Nurse Ethicists bring a unique perspective to clinical ethics consultation. This perspective provides an appreciation of ethical tensions that will exist beyond the consult question into the moral space of patient care. These tensions exist even when an ethically preferable plan of action is identified. Ethically appropriate courses of action can still lead to moral dilemmas for others. The nurse ethicist provides a lens well suited to identify and respond to these dilemmas. The nurse–patient relationship is the ethical foundation of (...) nursing practice and this relational ontology is well suited to addressing ethical dilemmas that exist prior to and beyond the initial consult question. This paper will describe one nurse ethicist’s phronetic and pragmatic approach to a clinical ethics consult elucidated through feminist ethics and systems thinking. This paper will describe the theoretical basis for this method, present a case, and describe how this consultation approach provides a rich analysis based around relationships and responsibilities that also highlights the important ethical tensions within the social structure that exists around the patient and continue after the consult question is answered. (shrink)

The moral expertise of clinical ethicists is not a question of mastering codelike theories and lawlike principles. Rather, ethicists are architects of moral space within the health care setting, as well as mediators in the conversations taking place within that space.

The figure of the cordial host of the Academy, who invited the most gifted mathematicians and cultivated pure research, whose keen intellect was able if not to solve the particular problem then at least to show the method for its solution: this figure is quite familiar to students of Greek science. But was the Academy as such a center of scientific research, and did Plato really set for mathematicians and astronomers the problems they should study and methods they should use? (...) Our sources tell about Plato's friendship or at least acquaintance with many brilliant mathematicians of his day (Theodorus, Archytas, Theaetetus), but they were never his pupils, rather vice versa -- he learned much from them and actively used this knowledge in developing his philosophy. There is no reliable evidence that Eudoxus, Menaechmus, Dinostratus, Theudius, and others, whom many scholars unite into the group of so-called "Academic mathematicians," ever were his pupils or close associates. Our analysis of the relevant passages (Eratosthenes' Platonicus, Sosigenes ap. Simplicius, Proclus' "Catalogue of geometers", and Philodemus' "History of the Academy", etc.) shows that the very tendency of portraying Plato as the architect of science goes back to the early Academy and is born out of interpretations of his dialogues. (shrink)

Despite their central role in the construction and development of the market for virtues as well as in the design, implementation, and evaluation of corporate sustainability strategies and governmental sustainability policies, sustainability consultants remain at best “hidden” corporate change agents. In this paper, we bring sustainability consultants back to the fore to account for how these actors discreetly regulate and shape contemporary sustainability transformations from the outside-in. We do so first by unpacking various roles of consultants as engineers, market builders, (...) power vehicles, boundary workers, issue translators, and soft regulators; then we conceptualize how, through these roles, they contribute to empowering, legitimizing but also potentially supplanting and undermining the activities of corporate change agents operating inside corporations. We finally propose some research orientations for studying further the role of sustainability consultants in corporate transformations toward sustainability. (shrink)

As James Coleman and Allan Gibbard have suggested, human morality may be viewed as a feedback control system. Each of the standard normative ethical theories emphasizes only part of this complex system. Social reform requires both new theoretical syntheses and a practical effort to better uphold ideal norms.

Eco-minimalism is an emerging approach to building design, construction, and retrofitting. The approach is exemplified by the work of architect Howard Liddell and sustainable water management consultant Nick Grant. The fundamental tenet of this approach is an opposition to the use of inappropriate, unnecessary, and ostentatious eco-technology—or “eco-bling”—where the main emphasis is on being seen to be green. The adoption of the principles of the eco-minimalist approach offers, they argue, a significant opportunity to improve sustainability in construction. However, (...) a critical examination of eco-minimalism as a design philosophy shows that eco-minimalism needs to be further developed within the framework of virtue ethics. The focus should be on two main themes: (1) incommensurabilities arising in relation to eco-minimalism’s goals of minimizing environmental impact and maximizing human benefit, which cannot be resolved from the principles Liddell and Grant have articulated, and (2) the practical importance of cultivating settled dispositions to act eco-minimally on the part of those who design, construct, and use buildings. A strong emphasis needs to be placed on the role of practical wisdom when navigating challenging decisions of the kind facing eco-minimalists in practice. (shrink)

