a source of knowledge; educational philosophy and (...) the value of physical education and/or sport; philosophical positions that have impacted the historical development of sport and physical education; the history of women in sport and physical education; the role and scope of sport and physical education in Ancient Greece and Rome; the Ancient Olympic Games; the relationship between sport and religion in ancient and modern times; the theoretical and professional development of physical education; the rise of sport in modern America; the history and politics of the modern Olympic Games; and the contributions of men, women, and social movements to the development of sport and physical education from ancient times to the modern era. (shrink)

Genes and the Agents of Life undertakes to rethink the place of the individual in the biological sciences, drawing parallels with the cognitive and social sciences. Genes, organisms, and species are all agents of life but how are each of these conceptualized within genetics, developmental biology, evolutionary biology, and systematics? The 2005 book includes highly accessible discussions of genetic encoding, species and natural kinds, and pluralism above the levels of selection, drawing on work from across the biological sciences. The book (...) is a companion to the author's Boundaries of the Mind (2004), also available from Cambridge, where the focus is the cognitive sciences. The book will appeal to a broad range of professionals and students in philosophy, biology, and the history of science. You can download the table of contents and the first chapter here. (shrink)

Discussions of whistleblowing and employee loyalty usually assume either that the concept of loyalty is irrelevant to the issue or, more commonly, that whistleblowing involves a moral choice in which the loyalty that an employee owes an employer comes to be pitted against the employee''s responsibility to serve public interest. I argue that both these views are mistaken and propose a third view which sees whistleblowing as entirely compatible with employee loyalty.