Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of (...) the CE chart note. The implementation of the “meaningful use” criteria for EHR, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, requires that health professionals meet certain standards for quality, efficiency, and safety, all of which overlap with the goals of standardization, peer review, and quality improvement within CE consultation. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe (...) primary objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

Experience with electronic communication in ethics committees at two hospitals is reviewed and discussed. A listserver of ethics committee members transmitted a synopsis of the ethics consultation shortly after the consultation was initiated. Committee comments were sometimes incorporated into the recommendations. This input proved to be most useful in unusual cases where additional, diverse inputs were informative. Efforts to ensure confidentiality are vital to this approach. They include not naming the patient in the e-mail, requiring a password for access (...) to the listserver, and possibly encryption. How this electronic communication process alters group interactions in ethics committees is a fruitful area for future investigation. (shrink)

Studies of academic dishonesty typically rely on potentially inaccurate self-reports or on actual behavior during less realistic tasks. Eliminating the drawbacks of such approaches, we assessed cheating during completion of actual coursework via electronic records of online behavior. Thirty-six college students completed unproctored, online quizzes. The majority of students responding to a follow-up questionnaire reported that they never considered consulting online sources during the quizzes. Computer logs reveal that although some students accessed relevant online information during the quizzes, many (...) did not: 6 instances over 72 quiz attempts are attributable to 3 or 4 individuals. Although online environments may offer more opportunities for academic dishonesty, electronic records of online activity provide a valuable and objective means of detecting such dishonesty. (shrink)

Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and potential barriers to formal consultation. Results: Less experienced pediatricians were more likely (...) to utilize formal ethics consultation and more likely to have formal ethics training. The most commonly reported reasons not to pursue formal ECS consultation were inconvenience and self-reported expertise in pediatric ethics. Conclusions: These results inform ongoing discussions about ethics consultation among pediatricians and the role of formal ethics training in both undergraduate and graduate medical education. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following (...) from this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

From a speech given at a conference sponsored by the Electronic Funds Transfer Association (EFTA) on "The Puzzle of Data Security and Consumer Privacy," Washington, DC, 16 November 1992. At that time, Dr. Perry was a Consultant in Advisory Services for the Ethics Resource Center.

A recently enacted law permits patients to see their electronic medical record (EMR) immediately after their careprovider writes in it. In this article I discuss a proposal that authors make in this issue of The Journal of Clinical Ethics, that ethics consultants (ECs) keep their notes in a separate section of the EMR that patients cannot access when their ethics notes may be troubling to patients, to avoid unduly harming them.I discuss this concern and three more widely applicable clinical (...) goals: to help patients feel safe; to gain patients’ trust; and to provide hope to patients, when possible. These goals apply to careproviders and ECs who seek to help patients and families resolve ethical conflicts. I explain why these goals are singularly important and how careproviders may pursue them, using as an example informing patients about temporal framing to help them find hope. (shrink)

The aim of the research is to identify the role of policies and procedures for the electronic document management system in the success of the electronic document management system in the Palestinian Pension Agency. In order to achieve the objectives of the study, the researchers used the analytical descriptive method in which the tries to describe the phenomenon studied, analyze its data, the relationship between its components and the opinions that are raised around it, and use the comprehensive (...) inventory method due to the small size of the society. (108) questionnaires were distributed to the community of 65 employees in Gaza Strip and 43 employees in the West Bank. All the responses were retrieved. The research found that there is a clear adoption by the Commission of the policies and procedures put in place to implement the electronic management system of electronic documents. The study showed that there are no statistically significant differences between the responses of the study population regarding the role of policies and procedures for the electronic document management system in the success of the electronic document management system in the Palestinian Pension Agency due to variable (age, nature of job, specialization). And showed that there is a fundamental difference in the opinion of members of the study community on the role of policies and procedures for the electronic document management system in the success of the electronic document management system in the Palestinian Pension Agency attributed to the scientific qualification, and shows the difference in favor of the bachelor's degree. And years of service, and shows the difference in favor of the 11-15 year category. The research led to a number of recommendations, the most important of which is the increase of interest and awareness of the need to implement policies and procedures to ensure the success of the electronic document management system through access to and benefit from the experiences of other institutions and the private sector. And the need to focus on the attention to develop appropriate and clear plans and dissemination on the electronic document management system and specific to specific objectives and the Commission is committed to apply them, the need to pay attention to the development of strategic plans and policies and work mechanisms commensurate with the electronic document management system, and the need to define a policy in advance to form a team of different specialties of the staff of the Authority and cooperation with consultants from outside the body to work on the electronic document system. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following (...) from this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

To meet all physicians' needs for ethics consultation in Finland, a novel form of service, the Physicians' Ethics Forum, was founded in 2003. The Forum is a cost-efficient service based on electronic communication. In this paper, experiences throughout its first 6 years are described.