Sexually transmitted infections (STIs) are socially constructed as more ‘dirty’ than other gynaecological conditions. This article analyses women’s accounts of interactions with clinicians, subsequent to a diagnosis of genital herpes simplex virus or human papilloma virus. Women conceptualised consultations as a ‘moral event,’ different from other consultations. This moral component is highlighted drawing on Foucault’s notion of ‘the confessional.’ Additionally, Douglas’ anthropological construction of ‘dirt’ is used to consider why these consultations are ‘confessional’ experiences. Email interviews were conducted with 26 (...) women diagnosed with a viral STI and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Findings indicated that discourses of morality shape sexual health consultations. Five themes were identified in relation to the moral ‘work’ in clinical consultations about a viral STI diagnosis: the particular ‘dirtiness’ of viral STIs, clinicians as moral agents, the ‘non‐judgmental’ clinician, women juggling truth‐telling and risk and clinicians prescribing moral work. Clinicians support and educate women more effectively if they recognise subjective, moral aspects of sexual health consultations rather than assuming that effective clinical teaching is rational, scientific and non‐judgmental. (shrink)

Healthcare ethics consultation is therefore one of the most consequential, institutionally accepted, and widespread forms of public philosophy in the United States. In this chapter, the authors begin with an overview of the development of healthcare ethics and its emergence as a concrete practice embedded in healthcare settings. They then describe the core ethical principles that inform the everyday practice of ethics consultations and the generally accepted steps involved in conducting a consultation. The authors discuss the role of clinical ethicists (...) in medical education and policy development. Finally, they conclude with some remarks on the distinctive contributions made by those with philosophical training to these endeavors and the importance of continued engagement by philosophers in this important public work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Womanist-Buddhist Consultation as a Reading CommunityCarolyn M. Jones MedineIn Breaking the Fall, the late Robert Detweiler (1932-2008) imagines what a reading community, "a contemporary version of the old storytelling cultures,"1 might look like. He suggests that in such a community, "The accent on community itself would offer a balance to our excessively privatizing tendencies; the communal interaction could counter our relentless drive to interpret... with attitudes of play (...) and Gelassenheit (abandonment, chance, and relaxation); the writing and reading community especially as a liminal entity, could nurture a respect for the incomprehensibility of form and a reverence for mystery."2 This description offers an entry to the work of the Womanist-Buddhist Consultations. To reach a provisional understanding of the meaning of that work, I shall reflect on first what we mean when we say that we want to read something. Second, I turn to a conversation with Robert Detweiler, who was one of my mentors, as a way to address the form of reading that we do and the form of community that we make in the Womanist-Buddhist Consultations. Third, I want to draw on the thought of the consultations themselves, using Emmanuel Levinas's work on reading and ethics, to examine the capacity the consultations have to hold tensions creatively and to allow multiple meanings to be part of them. Finally, I want to address the goals for the consultations. I am thinking specifically of Melanie Harris's desire to see the consultations as generating practices that promote peace, compassion, and justice, and Charlie Hallisey's desire to generate a more complex reading of Buddhist texts in and of themselves.The Womanist-Buddhist Consultations have met three times between 2009 and 2011. We met at Harvard Divinity School and at Texas Christian University for sessions of four days each, and for an evening at the University of Georgia between the two longer meetings. The Texas Christian meeting included some previous members from the Harvard meeting, and added new ones. The University of Georgia meeting consisted primarily of students who participated in the reading practice.In the meeting at the University of Georgia, Charles Hallisey looked askance at me when I said that Buddhism offers an entry into peace and compassion; yet Melanie Harris, when she constructed the later session at Texas Christian University, deployed the terms "peace" and "justice" as descriptors for the work of the group. Hallisey's ironic glance occurred right before we read, at the University of Georgia, a text that contained magic and murder. His glance and the content of that text have prompted [End Page 47] me to think through Harris's claims and to see how our group achieves both a reading of Buddhism and an ethical practice that generates peace and points to justice.The instructions that Hallisey gives for the reading process describe a practice of "being and reading together" as we encounter a variety of Buddhist texts.3 The group's guide is the bodhisattva Manjushri, who has overseen our work through an image gracing the wall at all our meetings. Manjushri has a sword to cut through obstacles, and holds a book, signifying wisdom. The practice of reading with friends, Hallisey told us, comes from Jewish tradition: we need a friend to help us overcome what we can and to begin to see what we cannot. The work involves three steps:1. To read passages individually.2. To read the same passages together in small groups.3. To gather again as a large group and discuss what we have discovered.The major goal of reading is to encounter levels of ourselves to which we ordinarily have no access, by examining a text that becomes "generous" to us. Reading together, Hallisey asserts, makes the generosity of the text visible to us.This process of reading, I would argue, is different from what we usually do when we read and different from what we mean when we tell students to read. Patricia O'Connell Killen, an AAR Teaching Award winner, has delineated some of what we mean when we say to our students: "Read chapter 2 of 'X' and come to class prepared."4... (shrink)

