Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Although patients and by extension their families are the common denominators in most ethics consultations, these constituents are the least likely to request (...) them. At many healthcare organisations in the USA, ethics consultations are overwhelmingly requested by physicians and other clinicians. We believe it is vital that healthcare institutions bridge the knowledge gaps and power imbalances over access to ethics consultation services through augmented policies, procedures and infrastructure. With enhanced education and support, patients and families may use ethics consultation to elevate their voices and prioritise their unique characteristics and preferences in the delivery of their healthcare. Empowering patients and families to request ethics consultation can only strengthen the patient/family–clinician relationship, enhance the shared decision-making model of care and ultimately lead to improved patient-centred care. (shrink)

In a healthcare setting, a multitude of ethical and moral challenges are often present when patients and families direct uncivil behavior toward clinicians and staff. These negative interactions may elicit strong social and emotional reactions among staff, other patients, and visitors; and they may impede the normal functioning of an institution. Ethics Committees and Clinical Ethics Consultation Services (CECSs) can meaningfully contribute to organizational efforts to effectively manage incivility through two distinct, yet inter-related channels. First, given their responsibility to promote (...) a humane, respectful, and professional climate, many CECSs and Ethics Committees may assist institutional leadership in evaluating and monitoring incivility policies and procedures. Second, when confronted with individual incidents of patient/family incivility, Ethics Consultants can and often do work with all stakeholders to address and mitigate potentially deleterious impacts. This manuscript presents an overview of the multifaceted ethical implications of incivility in the healthcare environment, discusses the inherent qualifications of Ethics Consultants for assisting in the management of incivility, and proposes specific mitigating actions within the purview of CECSs and Ethics Committees. We also invite healthcare organizations to harness the skills and reputation of their CECSs and Ethics Committees in confronting incivility through comprehensive policies, procedures, and training. (shrink)

Introduction -- Karl Marx's concept of alienation -- Objectification, alienation, and estrangement -- Other origins of alienation and objectification -- Marx's account of alienation : from early to late -- The alienated object of production : commodity fetishism -- The alienated means of production : machine fetishism -- Machines and the transformation of work -- Marx's energeticist turn -- The first law of thermodynamics -- From arbeit to arbeitskraft -- The second law of thermodynamics -- Machines in the communist future (...) -- Technology and the boundaries of nature -- Material wealth and value : the Grundrisse's fragment on machines -- The strife between technology and capital : the fall in the rate of profit -- Enjoyment not value : challenging the logic of exhaustion -- Man himself as fixed capital -- Class kinship and the redistribution of the means of production -- Machines in the capitalist reality -- Between thermodynamics and humanism : approaching capital -- Machinery as an historical category of production -- Machines, trains, and other capitalist monsters -- Rough, foul-mouthed boys : women's monstrous laboring bodies -- Wage labor and race -- Wage labor and sexuality -- Machinery and revolution -- Alienation beyond Marx -- Science and technology in Marx's excerpt notebooks -- Karl Marx and Charles Babbage -- Machines and temporality : the treadmill effect and free time -- Technophobia and technophilia -- Technophobia and twentieth-century theory. (shrink)

The legitimate authority principle has become reduced to the issue of state authority. In its current formulation, the state has the sole authority to wage war, and because non-state actors, by the...

Marx claims that economic crisis is endemic to capitalism and will worsen as capitalism develops. The article situates Marx’s crisis theory within the discipline of political economy, explains its relationship to mainstream economics, charts economic crises that have happened since the 1840s, and explains Marx’s crisis theorem of the fall in the rate of profit. In conclusion, the 2008 economic crisis, and the notion of crisis in general, are speculatively considered. Special attention is given to the affective desire to own (...) a home, particularly as this is desire is developed by capitalism, in relation to the sub-prime mortgage credit crisis. (shrink)

Karl Marx claims that alienation inheres in all wage labor. I raise questions about the applicability of this claim to subjects of patriarchy. In the first section, I discuss industrial wage labor and its allure for women who were trying to escape the norms of familial patriarchy. In the second section, I extend this criticism of Marx’s claim by considering the racially enslaved subjects of the Antebellum American South, for whom economicallyrecognized wage labor was still a bloody political battle. Finally, (...) I turn to the identification of working class women and sexuality, in order to show how wage labor offered liberation from narrow bourgeois sexual strictures. I conclude by reassessing the viability of Marx’s critique of alienation, taking into account the standpoints from which wage labor itself was a considerable political achievement. (shrink)

Essay Review of New Waves in the Philosophy of Technology (Olsen/Selinger). Treats issue of difference of technology in Marx and Heidegger at some length.