BackgroundThere are numerous challenges in the consultation services of the Hospital Ethics Committees (HEC) that can impact the means of providing healthcare. This review aimed to identify the main challenges in the application of consultation services of the HEC and propose possible solutions.MethodsThis systematic review was conducted through searching electronic databases including PubMed, Scopus, Science Direct, ProQuest, and Embase. Inclusion criteria included studies published in English language in a peer-reviewed journal, from 2000 to 2019 were identified, which clearly defined (...) the design, method, and results of the study. Study selections, quality assessments, data extraction, and analysis were completed by two researchers, independently. The thematic analysis was used to analyze the data.ResultsThe search yielded 1204 articles and 6 of these, included the analyses. Challenges were categorized into 9 themes: (a) personal views and believes in healthcare professionals, (b) sense of fear in the healthcare professionals, (c) medical culture, (d) environmental factors, (e) managerial and structural factors, (f) characteristics of the HEC members, (g) factors related to the HEC, (h) problematic process for HEC consultations, and (i) weakness of knowledge about HEC. Accordingly, proposed solutions were organized according to five themes: reforming the HEC executive processes, creating the appropriate communications, developing awareness about HEC, improving the competencies of HEC members, and (e) receiving support from HEC consultations.ConclusionsThis review highlights that proposed solutions serve as examples of strategies, which attempt to solve challenges related to the application of the consultation services of HEC by healthcare professionals. (shrink)

In the context of office work, learning to handle an Enterprise Resource Planning system is important as implementation costs for such systems and associated expectations are high. However, these expectations are often not met because the users are not trained adequately. Electronic Performance Support Systems are designed to support employees’ ERP-related problem-solving and informal learning. EPSS are supposed to enhance employees’ performance and informal workplace learning through task-specific and granular help in task performance and problem-solving. However, there is little (...) empirical research on EPSS. Two survey studies addressed this research gap. In the first study, 301 people working in Human Resource -related positions and functions evaluated the learning potential of EPSS as well as potential advantages and obstacles concerning the implementation and use of EPSS. Though other measures are currently assessed as more important for learning, HR employees expect a strong increase in the significance of EPSS for employee learning. In the second study, 652 users of ERP software completed a questionnaire on characteristics of their daily work tasks, team characteristics, individual dispositions, their coping with ERP-related problems, and characteristics of EPSS. Findings indicate that the most frequently available and used approach when dealing with an ERP-related problem is consulting colleagues. Three EPSS types can be distinguished by their increasing integration into the user interface and their context-sensitivity. While external and extrinsic EPSS are available to many users, intrinsic EPSS are less common but are used intensively if available. EPSS availability is identified to be a strong positive predictor of frequency of EPSS use, while agreeableness as well as the task complexity and information-processing requirements show small negative effects. Moreover, more intensive ERP users use EPSS more frequently. In general, ERP users value, features such as context-sensitivity, an integration of the EPSS into the ERP system’s user interface, the option to save one’s own notes, and information displayed in an extra window. It is expected that EPSS will play an important role in workplace learning in the future, along with other measures. (shrink)

Background The Patient Right to Autonomy Act (PRAA), implemented in Taiwan in 2019, enables the creation of advance decisions (AD) through advance care planning (ACP). This legal framework allows for the withholding and withdrawal of life-sustaining treatment (LST) or artificial nutrition and hydration (ANH) in situations like irreversible coma, vegetative state, severe dementia, or unbearable pain. This study aims to investigate preferences for LST or ANH across various clinical conditions, variations in participant preferences, and factors influencing these preferences among urban (...) residents. Methods Employing a survey of legally structured AD documents and convenience sampling for data collection, individuals were enlisted from Taipei City Hospital, serving as the primary trial and demonstration facility for ACP in Taiwan since the commencement of the PRAA in its inaugural year. The study examined ADs and ACP consultation records, documenting gender, age, welfare entitlement, disease conditions, family caregiving experience, location of ACP consultation, participation of second-degree relatives, and the intention to participate in ACP. Results Data from 2337 participants were extracted from electronic records. There was high consistency in the willingness to refuse LST and ANH, with significant differences noted between terminal diseases and extremely severe dementia. Additionally, ANH was widely accepted as a time-limited treatment, and there was a prevalent trend of authorizing a health care agent (HCA) to make decisions on behalf of participants. Gender differences were observed, with females more inclined to decline LST and ANH, while males tended towards accepting full or time-limited treatment. Age also played a role, with younger participants more open to treatment and authorizing HCA, and older participants more prone to refusal. Conclusion Diverse preferences in LST and ANH were shaped by the public’s current understanding of different clinical states, gender, age, and cultural factors. Our study reveals nuanced end-of-life preferences, evolving ADs, and socio-demographic influences. Further research could explore evolving preferences over time and healthcare professionals’ perspectives on LST and ANH decisions for neurological patients.. (shrink)