A businessperson acts,quabusinessperson, in two institutional contexts which in principle are completely distinct, and normally entail two different ways of relating to other people; on the one hand as an actor in the market, and on the other as the employees’ manager. We shall assume that different sets of norms govern how to relate to trading partners in the market and how to relate to subordinates in the company. The moral problems which arise in the two different institutions for conducting (...) human relations consequently also differ. The main problem relating to market operations originates in the fact that one achieves the most desirable consequences when the objective as such is difficult to justify on moral grounds. Profit is the target, if necessary at the expense of the person one is dealing with. In this context—i.e. in the market—altruistic considerations, or acting out of consideration for the other party, can produce socially undesirable results. The problems confronting the businessperson as manager are of a different nature. We shall not be considering all aspects of management or consultancy ethics, only what we regard as in principle the fundamental problem, one which in fact applies to all management in modern society. (shrink)

The fundamentals of Kahn's architectural philosophy begin with his personal history: his inherent talent; his family background and childhood experiences; his education, from elementary school through architectural school; the influences of Paul Philippe Cret and Beaux Arts architecture; and his travels, especially those to study the antique monuments of Egypt, Greece, and Rome. Because the causal aspects of these experiences were absorbed by him, rather than being the products of Kahn's own thinking, he rarely acknowledged them. His conclusions led to (...) a philosophy that echoed some of the thoughts of earlier philosophers, like Spinoza and Heidegger, but were arrived at independently.1 Kahn expressed his philosophy in lectures, seminars, writings, interviews, conversation, and often through sketches. However, he habitually expressed himself elliptically-his phrasing poetic, his metaphors original and apt. Therefore, his meaning was often felt rather than understood. Extensive studies of Louis Kahn's architecture exist, but few focus on his fully developed architectural philosophy.2 This text addresses that subject, incorporating his own words (in italics) and relating them where relevant to his final work, the Yale Center of British Art (hereafter, "the Center"). Kahn died during the construction of the building, the last material expression of his architectural philosophy. I was the first director of the Center, a participant in the selection of the architect and throughout the building's planning and creation. Coincidental with the early years of Kahn's planning for the Center, two young architectural historians-John Cook and Heinrich Klotz-interviewed several leading architects, including Kahn. Working with a verbatim transcript of the Kahn interviews, made by Karen Denavit, I produced an edited version of the interviews in book format. Louis I. Kahn in Conversation: Interviews with John W. Cook and Heinrich Klotz (hereafter, "Kahn in Conversation") is the source for many of the Kahn quotations included here. A researcher can consult the full, verbatim transcript of the interviews in the Center's Institutional Archives, in the Manuscripts and Archives collections in Sterling Memorial Library at Yale University, and in the Architectural Archives of the University of Pennsylvania. (shrink)

A businessperson acts,quabusinessperson, in two institutional contexts which in principle are completely distinct, and normally entail two different ways of relating to other people; on the one hand as an actor in the market, and on the other as the employees’ manager. We shall assume that different sets of norms govern how to relate to trading partners in the market and how to relate to subordinates in the company. The moral problems which arise in the two different institutions for conducting (...) human relations consequently also differ. The main problem relating to market operations originates in the fact that one achieves the most desirable consequences when the objective as such is difficult to justify on moral grounds. Profit is the target, if necessary at the expense of the person one is dealing with. In this context—i.e. in the market—altruistic considerations, or acting out of consideration for the other party, can produce socially undesirable results. The problems confronting the businessperson as manager are of a different nature. We shall not be considering all aspects of management or consultancy ethics, only what we regard as in principle the fundamental problem, one which in fact applies to all management in modern society. (shrink)

