The objective of this study was to take a closer look at defense-related expenses for medical malpractice cases over time. We conducted a retrospective review of medical malpractice claims reported to the Physician Insurers Association of America's Data Sharing Project with a closing date between January 1, 1985 and December 31, 2008. On average a medical malpractice claim costs more than $27,000 to defend. Claims that go to trial are much more costly to defend than are those that are dropped, (...) withdrawn, or dismissed. However, since the overwhelming majority of claims are dropped, withdrawn, or dismissed, the total amount spent to defend them surpasses that spent on claims that go to trial. Defense attorney expenses account for the majority of defense-related expenses (74%), while expert witness expenses and other expenses split the remaining 26%. A strong association was also found between the average indemnity payment and the amount it costs to defend individual claims by specialty. Our study found that defense-related expenses for medical malpractice claims are not an insignificant cost. As state and federal governments debate how to repair the malpractice system, addressing the high cost of defending claims should not be ignored. (shrink)

Whenever health care reform is debated, the state of the medical professional liability system in the United States re-emerges as an issue of importance. What exactly is broken with the MPL system and what the implications are is a point of contention among different stakeholder groups. Recent data demonstrate that medical liability premiums have been improving in recent years and the majority of premiums remained flat in 2010. General agreement still exists, however, that medical professional liability insurance premiums have become (...) unaffordable for many physicians, and coverage has become less available, especially for certain medical specialties and in specific areas of the country.Multiple factors go into the determination of medical professional liability insurance premiums including return on investments, reinsurance costs, claims frequency, average amount paid out on malpractice claims, defense expenses, and administrative costs such as underwriting expense. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

The aim of our themed symposium is to explore the limits and possibilities of corporate reputation for enabling corporate accountability. We articulate three perspectives on corporate accountability. The communicative perspective equates accountability with disclosure and stakeholder engagement. The phenomenological perspective focuses on stakeholder expectations and reputation management. The consequential perspective focuses on effects/consequences. We then examine how corporate accountability is understood, how it relates to ideals, mission, and purpose, alternative pathways to corporate accountability, reputational consequences, and the role algorithms play (...) in relationships between corporate reputation and accountability. Using a multitude of organizational contexts, these papers advance our understanding of how corporate reputation can be used as a mechanism for creating greater corporate accountability, and for identifying alternative pathways when corporate reputation fails to do so. (shrink)

Joseph Hannon has expressed a most surprising objection to Aquinas scholar Prof William E. Carroll in his latest paper “Theological Objections to a Metaphysicalist Interpretation of Creation.” The main claim is that Prof. Carroll misunderstands Aquinas' doctrine of creatio ex nihilo by reducing it to a metaphysical notion, rather than considering it in its full theological sense. In this paper I show Hannon's misinterpretation of Carroll's and Thomas Aquinas' thought, particularly by stressing the dependence that the doctrine (...) of providence through secondary causes has on the doctrine of creatio ex nihilo. (shrink)

Next SectionBecause of the radically incarnational nature of the Christian understanding of ethics and bioethics, according to Kierkegaard, there has always been an infinite gulf between Christian bioethics and secular bioethics. However, the process of the secularization of the public square has made this gulf more apparent and salient for the current ethical debates in biomedicine and the culture more generally.

In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)

Many psychological scientists and behavioral neuroscientists affirm that “emotion” influences thinking, decision-making, actions, social relationships, well-being, and physical and mental health. Yet there is no consensus on a definition of the word “emotion,” and the present data suggest that it cannot be defined as a unitary concept. Theorists and researchers attribute quite different yet heuristic meanings to “emotion.” They show considerable agreement about emotion activation, functions, and regulation. The central goal of this article is to alert researchers, students, and other (...) consumers of “emotion” research to the multiple meanings or aspects that distinguished scientists attribute to ”emotion,” increase appreciation of its interesting and challenging complexity, and sharpen perspectives on “emotion” and the associated body of literature that is of critical significance to science and society. (shrink)

This article clarifies my current and seemingly ever-changing position on issues relating to emotions. The position derives from my differential emotions theory and it changes with new empirical findings and with insights from my own and others’ thinking and writing. The theory distinguishes between first-order emotions and emotion schemas. For example, it proposes that first-order negative emotions are attributable mainly to infants and young children in distress and to older individuals in emergency or highly challenging situations. Emotion schemas are defined (...) as emotion feelings interacting with cognition in motivating the decision making and actions of everyday life. (shrink)