Can new technology enhance purpose-driven, democratic dialogue in groups, governments, and societies? Online Deliberation: Design, Research, and Practice is the first book that attempts to sample the full range of work on online deliberation, forging new connections between academic research, technology designers, and practitioners. Since some of the most exciting innovations have occurred outside of traditional institutions, and those involved have often worked in relative isolation from each other, work in this growing field has often failed to reflect the full (...) set of perspectives on online deliberation. This volume is aimed at those working at the crossroads of information/communication technology and social science, and documents early findings in, and perspectives on, this new field by many of its pioneers. -/- CONTENTS: -/- Introduction: The Blossoming Field of Online Deliberation (Todd Davies, pp. 1-19) -/- Part I - Prospects for Online Civic Engagement -/- Chapter 1: Virtual Public Consultation: Prospects for Internet Deliberative Democracy (James S. Fishkin, pp. 23-35) -/- Chapter 2: Citizens Deliberating Online: Theory and Some Evidence (Vincent Price, pp. 37-58) -/- Chapter 3: Can Online Deliberation Improve Politics? Scientific Foundations for Success (Arthur Lupia, pp. 59-69) -/- Chapter 4: Deliberative Democracy, Online Discussion, and Project PICOLA (Public Informed Citizen Online Assembly) (Robert Cavalier with Miso Kim and Zachary Sam Zaiss, pp. 71-79) -/- Part II - Online Dialogue in the Wild -/- Chapter 5: Friends, Foes, and Fringe: Norms and Structure in Political Discussion Networks (John Kelly, Danyel Fisher, and Marc Smith, pp. 83-93) -/- Chapter 6: Searching the Net for Differences of Opinion (Warren Sack, John Kelly, and Michael Dale, pp. 95-104) -/- Chapter 7: Happy Accidents: Deliberation and Online Exposure to Opposing Views (Azi Lev-On and Bernard Manin, pp. 105-122) -/- Chapter 8: Rethinking Local Conversations on the Web (Sameer Ahuja, Manuel Pérez-Quiñones, and Andrea Kavanaugh, pp. 123-129) -/- Part III - Online Public Consultation -/- Chapter 9: Deliberation in E-Rulemaking? The Problem of Mass Participation (David Schlosberg, Steve Zavestoski, and Stuart Shulman, pp. 133-148) -/- Chapter 10: Turning GOLD into EPG: Lessons from Low-Tech Democratic Experimentalism for Electronic Rulemaking and Other Ventures in Cyberdemocracy (Peter M. Shane, pp. 149-162) -/- Chapter 11: Baudrillard and the Virtual Cow: Simulation Games and Citizen Participation (Hélène Michel and Dominique Kreziak, pp. 163-166) -/- Chapter 12: Using Web-Based Group Support Systems to Enhance Procedural Fairness in Administrative Decision Making in South Africa (Hossana Twinomurinzi and Jackie Phahlamohlaka, pp. 167-169) -/- Chapter 13: Citizen Participation Is Critical: An Example from Sweden (Tomas Ohlin, pp. 171-173) -/- Part IV - Online Deliberation in Organizations -/- Chapter 14: Online Deliberation in the Government of Canada: Organizing the Back Office (Elisabeth Richard, pp. 177-191) -/- Chapter 15: Political Action and Organization Building: An Internet-Based Engagement Model (Mark Cooper, pp. 193-202) -/- Chapter 16: Wiki Collaboration Within Political Parties: Benefits and Challenges (Kate Raynes-Goldie and David Fono, pp. 203-205) -/- Chapter 17: Debian’s Democracy (Gunnar Ristroph, pp. 207-211) -/- Chapter 18: Software Support for Face-to-Face Parliamentary Procedure (Dana Dahlstrom and Bayle Shanks, pp. 213-220) -/- Part V - Online Facilitation -/- Chapter 19: Deliberation on the Net: Lessons from a Field Experiment (June Woong Rhee and Eun-mee Kim, pp. 223-232) -/- Chapter 20: The Role of the Moderator: Problems and Possibilities for Government-Run Online Discussion Forums (Scott Wright, pp. 233-242) -/- Chapter 21: Silencing the Clatter: Removing Anonymity from a Corporate Online Community (Gilly Leshed, pp. 243-251) -/- Chapter 22: Facilitation and Inclusive Deliberation (Matthias Trénel, pp. 253-257) -/- Chapter 23: Rethinking the ‘Informed’ Participant: Precautions and Recommendations for the Design of Online Deliberation (Kevin S. Ramsey and Matthew W. Wilson, pp. 259-267) -/- Chapter 24: PerlNomic: Rule Making and Enforcement in Digital Shared Spaces (Mark E. Phair and Adam Bliss, pp. 269-271) -/- Part VI - Design of Deliberation Tools -/- Chapter 25: An Online Environment for Democratic Deliberation: Motivations, Principles, and Design (Todd Davies, Brendan O’Connor, Alex Cochran, Jonathan J. Effrat, Andrew Parker, Benjamin Newman, and Aaron Tam, pp. 275-292) -/- Chapter 26: Online Civic Deliberation with E-Liberate (Douglas Schuler, pp. 293-302) -/- Chapter 27: Parliament: A Module for Parliamentary Procedure Software (Bayle Shanks and Dana Dahlstrom, pp. 303-307) -/- Chapter 28: Decision Structure: A New Approach to Three Problems in Deliberation (Raymond J. Pingree, pp. 309-316) -/- Chapter 29: Design Requirements of Argument Mapping Software for Teaching Deliberation (Matthew W. Easterday, Jordan S. Kanarek, and Maralee Harrell, pp. 317-323) -/- Chapter 30: Email-Embedded Voting with eVote/Clerk (Marilyn Davis, pp. 325-327) -/- Epilogue: Understanding Diversity in the Field of Online Deliberation (Seeta Peña Gangadharan, pp. 329-358). -/- For individual chapter downloads, go to odbook.stanford.edu. (shrink)

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey (...) administered to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

BackgroundInternational guidelines on research have focused on protecting research participants. Ethical Research Committee (ERC) approval and informed consent are the cornerstones. Externally sponsored research requires approval through ethical review in both the host and the sponsoring country. This study aimed to determine to what extent ERC approval and informed consent procedures are documented in locally and internationally published human subject research carried out in Sri Lanka.MethodsWe obtained ERC approval in Sri Lanka and the United Kingdom. Theses from 1985 to 2005 (...) available at the Postgraduate Institute of Medicine (PGIM) library affiliated to the University of Colombo were scrutinised using checklists agreed in consultation with senior research collaborators. A Medline search was carried out with MeSH major and minor heading 'Sri Lanka' as the search term for international publications originating in Sri Lanka during 1999 to 2004. All research publications from CMJ during 1999 to 2005 were also scrutinized.ResultsOf 291 theses, 34% documented ERC approvals and 61% documented obtaining consent. From the international journal survey, 250 publications originated from Sri Lanka of which only 79 full text original research publications could be accessed electronically. Of these 38% documented ERC approval and 39% documented obtaining consent. In the Ceylon Medical Journal 36% documented ERC approval and 37% documented obtaining consent.ConclusionOnly one third of the publications scrutinized recorded ERC approval and procurement of informed consent. However, there is a positive trend in documenting these ethical requirements in local postgraduate research and in the local medical journal. (shrink)