Recent scholarship has tied duties of distributive justice to the existence of coercive institutions. This body of work argues that, because the international system lacks institutions that can coerce individuals in the same manner as domestic institutions, there are no international obligations to address relative poverty and inequality. Proponents of this view use it to support the existence of a compatriot preference that requires us to meet the needs of compatriots before meeting those of the global poor. Even supposing distributive (...) justice to be linked to coercion, coercive institutions do exist at the international level. These institutions coerce states rather than individuals, but their ability to coerce gives rise to duties of economic redistribution between states. (shrink)

The concepts that organize our thinking wield, by virtue of this fact, a great deal of political power. This book looks at five concepts whose dominion has increased, steadily, during the bourgeois period of modernity: Labor, Time, Property, Value, and Crisis. These ruling ideas are central not only to many academic disciplines— from philosophy and law to the political, social, and economic sciences— but also to everyday life.

In this paper, I argue that companies who use functional Magnetic Resonance Imaging (fMRI) scans for lie detection encounter the same basic ethical stumbling blocks as commercial companies that market traditional polygraphs. Markets in traditional voluntary polygraphs are common and fail to elicit much uproar among ethicists. Thus, for consistency, if markets in polygraphs are ethically unproblematic, markets using fMRIs for lie detection are equally as acceptable. Furthermore, while I acknowledge two substantial differences between the ethical concerns involving polygraphs and (...) fMRI lie detection, I argue that these concerns can be overcome and do not lead to the conclusion that markets in fMRI lie detection are ethically dubious. It is my conclusion that voluntary markets in fMRI lie detection can be justified by consumer autonomy and should be allowed to persist. (shrink)

Is the meaning of life to get rich quick? That would certainly explain the way many people have lived under the spell of a constitutive fantasy: the fantasy of instant wealth. Drawing on Lacan’s Discourse of the Capitalist, the article explores the fantasy of instant wealth and its relationship to addiction, especially addiction to shopping. The article concludes with a meditation on how the fantasy of instant wealth supplants and in some ways contradicts another fantasy: the fantasy of labour.

Of general interest, this study confirms the syntactic manifestation of the interpersonal dynamics of the participants in discourse and of their high-level cognitive processes therein. More specifically, this study formalizes categories of the Spanish indicative and subjunctive in a cognitive map based on the deictic organization of the Spanish mood system. This cognitive map, based on a pragmasyntactic approach to mood use, allows us to view mood in Spanish as a mechanism that establishes metaphorical distance from the individual¿s here and (...) now. This study treats the indicative and subjunctive moods of Spanish with special attention to the so-called ¿factive¿ clauses [those clauses subordinated to matrices of subjective comment such as me alegro que (I am glad that), es bueno que (It is good that), no me gusta que (I don¿t like it that), etc. and mental act matrices such as darse cuenta de que (to realize that), tomar en consideración que (to take into account that), etc.]. We propose an approach to analyzing mood use that is based on the information value of an utterance in discourse. In considering information value we take into account (a) Lambrecht¿s (1994) work featuring presuppositions as inherent parts of certain syntactical structures; (b) Mejías-Bikandi¿s (1994) claim that the subjective comment structure in Spanish (subjective comment + que + clause marked with subjunctive) inherently contains a pragmatic presupposition; (c) Mejías-Bikandi¿s reaffirmation that assertion is the role of the indicative and non-assertion is the role of the subjunctive in Spanish; (d) Lunn¿s (1988, 1989a & b) suggestion that the indicative is used to assert propositions with high information value while the subjunctive¿s role is to not assert propositions with low information value; and (e) Lambrecht¿s (1994) ideas on what constitutes information. We assume that non-assertion, including pragmatic presupposition, and asserted propositions work together to create the relative information value of utterances. We show how the information value of utterances can be organized by means of deixis to create a cognitive map. The graphic design for the three dimensional version, which incorporates the notion of the time line with that of metaphorical distance from any individual¿s deictic center, was inspired by Langacker¿s (1991) Cognitive Gram- mar. (shrink)

Neural substrates of fatigue in traumatic brain injury are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (...) and frontoparietal networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort utilized to manually squeeze a pneumostatic bulb across six 30-s trials. Network-based statistics assessed within-network organization and fluctuation with task manipulations by group. Results demonstrate small group differences in network organization, but considerable group differences in the evolution of task-related modulation of connectivity. The mild TBI group demonstrated elevated CO connectivity throughout the task with little variation in effort level or time on task, while CO connectivity diminished over time in controls. Several interregional CO connections were predictive of fatigue in the TBI group. In contrast, FP connectivity fluctuated with task manipulations and predicted fatigue in the controls, but connectivity fluctuations were delayed in the mild traumatic brain injury group and did not relate to fatigue. Thus, the mTBI group’s hyper-connectivity of the CO irrespective of task demands, along with hypo-connectivity and delayed peak connectivity of the FP, may allow for attainment of task goals, but also contributes to fatigue. Findings are discussed in relation to performance monitoring of prediction error that relies on internal cues from sensorimotor feedback during task performance. Delay or inability to detect and respond to prediction errors in TBI, particularly evident in bilateral insula-temporal CO connectivity, corresponds to day-to-day fatigue and fatigue during task performance. (shrink)