This article suggests a way to circumvent some of the problems that follow from the lack of consensus on a definition of emotion (Izard, 2010; Kleinginna & Kleinginna, 1981) and emotion regulation (Cole, Martin, & Dennis, 2004) by adopting a conceptual framework based on discrete emotions theory and focusing on specific emotions. Discrete emotions theories assume that neural, affective, and cognitive processes differ across specific emotions and that each emotion has particular motivational and regulatory functions. Thus, efforts at regulation should (...) target the specific dysregulated emotions. The positive effects of emotion regulation are more likely to be optimized when they result from or lead to emotion utilization—the constructive use of the energy of emotion arousal. Effective processes for regulation differ for basic emotions and emotion schemas. This article identifies neural systems that facilitate emotion experiences and emotion regulation processes. It considers the implications of the developmental change from basic emotions to emotion schemas, and also briefly discusses the effects of interventions on changes in emotion knowledge, emotion regulation, and social and emotional competence. (shrink)

The American conservative movement is a force of anti-reflexivity insofar as it attacks two key elements of reflexive modernization: the environmental movement and environmental impact science. Learning from its mistakes in overtly attacking environmental regulations in the early 1980s, this counter-movement has subsequently exercised a more subtle form of power characterized by non-decision-making. We examine the conservative movement’s efforts to undermine climate science and policy in the USA over the last two decades by using this second dimension of power. The (...) conservative movement has employed four non-decision-making techniques to challenge the legitimacy of climate science and prevent progress in policy-making. We argue that reflexive modernization scholars should focus more attention on similar forces of anti-reflexivity that continue to shape the overall direction of our social, political and economic order, and the life chances of many citizens. Indeed, better understanding of the forces and effectiveness of anti-reflexivity may very well be crucial for societal resilience and adaptation, especially in the face of global environmental problems like climate change. (shrink)

Many emotion researchers would probably agree that at least some aspects of discrete emotions are evolutionarily conserved (e.g., the sensation/feeling component cannot be learned). Such agreement probably extends to the notion that aspects of emotions emerge in ontogeny as a function of developmental, learning, and cultural processes. Determining when and under what circumstances they emerge seems largely a matter for empirical research, though theories differ in their predictions and in the way they describe the relevant emotional-, cognitive-, and neuro-developmental processes.

I am very appreciative of those who wrote comments on my article. They raised some interesting and some quite challenging questions. Their responses seem quite in synchrony with my focus and intent—to reveal some problems that we need to address in advancing emotion science. The authors of the commentaries reflected some of the same sort of differences among themselves as I found among the emotion scientists whom I surveyed in search of a definition of emotion. Like the emotion scientists who (...) responded to my survey, most of the authors of the commentaries were generally in agreement on the significance of research in the emotion domain but not in agreement on the meaning of the term emotion. I briefly discuss the noteworthy question (raised in one of the commentaries) as to whether and when discrete emotion concepts might someday share the same fate as the general term emotion and disappear from emotion science. (shrink)

In this article we consider the material dimensions of schooling as constitutive of the possibilities inherent in “fixing” education. We begin by mapping out the problem of “fixing education,” pointing to the necrophilic tendencies of contemporary education—a desire to kill what otherwise might be life-giving. In this sense, to “fix” education is to make otherwise fluid processes-of-living static. We next point to the material realities of this move to fix. After establishing the material consequences of perpetually fixing schools, we provide (...) a brief overview of two critical perspectives that might be shown as attempts to “unfix” education: critical pedagogy and unschooling. Though both offer critiques of normative education, these approaches are also bound by their failure to fully engage with the material dimensions of schooling. As such, both critical pedagogy and unschooling inadvertently cut off key possibilities for human flourishing within educational environments. In their rush to “unfix”—to counter the necrophilic tendencies of contemporary education—these approaches exclude or otherwise foreclose upon resistive challenges to the normative order that extend from the margins. In response, we turn to the possibilities for unschooling within the materially public spaces of schools. These are the spaces where fixity fails—possibility extends from unschooling in schools, from unfixing the process of fixing education. We end by considering the possibilities inherent in Community Service Learning as a valuable means to engage in a radically public, and unfixed, educational system. (shrink)

Capitalizing on the hype surrounding stem cell research, numerous clinics around the world offer “stem cell therapies” for a variety of medical conditions. Despite questions about the safety and efficacy of these interventions, anecdotal evidence suggests a relatively large number of patients are traveling to receive these unproven treatments — a practice called “stem cell tourism.” Because these unproven treatments pose risks to individual patients and to legitimate translational stem cell research, stem cell tourism has generated substantial policy concern and (...) inspired attempts to reduce these risks through the development of guidelines for patients and medical practitioners. This paper examines the roles and responsibilities of physicians in patients' home countries with respect to patients' decisions to try unproven stem cell therapies abroad. Specifically, it examines professional guidance from two organizations — the American Medical Association and the International Society for Stem Cell Research — and assesses physicians' professional and legal obligations to patients considering unproven stem cell therapies. Then, drawing on qualitative interviews conducted with patients who traveled abroad for unproven stem cell treatments, it explores the roles that physicians actually play in patients' decisions and compares these actual roles with their professional and legal responsibilities. The paper concludes with a discussion of strategies to help improve the guidance physicians provide to patients considering unproven treatments. (shrink)