Recently a well-known magazine published an article entitled ‘Moral Specialist.’ This article recounts the activities of Russell McIntyre, described by the authors as a theologian and philosopher who specializes in bioethics. McIntyre is routinely consulted by physicians for help in solving ethical problems. He is asked for moral advice on such matters as abortion, euthanasia, and sterilization for teenagers. McIntyre even wears an electronic ‘beeper’ so that when untimely moral quandaries arise he can easily be reached. McIntyre says that (...) ultimately such moral decisions should be made by the people involved — the physician, the patient, and the family. However, he claims that there are still many gray areas in bioethics ‘where it is best to call in an expert for consultation.’. (shrink)

Some time ago I wrote a paper about conceivability and knowledge. An anonymous referee rejected it on the grounds that the result had already been established in a short story by Jorge Luis Borges. Intrigued, I looked for the story but found no mention of it in Louis and Ziche’s extensive bibliography. I spent months consulting archives and electronic records to no avail. I had begun to doubt whether the story even existed when I had the curious good luck (...) to encounter Sir Thomas Browne of Pembroke College, Oxford, who assured me of the piece’s authenticity and introduced me to Brother Christian Rosenkreuz of Invisible College who in turn generously put me into correspondence with Borges himself. The literary defects in what follows reflect not a diminution of Borges’s undoubted power as a storyteller, but merely my limited ability as an amateur translator. Whatever the translation’s literary faults may be, I hope the story’s philosophical interest—i.e., an argument that ideal conceivers have higher-order knowledge of necessary truths—remains. [Trans.]. (shrink)

The move towards the use of new technologies and the new focus on citizen engagement in Scotland provides the opportunity for e-democracy to emerge. Working towards the goal of e-democracy, the International Teledemocracy Centre is developing a body of ICT, supporting skills, tools and techniques, designed specifically to facilitate the use of technology, capable of enhancing democratic engagement. This paper begins to articulate how citizens are engaging with government and with their elected representatives about issues that concern them, using technology (...) specially designed for the purpose. The paper examines the nature of e-democracy and considers concepts of democracy, issues of democratization, and issues surrounding citizen access and participation. In addition, the paper discusses the design and use of two electronic tools developed by the ITC between 1999 and 2001 i. e. e-consultant and e-petitioner. Finally, the paper presents analyses of findings drawn from research to monitor and evaluate the use of these tools and the arrangements which accompany their entry into society. (shrink)

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians’ nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content (...) online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA’s Code of Medical Ethics). (shrink)

Confidentiality of health information is increasingly relevant in the era of electronic medical records. We discuss the case of a hospitalized patient who requested a neurology consultation for an episode he described as an “LSD-like” flashback. The patient expressed concern that the episode was a residual effect of past drug use, but subsequently requested that his drug use not be documented. Involved in a custody battle, he feared that if his records were released to the court he could lose (...) custody of his children. Ethical concerns arose with regards to the physician’s competing obligations with a duty to record information accurately and honestly, respect patient autonomy, and maintain patient confidentiality. We discuss the decision of the team to document the patient’s drug use by arguing that the obligation to maintain confidentiality did not supersede the primary role of the medical record as a complete and accurate account, which cannot be altered at a patient’s behest. (shrink)

First, something about the word. 'Bureau' (French, borrowed into German) is a desk, or by extension an office (as in 'I will be at the office tomorrow'; 'I work at the Bureau of Statistics'). 'Bureaucracy' is rule conducted from a desk or office, i.e. by the preparation and dispatch of written documents - or, these days, their electronic equivalent. In the office are kept records of communications sent and received, the files or archives, consulted in preparing new ones. This (...) kind of rule is of course not found in the ancient classifications of kinds of government: monarchy, aristocracy, democracy - and bureaucracy? In fact it does not belong in such a classification. It is a servant of government, a means by which a monarchy, aristocracy, democracy, or other form of government, rules. Those who invented the word wanted to suggest that the servant was trying to become the master. Weber is of course aware of this tendency; in fact he attacked the pretensions of the Prussian bureaucracy to be an objective and neutral servant of society, above politics, and emphasized that every bureaucracy has interests of its own, and connections with other social strata (especially among the upper classes); see Beetham, chapter 3. But formally and in theory the bureaucracy is merely a means, and this is largely true also in practice: someone must provide policy direction and back the bureaucrat up (if necessary) with force. 'At the top of a bureaucratic organization, there is necessarily an element which is at least not purely bureaucratic', SEO, p. 335, to give policy direction. (shrink)