Much has been written about the importance of narrative in teaching ethics and humanities to medical students and residents, as well as the value of narratives in clinical care. Relatively little has been said about the essential role of narrative in bioethics consultations. For most consults, the interpretation of narratives is the central moral feature, and the ethics consultant is inevitably one of the narrators. In a recent consult in which I participated, at least three narratives were in play. (...) The medical record itself was a narrative, or really, a variety of narratives. A second distinct narrative was the story of why this case had come to be categorized as an ethical concern for the medical team. A third narrative was the tentative sketch running through my mind as a consultant‐partly factual, partly anticipatory and conjectural, inevitably personal‐about what was going on here. (shrink)

Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide realtime feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities. The primary (...) purpose of this article is to equip and encourage others to engage in ongoing evaluation of their own ECS. Toward that end, the following resources are shared: (1) the survey tool used to gather the evaluation data, (2) the procedure used to elicit and collate responses, and (3) how the resulting data are used to support continuous quality improvement and justify the continued financial support of the ECS to hospital administration. (shrink)

RESUMEN: El presente trabajo propone un análisis de los Derechos Fundamentales de los pueblos indígenas a la luz de los principios internacionales de Libre Determinación y Consulta Previa, como fundantes y presupuestos de los demás Derechos Indígenas. En consecuencia, se analiza el Derecho a la Consulta, que debe ser previa, libre, informada, de buena fe, culturalmente adecuada y con el propósito de obtener el consentimiento; donde todas éstas características son el estándar mínimo a cumplir en cualquier proyecto de desarrollo o (...) extractivo que afecte a pueblos indígenas, por lo que debe explicarse también el extractivismo al interior de los estados-nación y su modus operandi, que ha provocado la existencia de zonas y regiones que algunos autores caracterizan como “estados de excepción” o estados de “de no-derecho”. El análisis propuesto contrasta las bases mencionadas con algunos casos llevados ante la jurisdicción del Sistema Interamericano de Derechos Humanos, cuya última fase descansa en las sentencias de la Corte IDH.ABSTRACT: The present paper proposes an analysis of the Fundamental Rights of the indigenous peoples in the light of the international principles of Free Determination and Prior Consultation, as foundations and budgets of the other Indigenous Rights. Consequently, the Right to Consultation is analyzed, which must be prior, free, informed, in good faith, culturally appropriate and with the purpose of obtaining consent; where all these characteristics are the minimum standard to be met in any development or extractive project that affects indigenous peoples, so the extractivism within the nation-states and its modus operandi, which has caused the existence of zones and regions that some authors characterize as "states of exception" or "non-right" states. The proposed analysis contrasts the mentioned basis with some cases brought before the jurisdiction of the Inter-American Human Rights System, whose last phase rests on the judgments of the Inter-American Court.PALABRAS CLAVE: Libre determinación y consulta, Derechos Fundamentales, pueblos indígenas. KEYWORDS: Free determination and consultation, Fundamental Rights, indigenous peoples. (shrink)

Research assistantships have long been viewed as an extension of the formal education process, a form of apprenticeship, and a pathway into the professional practice of research in institutional settings. However, there are other contexts in which researchers practice research. Our self-reflective analysis identified that RAship experiences during the masters and the PhD may serve developmentally foundational roles in the advancement of an RA’s knowledge, skills, and passion for research. Further, analysis of participants’ experiences revealed that RA supervisors play critical (...) roles in the development of RAs as researchers. We conclude with the understanding that RAships may be formative in contributing to the development of individuals who go on to specialise as professional research consultants as research consulting is a natural extension of the RA role. Students entering into RAships, current RAs, new faculty members, current RA supervisors, faculty members looking to improve their research productivity, and Chairs of departments will all benefit from reading this paper and its contribution to the current understanding of how RAships impact the development of researchers, and specifically how RAships contribute to the development of research consultants. (shrink)

The year 2013 may someday be seen as the year a new profession was born. Clinical ethics consultation has been practiced in different ways for roughly 30 years, originally initiated by a group of h...