Stem cell science, using both embryonic and a variety of tissue-specific stem cells, is advancing rapidly and offers promise to improve medical care in the future. Yet, with the notable exception of hematopoietic stem cell transplantation, a long-established approach to treating certain cancers of the blood system, this promise is long term and most stem cell research focuses on basic scientific questions or the collection of pre-clinical data. Although some clinical trials are underway, most are focused on safety, and novel (...) effective therapy is likely a long way off. Despite the preliminary nature of most stem cell research, however, numerous clinics around the world offer stem cell “therapies” to patients today outside the context of a clinical trial. Although the number of patients who have received these stem cell-based interventions is unknown, anecdotal reports suggest a substantial population of patients is willing to try them, despite unresolved questions about their safety and efficacy. (shrink)

Background Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling, which involves a healthcare professional using a social networking site or publicly available search engine to find patient information online. The study’s aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. Method The authors surveyed final year medical students at the (...) Otago Medical School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students’ attitudes towards PTG, and reasons why they might engage in PTG. Results Fifty-four students completed the survey, which showed that PTG was uncommon. Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue. SNS usage was high ; participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. Conclusions The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information. (shrink)

Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling, which involves a healthcare professional using a social networking site or publicly available search engine to find patient information online. The study’s aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. The authors surveyed final year medical students at the Otago Medical (...) School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students’ attitudes towards PTG, and reasons why they might engage in PTG. Fifty-four students completed the survey, which showed that PTG was uncommon. Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue. SNS usage was high ; participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information. (shrink)

Mazur & Booth present an intriguing model of the relationship between circulating testosterone levels and dominance behaviour in man, but their review of studies on testosterone–behaviour relationships in man is selective. Much of the evidence they cite is correlational in nature. Placebo-controlled manipulations of testosterone levels are required to test their hypothesis that dominance levels are testosterone-dependent in man. The changes in testosterone level that follow behavioural experience may be a consequence of stress. Testosterone levels in man are determined by (...) a wide variety of factors, and a multivariate approach is required. (shrink)

Carpendale & Lewis's (C&L's) interesting and insightful article did not integrate several potentially useful notions from emotion theory and research into their explanatory framework. I propose that emotions are indigenous elements of mind and that children's understanding of them is fundamental to their understanding of the mental life of self and others, understandings critical to the development of social and emotional competence.

Despite advances in medical knowledge regarding pain management, pain continues to be significantly undertreated in the United States. There are many drug and nondrug treatments, but the use of controlled substances, particularly the opioid analgesics, is universally accepted for the treatment of pain from cancer. Although opioid analgesics are safe and effective in treating chronic pain, there is continued research and discussion about patient selection and long-term effects. A number of barriers in the health care and drug regulatory systems account (...) for the gap between what is known about pain management and what is practiced. Among the barriers are physicians’ fears of being disciplined by state regulatory boards for inappropriate prescribing.State medical boards are in a unique position not only to address physicians’ concerns about being investigated, but also to encourage pain management. Prior to 1989, a few state medical boards had policies relating to controlled substances or pain. Subsequently, state medical boards began adopting policies regarding the prescribing of opioids for the treatment of pain; many of these specifically addressed physicians’ fear of regulatory scrutiny. (shrink)

Lewis makes a strong case for the interdependence and integration of emotion and cognitive processes. Yet, these processes exhibit considerable independence in early life, as well as in certain psychopathological conditions, suggesting that the capacity for their integration emerges as a function of development. In some circumstances, the concept of highly interactive emotion and cognitive systems seems a viable alternative hypothesis to the idea of systems integration.

This study examined the emergence of corporate social responsibility (CSR) as a public issue over 25 years using a content analysis of two national news- papers and seven regional, geographically-dispersed newspapers in the U.S. The present study adopted a comprehensive definition encompassing all four CSR dimensions: economic, ethical, legal, and philanthropic. This study examined newspaper editorials, letters to the editor, op-ed columns, news analyses, and guest columns for three aspects: media attention, media prominence, and media valence. Results showed an increase (...) in the number of opinion pieces covering CSR issues over the 25-year period. The prominence of each of the four CSR dimensions varied over time. Each of the four CSR dimensions had its moment of media prominence when it was more important than the other dimensions. The most prevalent valence of the opinion pieces was negative; the volume of negative pieces increased over the 25 years, whereas the number of opinions with positive, neutral, and mixed tones showed little change over time. The study concludes by tracing the implications of the role of the news media for business ethics research. (shrink)