Healthcare expenditures account for approximately 9% of GDP in OECD countries and are on an upward trajectory (OECD, 2017). This significant financial burden, combined with an aging global population and increasing demand, emphasizes the imperative for sustained research and innovation to enhance health system efficacy. Key to this transformation are technological advancements, including digital health, which presents novel opportunities for improvement. Emerging digital health technologies, such as virtual consultations, complex imaging procedures, and electronic medical records, are fundamental to (...) modern healthcare infrastructures. However, significant gaps remain in the evaluation and understanding of these innovations, especially for nascent technological areas. This thesis addresses this subject, aiming to delineate how individuals and institutions can bolster their evaluative capabilities, strategic decision-making, and planning for the deployment of emerging digital healthcare technologies. The research methodology amalgamates theoretical exploration, literature scrutiny, and empirical examinations, presenting an integrated perspective that intersects the disciplines of Management & Decision Science, Technology & Innovation, and Health Economics & Outcomes Research. From an applied perspective, this research focuses on developing evidence within the context of pediatric healthcare in Canada — a context notably underrepresented in healthcare management research, despite its disproportionate per capita expenditure. Technologically, the predominant focus is on applications in virtual reality (VR) and three-dimensional (3D) printing and virtualization, though with the aspiration of ensuring the generalizability of results. The current thesis is structured to parallel the progression of the research itself, as three distinct phases; this begins with a comprehensive Background that contextualizes the initial intent, exploring the relationship between technology, innovation, and health outcomes. In this phase, each academic discipline is analyzed to identify base theoretical underpinnings for the research. The second phase of this work includes five empirical studies, each preceded by context-specific literature reviews for the respective technological domain, providing insight into the current state of evidence related to value-based assessment and economic evaluation in that area. Empirical studies included a randomized controlled trial and a cost consequences assessment of VR for pre-procedural preparation for medical imaging. Additionally, novel applications of 3D printing and virtualization are critically analyzed, accompanied by a multi-case study on the implementation of 3D printing in pediatrics, a cost-consequences study of applications for thoracoabdominal surgeries, and an outcomes study on the use of 3D virtualization in medical education during the COVID-19 pandemic. The final phase of this research includes the critical analysis and synthesis of findings into a proposal for a novel value-based assessment and decision-making framework specific to emerging health innovations; this framework integrates insights and resources for clinicians, administrators, and policymakers. The outcomes of this research are skewed toward Knowledge Users, but also aims to advance the theoretical basis for health technology assessment (HTA). (shrink)

The modern world space, which is affected by the post-pandemic consequences, is noted by the globalization of society, the increasing role of citizenship in making important state and international decisions has become possible in the context of the information revolution and has its own characteristics of communication in information and communication networks. The importance and need for a thorough study of the chosen topic is that the widespread use of various forms and methods of civil communication, free access of citizens (...) to information at all stages of decision-making and the functioning of central and local governments, the participation of civil society institutions in the work of expert, consultative, and advisory public councils on the expression and protection of the rights and freedoms of citizens, public control, direct electronic receipt of public services, etc. are important factors in the democratization of government in post-pandemic modern times. After all, we are talking about a deliberate orientation to new values - the person and the collective, their direct participation in the democratic organization of life of the state and society. The main thing in this context is that the rational consensus of civil society and the state is a factor in universal social discourse and a strategic resource for democratic development in the context of post-pandemic modernity. The aim of the article is to consider the epistemological and sociocultural aspects of the functioning of the communication capabilities of civil society institutions in the context of revealing the possibility and significance of their involvement in the processes of implementing state security policy. (shrink)