This qualitative social scientific interview study delves into the ways in which professional vision is constructed in clinical ethics consultation (CEC). The data consist of 11 semi-structured interviews that were conducted with clinical ethics consultants currently working in hospitals in one major urban area in the U.S. The interviews were analyzed with the qualitative research method of critical discourse analysis, with a focus on identifying the cultural structures of knowledge that shape CEC as a professional practice. The discourses were first (...) identified as belonging to two higher discourse categories, order and agency. Order was divided into three lower categories, emotional, managerial, and rational order, and discourses of agency into the lower categories of exploration, technique, deliberation, and distancing. An additional discourse of neutral interaction was identified as a bridging discourse, activated to level tensions emerging out of conflicting goals and agencies embedded in CEC practice. This analysis brings out as its main observation that clinical ethics consultants draw on and shift between potentially ideologically conflicting social positions that can create built-in tensions within the professional domain. The study calls attention to these tensions and suggests for the professional group to discuss the possibility of defining priorities between different kinds of order, identified in this study, that shape the CEC domain. (shrink)

This article rejects the claim made by other scholars that Plato in the Statesman, by employing the so-called ‘architect’ (ὁ ἀρχιτέκτων) in one of the early divisions leading to the definition of political expertise, prefigured and anticipated the architectonic conception of political expertise advanced by Aristotle. It argues for an alternative reading in which Plato in the Statesman, and in the only other of his works (Gorgias) in which the word appears, closely tracks the existing social role of the (...) architektōn, who was designated as such only in virtue of appointment by a city to a role that was crucially defined as epitactic, involving overseeing the workers on site engaged in constructing some civic building works. It is this epitactic dimension of the role on which Plato relies in the Statesman, as opposed to the kind of claim to overarching integrative expertise that Aristotle would use the figure of architectonic political knowledge to make. (shrink)

The author argues that bioethics ought properly to be regarded "both" as a consulting profession that counsels health practitioners in dealing with the individual problems they face "and" as an academic discipline that defines problem areas on its own and includes attention to the institutional and social aspects of health care. The argument is conducted by means of a brief history of bioethics and comparison of its development with that of history of medicine and sociology of medicine. Several examples of (...) the social issues in bioethics are examined. (shrink)

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable (...) medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. (shrink)

In aiming to frame plagiarism as an academic literacy issue, this paper focuses on the strategies used by firsts years Portuguese university students, when writing from sources, along with the relationship between these strategies and the way students view themselves as readers, writers and users of sources. The study was based on 44 short summary essays written by students as well as their responses to a questionnaire and checklist on citation rules. The evaluation of the essays revealed that students often (...) use copying and patchwriting. In addition, we found that much of the time students changed the meaning of the content expressed in the source. In relation to the way students evaluated themselves, generally their view was they used appropriate strategies. The study did not reveal a relationship between perceptions of using appropriate strategies and the use of those same strategies. Nonetheless, we found an association between performance and perceptions of using copying. Perceived use of a ‘think-then-do’ strategy was also related to changing the meaning when writing from sources. Concerning school achievement, stronger students evaluated themselves as using more appropriate strategies, and those who had not previously failed school year also displayed a better knowledge of citation rules. However, we failed to find any relationship between school achievement and the use of strategies for writing from sources. The main findings of the current research point to the existence of issues concerning how to address academic literacy, findings that go beyond plagiarism and, consequently, indicate the need for pedagogical responses. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Effective evaluation of any activity requires, first, that we understand what its objectives are, and second, that we can define and measure these objectives. For instance, a publicly listed compan...

The shared values, beliefs, and behaviors by which people interpret life events are what we call culture. More than medical science, culture determines how people react to illness and death. Science may determine which drug or surgery best treats the disease, but culture often determines how the health professional best treats a patient with the disease. Culture influences when the patient believes he is ill, which treatments he accepts, and which results he prefers. Because culture surely affects illness outcomes, health (...) professionals must not ignore it. (shrink)

Background and aimsFew Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, at least (...) 10% of all chaplains currently working in Polish hospitals.ResultsOf the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy—as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics.ConclusionsIn order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains. (shrink)

Some 30 years ago the role of the clinical ethics consultant (CEC) was formalized. At the time, the perception of the role differed between two groups serving in that capacity, clinicians and nonclinicians. Differences in their roles reflected their training and experience.These divergent views were resolved semantically by designating the role of the CEC as “ethics facilitation.” In practice the different perspectives have remained. However, the subsequent published literature on clinical ethics consultation has not adequately reflected the activity of (...) the clinician as a CEC.There have been recurring unanswered calls for the acquisition of empirical data on the nature of the problems that prompt ethics consultation requests and the functions required to address them. The authors introduce a template that provides a means to acquire such data for clinician ethicists. A similar instrument could be constructed to reflect the role of the nonclinician ethicist serving in that capacity. (shrink)