In his provocative book War and Self-Defense, David Rodin criticizes attempts to justify national defense based on an analogy between the individual and the state. In doing so, he treats state personality as an analogy to the personality of the individual. Yet the state possesses the key attributes of moral personality, including a conception of the good life and a sense of justice. The state's unobservable – but nevertheless real – moral personality means that it also possessed the right to (...) defend the continued existence of that personality against an attack. Subject to the same constraints that are placed on individuals, such as necessity and proportionality, the state possesses the right to national defense based on its own personality. (shrink)

Not long after matriculation—sometimes even before—medical students begin hearing the question, "So, what are you going into?" It can be heard as a colloquial version of a practical question, "To which type of residency are you planning to apply?" Some will evade the question, claiming, perhaps sincerely, to be fascinated by everything from radiology to geriatrics, open to all possible paths. Others will acknowledge that they enjoy or dread working with children, that they crave long-term relationships or bursts of adrenaline, (...) that they are drawn to the knife or sickened at the sight of blood. A smaller number will confess to having a clear vision of their futures, perhaps a desire to... (shrink)

Of general interest, this study confirms the syntactic manifestation of the interpersonal dynamics of the participants in discourse and of their high-level cognitive processes therein. More specifically, this study formalizes categories of the Spanish indicative and subjunctive in a cognitive map based on the deictic organization of the Spanish mood system. This cognitive map, based on a pragmasyntactic approach to mood use, allows us to view mood in Spanish as a mechanism that establishes metaphorical distance from the individual’s here and (...) now. This study treats the indicative and subjunctive moods of Spanish with special attention to the so-called ‘factive’ clauses [those clauses subordinated to matrices of subjective comment such as me alegro que, es bueno que, no me gusta que, etc. and mental act matrices such as darse cuenta de que, tomar en consideración que, etc.]. We propose an approach to analyzing mood use that is based on the information value of an utterance in discourse. In considering information value we take into account Lambrecht’s work featuring presuppositions as inherent parts of certain syntactical structures; Mejías-Bikandi’s claim that the subjective comment structure in Spanish inherently contains a pragmatic presupposition; Mejías-Bikandi’s reaffirmation that assertion is the role of the indicative and non-assertion is the role of the subjunctive in Spanish; Lunn’s suggestion that the indicative is used to assert propositions with high information value while the subjunctive’s role is to not assert propositions with low information value; and Lambrecht’s ideas on what constitutes information. We assume that non-assertion, including pragmatic presupposition, and asserted propositions work together to create the relative information value of utterances. We show how the information value of utterances can be organized by means of deixis to create a cognitive map. The graphic design for the three dimensional version, which incorporates the notion of the time line with that of metaphorical distance from any individual’s deictic center, was inspired by Langacker’s Cognitive Gram- mar. (shrink)

Medical anthropologists have long recognized variation between cultures with regard to the locus of healing in different systems and traditions: that is, in some cultures, the human body is a “bounded physical unit” and healing is thus focused on the body alone. This perspective will be most familiar to Western health-care providers, and indeed, many providers do not imagine an alternative perspective. However, in many cultures, experiences of health, illness, disease, and healing are intricately connected with the social spheres. In (...) these contexts, healing practices and rituals may seek to address family dynamics, alter roles within a community, and resolve social rifts, and illness itself may be... (shrink)

Although parents are the default legal surrogate decision-makers for minor children in the U.S., shared decision making in a pluralistic society is often much more complicated, involving not just parents and pediatricians, but also grandparents, other relatives, and even community or religious elders. Parents may not only choose to involve others in their children’s healthcare decisions but choose to defer to another; such deference does not imply agreement with the decision being made and adds complexity when disagreements arise between surrogate (...) decision-makers for minor children and their physicians. I argue that clinicians and ethicists have a duty to consider voices marginalized by hierarchical structures, including but not limited to gender-based inequalities. This approach involves negotiating potential conflicts: between respecting differences of culture and religion, on one hand, and assuring that the wishes of those who are most invested in children’s lives are considered, on the other. (shrink)