This paper explores the role of regulation and legislation on influencing the development and diffusion of technologies and methods of crop production. To do this, the change in pesticide registration under European Regulation 1107/2009 ‘Placing Plant Protection Products on the Market’ was followed through the UK’s agricultural system of innovation. Fieldwork included: a series of interviews conducted with scientists, agronomists and industry organisations; a programme of visiting agricultural events; as well as sending an electronic survey to British potato growers. (...) The innovation system is noted to have made the legislation less restrictive than originally proposed. The most notable system response to the legislation is the adjustment of agrochemical company pesticide discovery strategy and their expansion into biologically derived treatments. There have also been other innovation responses: agricultural seed companies have been breeding in pathogen resistance in their cultivars; agricultural consultancies are prepared to recommend pathogen-resistant seeds; scientists are using the change as justification for adopting their solutions; the agricultural levy boards funded research into off-label pesticide uses; and producers, potato growers in particular, have been seeking advice, but not changing their growing practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Pour une histoire de la ‘double vérité’David PichéLuca Bianchi. Pour une histoire de la ‘double vérité’. Conférences Pierre Abélard. Paris: Vrin, 2008. Pp. 192. Paper, €18.00.Since the publication of the work of the Belgian medievalist Fernand Van Steenberghen, a solid consensus seems to have emerged in the community of historians of medieval philosophy: no scholar in the Middle Ages defended the so-called “doctrine of the double truth” that (...) the Bishop of Paris, Stephen Tempier, had denounced in the prologue of his 1277 Condemnation. Moreover, how could a professional philosopher or theologian seriously contend that two contradictory statements are simultaneously true, one due to natural reason, and the other through the authority of faith? Therefore, the matter seemed settled and the file definitely closed: the double truth is nothing more than a “legend.” Yet the Italian medievalist Luca Bianchi’s in-depth critical analysis of the pseudo-historical evidence has now changed this. Without wanting to propose an entirely new interpretation of the historical ins and outs of this famous doctrine, Bianchi carries out a re-examination of the subject through a meticulous study of certain key texts that he has read in the light of a three-fold question: What impact did passages from Tempier’s decree on the “double truth” have on the medieval scholars themselves? Does the expression itself, ‘duplex veritas’, appear in some medieval documents? What were medieval thinkers’ attitudes in the face of philosophical arguments leading to conclusions contradicting the teachings of the Catholic faith?Due to space constraints, I will limit my discussion to Bianchi’s most crucial results. The answer to the first question (ch. 1) leads us in a surprising fashion to the famous Disputatio of Luther (1539). In this text, the father of the Reformation opposes the principle according to which what is true in theology must also be true in philosophy—a thesis whose paternity he attributes to Parisian theologians. Wanting to ensure the pre-eminence of faith-based teachings over all forms of human rationalization, Luther came to subscribe to a certain form of the double truth, since he claimed that what is absolutely true according to faith can be false and impossible from the perspective of philosophy. This explains his radical opposition to the “Parisian” principle that Bianchi calls “the principle of the oneness of truth.” We learn that some theologians in fifteenth- century Paris, notably Jean Gerson and Guillaume Baudin, were actually inspired by Tempier’s decree to defend some form of this principle.To respond to the second question (ch. 2), Bianchi first researched the electronic database Library of Latin Texts (CLCLT-6), and came up with “disappointing results”: no author uses the expression ‘duplex veritas’ in the relevant sense. Nevertheless, as imposing as it is, this database is not exhaustive, and Bianchi, well aware of this, extended his research by consulting other documents on paper, allowing him ultimately to reach a positive conclusion: the expression ‘duplex veritas’ appears in the course of a debate that took place around [End Page 99] 1470 on the subject of the truth-value of statements about future contingents. This debate involved a master of arts from Louvain, Pierre de Rivo, who considered it essential to distinguish between the truth of philosophers and the “popular” truth upheld by the churchmen, and a Parisian theologian whom we have already encountered, Guillaume Baudin, who invoked the “principle of the oneness of truth” to denounce the “double truth” that his adversary was promoting.From Bianchi’s multifaceted response to the third question (chs. 3–4), I can only present the groundswell. From the statutes promulgated by the Parisian Arts Faculty in 1272 up to the condemnation of Galileo in 1633, including the constitution Apostolici regiminis issued by the Fifth Lateran Council (1513), a significant evolution may be observed in the requirements academic and religious authorities imposed on professors of philosophy (as well as on scientists) in the western Christian world. Indeed, we may observe that these requirements correspond, first, to the obligation to counter, as far as possible, arguments that contradict faith, and then transform into the duty to commit to a strong... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Pour une histoire de la ‘double vérité’David PichéLuca Bianchi. Pour une histoire de la ‘double vérité’. Conférences Pierre Abélard. Paris: Vrin, 2008. Pp. 192. Paper, €18.00.Since the publication of the work of the Belgian medievalist Fernand Van Steenberghen, a solid consensus seems to have emerged in the community of historians of medieval philosophy: no scholar in the Middle Ages defended the so-called “doctrine of the double truth” that (...) the Bishop of Paris, Stephen Tempier, had denounced in the prologue of his 1277 Condemnation. Moreover, how could a professional philosopher or theologian seriously contend that two contradictory statements are simultaneously true, one due to natural reason, and the other through the authority of faith? Therefore, the matter seemed settled and the file definitely closed: the double truth is nothing more than a “legend.” Yet the Italian medievalist Luca Bianchi’s in-depth critical analysis of the pseudo-historical evidence has now changed this. Without wanting to propose an entirely new interpretation of the historical ins and outs of this famous doctrine, Bianchi carries out a re-examination of the subject through a meticulous study of certain key texts that he has read in the light of a three-fold question: What impact did passages from Tempier’s decree on the “double truth” have on the medieval scholars themselves? Does the expression itself, ‘duplex veritas’, appear in some medieval documents? What were medieval thinkers’ attitudes in the face of philosophical arguments leading to conclusions contradicting the teachings of the Catholic faith?Due to space constraints, I will limit my discussion to Bianchi’s most crucial results. The answer to the first question (ch. 1) leads us in a surprising fashion to the famous Disputatio of Luther (1539). In this text, the father of the Reformation opposes the principle according to which what is true in theology must also be true in philosophy—a thesis whose paternity he attributes to Parisian theologians. Wanting to ensure the pre-eminence of faith-based teachings over all forms of human rationalization, Luther came to subscribe to a certain form of the double truth, since he claimed that what is absolutely true according to faith can be false and impossible from the perspective of philosophy. This explains his radical opposition to the “Parisian” principle that Bianchi calls “the principle of the oneness of truth.” We learn that some theologians in fifteenth- century Paris, notably Jean Gerson and Guillaume Baudin, were actually inspired by Tempier’s decree to defend some form of this principle.To respond to the second question (ch. 2), Bianchi first researched the electronic database Library of Latin Texts (CLCLT-6), and came up with “disappointing results”: no author uses the expression ‘duplex veritas’ in the relevant sense. Nevertheless, as imposing as it is, this database is not exhaustive, and Bianchi, well aware of this, extended his research by consulting other documents on paper, allowing him ultimately to reach a positive conclusion: the expression ‘duplex veritas’ appears in the course of a debate that took place around [End Page 99] 1470 on the subject of the truth-value of statements about future contingents. This debate involved a master of arts from Louvain, Pierre de Rivo, who considered it essential to distinguish between the truth of philosophers and the “popular” truth upheld by the churchmen, and a Parisian theologian whom we have already encountered, Guillaume Baudin, who invoked the “principle of the oneness of truth” to denounce the “double truth” that his adversary was promoting.From Bianchi’s multifaceted response to the third question (chs. 3–4), I can only present the groundswell. From the statutes promulgated by the Parisian Arts Faculty in 1272 up to the condemnation of Galileo in 1633, including the constitution Apostolici regiminis issued by the Fifth Lateran Council (1513), a significant evolution may be observed in the requirements academic and religious authorities imposed on professors of philosophy (as well as on scientists) in the western Christian world. Indeed, we may observe that these requirements correspond, first, to the obligation to counter, as far as possible, arguments that contradict faith, and then transform into the duty to commit to a strong... (shrink)