Ernst Mayr''s contributions to 20th century biology extend far beyond his defense of certain elements in evolutionary theory. At the center of mid-century efforts in American evolutionary studies to build large research communities, Mayr spearheaded campaigns to create a Society for the Study of Evolution and a dedicated journal,Evolution, in 1946. Begun to offset the prominence ofDrosophila biology and evolutionary genetics, these campaigns changed course repeatedly, as impediments appeared, tactics shifted, and compromises built a growing coalition of support. Preserved, however, (...) were designs to balance the community and journal with careful equation of status and explicit partitioning of responsibilities within the working coalition. Choice terms such as cooperation and unity carried a strong political message. Mayr''s editorship ofEvolution provides a superb example of these balancing efforts. The mid-century infrastructural activities described herein also represented aggressive attempts to leverage control across several layers of community. Leaders of these campaigns sought: (1) to promote evolutionary studies as a modernized research discipline and place it at the center of American biology, (2) to promote evolutionary studies within existing disciplines — e.g. systematics, genetics, and paleontology, (3) to foster certain research styles within evolutionary studies, and (4) to emphasize certain solutions to prominent research questions. Throughout, Mayr interjected his priorities, tactics and energy. (shrink)

With “The Zadeh Scenario,” Finder offers us a gift…a rich and thoughtful first-person account of the gradual unfolding of a specific ethics consultation conducted by a specific ethics consultant in a specific context. This is not your average case report, stripped to the bare facts and devoid of the ambiguity of real-time human interactions. It’s also not simply an example of thick description, offering the reader a detailed account of the context out of which an abstract ethical dilemma has (...) emerged, with the ethics consultant describing all from a distance, above the fray. What Finder offers and models for us instead is something entirely new and different. He offers us a case narrative into which he has chosen to place himself squarely and explicitly. And in the spirit of “peer review” he has generously revealed his own inner dialogue in response to twists and turns in the case, sharing his personal reflections as events unfolded, and his musings about various actions he took and choices he made in his role. By inviting us to ponder his story about the story of the case, he generously extends a gift to us: the opportunity to reflect on his—and therefore our own—consultation practice, and the opportunity to try a new kind of peer review. (shrink)

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. (...) The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties’ respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place. (shrink)

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for dialogue and (...) the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies. (shrink)

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- whether ethics consultation is best done by individuals, teams, or committees (...) how an ethics consult service should be structured the need for institutional support and techniques and programs for educating and training staff -- without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics. (shrink)

Over the past few decades, Indigenous communities have successfully campaigned for greater inclusion in decision-making processes that directly affect their lands and livelihoods. As a result, two important participatory rights for Indigenous peoples have now been widely recognized: the right to consultation and the right to free, prior and informed consent (FPIC). Although these participatory rights are meant to empower the speech of these communities—to give them a proper say in the decisions that most affect them—we argue that the way (...) these rights have been implemented and interpreted sometimes has the opposite effect, of denying them a say or ‘silencing’ them. In support of this conclusion we draw on feminist speech act theory to identify practices of locutionary, illocutionary, and perlocutionary group silencing that arise in the context of consultation with Indigenous communities. (shrink)

ABSTRACTDo physicians have a duty to sustain the pregnancies of women who die during the first or second trimester? Physicians cannot simply assume that the woman would have wished the pregnancy to continue, nor is it clear that the state has any interest in fetal life before viability. The conditions for beneficence‐based duties of fetal rescue will often be unmet, both because sustaining the pregnancy is not always a clear gain to the born child and because it may impose a (...) substantial burden on the benefactor. And duties of special relationship cannot readily be applied in these cases, as it is difficult to see how the relationship between someone who no longer exists and someone who does not yet exist can breed special duties. Further, to draw on Marx's distinction between the architect, who builds purposefully, and the bee, who cannot help what she is doing, I argue that human pregnancy is in a number of respects purposeful, creative, and deliberate, and that postmortem pregnancy, which follows the model of the bee, is a destructive icon that undercuts women's agency. (shrink)

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