The OpenNotes (ON) mandate in the 21st Century Cures Act requires that patients or their legally authorized representatives be able to access their medical information in their electronic medical record (EMR) in real time. Ethics notes fall under the domain of this policy. We argue that ethics notes are unique from other clinical documentation in a number of ways: they lack best-practice guidelines, are written in the context of common misconceptions surrounding the purpose of ethics consultation, and often answer (...) questions of a different nature than other documentation. Thus, we believe the clinical ethics community would benefit from clarification on when the withholding of ethics notes is justified. We provide recommendations for excluding information from ethics documentation based on the likelihood and magnitude of harm that may occur with particular disclosures and suggest approaches to decrease the potential harms that may occur. We define and explain six types of reasons to exclude information from ethics notes based on significant harms that are not addressed in the ON policy: (1) harmful revelations from a protected chart note; (2) negative emotional effects on patients or families; (3) the purpose of the consultation is undermined by harmful consequences; (4) avoidable negative impact on interpersonal dynamics; (5) inappropriate labeling or disclosure of medical, social, or financial information; and (6) inclusion of biasing or otherwise unfair information. We also suggest approaches to mitigate harm when excluding, including, reframing, or delaying release of information that is perceived to be relevant to an ethics case. Overall, we hope our analysis and recommendations will initiate a much-needed discussion about the impact of the ON mandate on clinical ethics documentation. (shrink)

Religious belief can complicate the usual management of seriously ill patients when the patient is a Jehovah’s Witness and the treatment is a blood transfusion. This narrative highlights critical points in a discussion of two cases wherein the process to promote an exercise of free will also becomes an exercise for the ethics consultant and healthcare team. Despite a medical care program’s carefully considered additions to an electronic healthcare record, additional conversation, investigation, preparation, and an open mind are required. (...) Helping conflicted family members and considering whether and in what context to contact the Jehovah’s Witness Hospital Liaison Committee complicates the approach. (shrink)

Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to evaluate (...) clinical ethics support services near the end of life. Methods: Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241. Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results. Conclusion: Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services. (shrink)

This paper is an empirical study of what solidarity in a Western European healthcare system means today. Drawing upon empirical research on the 2015 refugee cohort's health needs and their health-seeking behaviour, it unites claims from the literature on solidarity in the fields of migration and healthcare. I argue that the Austrian healthcare system not only is an example of ‘civic solidarity’ in the form of institutionalised obligations to citizens but that it also enacts political forms of solidarity and produces (...) political inclusion for marginalised groups such as refugees. My findings show that being entitled to and accessing services in the healthcare system holds meaning beyond the provision of care: It enables to act autonomously, to build familiar relationships with Austrian institutions, inclusion via the personal electronic health card and to support others in the same solidaristic system. These insights can be used to raise awareness about the inclusional function of healthcare services among practitioners. They also show how solidarity-based healthcare systems can be a motor for shaping positive relationships between immigrants and the host country, and point to additional modes of solidarity in the context of forced migration next to civil society and nonstate support structures. This paper builds upon ethnographic data that were collected between 2018 and 2020 in Vienna, Austria (observational notes before, during and after medical consultations with refugees; interviews with them; interviews with healthcare practitioners and other care providers). (shrink)

One of the consequences of the renewed interest in philosophical aspects of chemistry has been the corresponding renewed interest in the periodic system of the elements which embodies so much chemical knowledge in an implicit form.We have therefore decided to further promote scholarship on the periodic system by compiling a bibliography of previously published material. As the title of this article implies, we restrict ourselves to secondary sources. Readers interested in primary material can consult a number of useful references for (...) this purpose. These include the classical treatment on the History of the periodic system by van Spronsen as well as Mazurs’s compilation of over 700 forms of the periodic system. Mazurs also includes a detailed bibliography of articles and books in several different languages. Additional sources of primary articles which come to mind include David Knight’s Classics in the History of Chemistry, Carmen Giunta’s web pages for the history of chemistry and entries under individual scientists in the Dictionary of Scientific Biography. Turning to the present compilation we do not claim this to be a comprehensive list, since it partly reflects the interests of the senior author (E.R.S.), namely the relationship between the periodic system and quantum mechanics. For example, in addition to articles specifically on the periodic system we include a number of articles which deal with the related themes of electronic configurations of the elements. This bias also explains the disproportionate number of references to the work of the senior author.We have tried to include as many as possible of the articles on the periodic system which have appeared in the philosophy of science literature. These include Bensaude, Christie, Hettema and Kuipers, Kultgen, Lipton, Maher, Scerri, Shapere and Sundaram, among others. (shrink)

What are the main learning difficulties or advantages encountered by students with learning disabilities within e-environments? As a result of the Covid-19 emergency, e-learning is being increasingly used to support students’ learning processes. A number of countries closed their schools altogether, so face-to-face lessons were and have been replaced by distance lessons. A search of current literature via Scopus, Eric and Google Scholar electronic databases was conducted according to Prisma Guidelines. Other sources of literature were also considered, starting from (...) the references in the full text of the articles consulted. We used the following search keywords: “LDs” combined with the “AND/OR” Boolean operator and “e-learning platforms,” “well-being,” “psychological factors,” “emotional distress,” and “self-regulation.” One body of literature highlights the lack of inclusive accessibility standards and a lack of attention to specific tools for addressing LDs, which causes students to develop high levels of stress/anxiety and emotional distress, in addition to low levels of well-being, self-esteem and self-efficacy. Another area of literature looks at how students can develop high levels of self-regulation and emotional awareness, as well as high levels of inclusion. Results are discussed in terms of the promotion of e-learning that focuses on the psychological well-being of students and teachers use of technological tools. (shrink)

Introduction The bioethics literature reflects significant interest in and concern with the use of genetic and genomic information in various settings. Because psychiatric treatment and research raises unique ethical, legal, and social issues, we conducted a scoping review of the biomedical, bioethics, and psychology literature regarding the application of genetic and genomic tools to psychiatric disorders (as listed in the DSM-5) and two associated behaviors or symptoms to provide a more detailed overview of the state of the field. Objectives The (...) primary objective was to examine the available bioethics, biomedical, and psychology literature on applying genetic and genomic tools to psychiatric disorders (other than neurodevelopmental disorders) and two behaviors or symptoms sometimes associated with them (aggression or violence and suicidality) to identify the disorders to which these tools have been applied, the contexts in or purposes for which they have been applied, the ethical, legal, or social concerns associated with those uses, and proposed recommendations for mitigating those concerns. Methods We used Arksey and O’Malley’s scoping review framework: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; and (5) collate, summarize, and report results (2005). We relied on Levac et al. to inform our application of the framework (2010). The PRISMA extension for scoping reviews checklist informed our reporting (2018). We searched three electronic databases MEDLINE (PubMed), Embase, and PsycInfo (EbscoHost) for peer-reviewed journal articles in English to identify relevant literature. One author screened the initial results and additional screening was done in consultation with other authors. A data extraction form using DSM-5 diagnostic categories (excluding neurodevelopmental disorders) was developed and two authors independently each reviewed approximately half of the articles. Inter-rater reliability was ensured by double-coding approximately 10% of the papers. An additional author independently coded 10% of the articles to audit the data. Results In 365 coded publications, we identified 15 DSM-5 diagnostic categories in addition to the two pre-selected behaviors or symptoms (aggression or violence and suicidality) to which genetic or genomic tools have been applied. We identified 11 settings in or purposes for which these tools were applied. Twenty-two types of ethical, legal, or social concerns associated with the application of genetic or genomic tools to these disorders or behaviors/symptoms were identified along with 13 practices or policies that could mitigate these concerns. Conclusion Genetic and genomic tools have been applied to a wide range of psychiatric disorders. These raise a range of ethical, legal, and social concerns. Additional research is warranted to better understand the concerns and effective ways to address them. Advancing the literature to identify relevant ethical, legal, or social concerns and solutions to those problems likely requires greater attention to specific applications of genetic or genomic tools to particular psychiatric disorders and associated behaviors/symptoms as well as broad stakeholder engagement. (shrink)

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)

Objectives—While clinical practice is complicated by many ethical dilemmas, clinicians do not often request ethics consultations. We therefore investigated what triggers clinicians' requests for ethics consultation. Design—Cross-sectional telephone survey.Setting—Internal medicine practices throughout the United States.Participants—Randomly selected physicians practising in internal medicine, oncology and critical care.Main measurements—Socio-demographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results—One hundred and ninety of 344 responding physicians (55%) reported requesting (...) ethics consultations. Physicians most commonly reported requesting ethics consultations for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were: 1) wanting help resolving a conflict; 2) wanting assistance interacting with a difficult family, patient, or surrogate; 3) wanting help making a decision or planning care, and 4) emotional triggers. Physicians who were ethnically in the minority, practised in communities under 500,000 population, or who were trained in the US were more likely to request consultations prompted by conflict. Conclusions—Conflicts and other emotionally charged concerns trigger consultation requests more commonly than other cognitively based concerns. Ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations when consulting. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills. (shrink)

This paper inquiries into the complex issue of informed consent applying artificial intelligence in medical diagnostic consultations. The aim is to expose the main ethical and legal concerns of the New Health phenomenon, powered by intelligent machines. To achieve this objective, the first part of the paper analyzes ethical aspects of the alleged right to explanation, privacy, and informed consent, applying artificial intelligence in medical diagnostic consultations. This analysis is followed by a legal analysis of the limits and (...) requirements for the explainability of artificial intelligence. Followed by this analysis, recommendations for action are given in the concluding remarks of the paper. (shrink)

Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in (...) the communication behaviour in online conversations. We hypothesise that this might impact ethically relevant aspects of the therapeutic relationship, which plays a prominent role in psychiatry. In this paper, we review effects of video-based consultations on communication between therapists and patients in psychiatry. Based on a common understanding of video-based consultations as changing the lived experience of communication, we categorise these effects according to sensory, spatial and technical aspects. Departing from a power-based model of therapeutic relationships, we then discuss the ethical significance of this changed communication situation, based on dimensions of respect for autonomy, lucidity, fidelity, justice and humanity. We conclude that there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations. These changes need to be more carefully considered in psychiatric practice and future studies. (shrink)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. (...) The tool was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

BackgroundAmidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the (...) quality of CECons.MethodsGuided by Levac et al’s (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings.ResultsNine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified – the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations.ConclusionThis review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy.To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards. (shrink)