Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

In Bester’s article (2018) challenging the use of the harm principle and advocating sole reliance on the use of a best interest standard (BIS) in pediatric decision-making, we believe that the auth...

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

Decisions regarding life-sustaining medical treatments for young children with profound disabilities can be extremely challenging for families and clinicians. In this study, Brick and colleagues1 surveyed adult residents of the UK about their attitudes regarding withdrawal of treatment using a series of vignettes of infants with varying levels of intellectual and physical disability, based on real and hypothetical cases.1 This is an interesting study on an important topic. We first highlight the limitations of using these survey data to inform public (...) policy and then offer a different interpretation from the authors’ regarding their findings about the value the public appears to place on relational capacity. The authors asked members of the lay public to interpret a disabled child’s best interest in a series of vignettes. The respondents were 92% white; 59% were atheist or reported no religious affiliation. Though the authors note this lack of diversity as a limitation, we would add that this limitation is particularly problematic in this context. Minority views on this issue may differ significantly from the majority perspective. When the stakes are high, use of public opinion data to directly inform policy requires, at a minimum, a representative sample reflecting both the true diversity of views within the public and a method to justly account for the alternate views of the minority. Even if the sampled population were more …. (shrink)

This paper provides a brief overview and critique of the dominant objectivist understanding and use of illness narrative in Enlightenment (scientific) medicine and ethics, as well as several revisionist accounts, which reflect the evolution of this approach. In light of certain limitations and difficulties endemic in the objectivist understanding of illness narrative, an alternative phronesis approach to medical ethics influenced by Charles Taylor’s account of the interpretive nature of human agency and language is examined. To this end, the account of (...) interpretive medical responsibility previously described by Schultz and Carnevale as "clinical phronesis" (based upon Taylor’s notion of "strong" or "radical evaluation") is reviewed and expanded. The thesis of this paper is that illness narrative has the ability to benefit patients as well as the potential to cause harm or iatrogenic effects. This benefit or harm is contingent upon how the story is told and understood. Consequently, these tales are not simply "nice stories," cathartic gestures, or mere supplements to scientific procedures and decision making, as suggested by the objectivist approach. Rather, they open the agent to meanings that provide a context for explanation and evaluation of illness episodes and therapeutic activities. This understanding provides indicators (guides) for right action. Hence, medical responsibility as clinical phronesis involves, first, the patient and provider’s coformulation and cointerpretation of what is going on in the patient’s illness narrative, and second, the patient and provider’s response to interpretation of the facts of illness and what they signify–not simply a response to the brute facts of illness, alone. The appeal to medical responsibility as clinical phronesis thus underscores the importance of getting the patient’s story of illness right. It is anticipated that further elaboration concerning the idea of clinical phronesis as interpretive illness narrative will provide a new foundation for medical ethics and decision making. (shrink)

This is an introduction to, and survey of, the constructive approaches to pure mathematics. The authors emphasise the viewpoint of Errett Bishop's school, but intuitionism. Russian constructivism and recursive analysis are also treated, with comparisons between the various approaches included where appropriate. Constructive mathematics is now enjoying a revival, with interest from not only logicans but also category theorists, recursive function theorists and theoretical computer scientists. This account for non-specialists in these and other disciplines.

In this bold, challenging book, D. S. Clarke outlines reasons for accepting panpsychism and defends the doctrine against its critics.

An anthology of readings in panpsychism, spanning two millennia.

Originally published in 1986. Both moral philosophers and philosophical psychologists need to answer the question ‘what is a virtue?’ and the best answer so far give is that of Aristotle. This book is a rigorous exposition of that answer. The elements of Aristotle’s doctrine of virtue are scattered throughout his writings; this book reconstructs his complex and comprehensive doctrine in one place. It also covers Aristotle’s views about choice, character, emotions and the role of pleasure and pain in virtue. The (...) celebrated function is considered carefully as well as the doctrine of virtue being related to Aristotle’s metaphysics and categories. (shrink)

Preimplantation genetic diagnosis (PID) is often seen as an improvement upon prenatal testing. I argue that PID may exacerbate the eugenic features of prenatal testing and make possible an expanded form of free-market eugenics. The current practice of prenatal testing is eugenic in that its aim is to reduce the numbers of people with genetic disorders. Due to social pressures and eugenic attitudes held by clinical geneticists in most countries, it results in eugenic outcomes even though no state coercion is (...) involved. I argue that technological advances may soon make PID widely accessible. Because abortion is not involved, and multiple embryos are available, PID is radically more effective as a tool of genetic selection. It will also make possible selection on the basis of non-pathological characteristics, leading, potentially, to a full-blown free-market eugenics. For these reasons, I argue that PID should be strictly regulated. (shrink)

Nicholas Shackel (2011) has proposed a number of arguments to save the Dipert–Bird model of physical reality from the sorts of unpalatable consequence I identified in Oderberg 2011. Some consequences, he thinks, are only apparent; others are real but palatable. In neither case does he seem to me to have deflected the concerns I raised, leaving graph structuralism on Dipert–Bird lines as problematic as ever.

Within the increasingly complex picture which has emerged in recent years of the manuscript tradition of Ovid's Amores the relationship of the two earliest MSS appears to remain firm: cod. P or Puteaneus of the 9th or early 10th century, which begins at Am. 1.2.51, was copied, probably directly, from the second half of the 9th-century cod. R or Regius , whose first half now ends at Am. 1.2.50. This view, which originates in S. Tafel's dissertation of 1910 and lies (...) behind the stemma constructed by E. J. Kenney for his OCT edition of 1961 , has come to be taken by Ovidian scholars to be the truth. My purpose in this first section is to show that this idea is unlikely to be the truth and, in the form in which it has most strongly been put forward, cannot be the truth. In the second section consequences for the manuscript tradition as a whole are explored. First we shall need some details. P, the slightly later manuscript, consists in all of 99 folia, of which 1–54 contain most, but not all, of the Heroides — not all, because they are in a lacunose state, a point to which we shall return in greater detail later. Foll. 55–6 are blank sheets of paper, not parchment, clearly inserted at a much later date during rebinding. (shrink)

Within the increasingly complex picture which has emerged in recent years of the manuscript tradition of Ovid's Amores the relationship of the two earliest MSS appears to remain firm: cod. P or Puteaneus of the 9th or early 10th century, which begins at Am. 1.2.51, was copied, probably directly, from the second half of the 9th-century cod. R or Regius, whose first half now ends at Am. 1.2.50. This view, which originates in S. Tafel's dissertation of 1910 and lies behind (...) the stemma constructed by E. J. Kenney for his OCT edition of 1961, has come to be taken by Ovidian scholars to be the truth. My purpose in this first section is to show that this idea is unlikely to be the truth and, in the form in which it has most strongly been put forward, cannot be the truth. In the second section consequences for the manuscript tradition as a whole are explored. First we shall need some details. P, the slightly later manuscript, consists in all of 99 folia, of which 1–54 contain most, but not all, of the Heroides — not all, because they are in a lacunose state, a point to which we shall return in greater detail later. Foll. 55–6 are blank sheets of paper, not parchment, clearly inserted at a much later date during rebinding. (shrink)

Introduction What is the point of studying Aristotle's theory of moral virtue? In the first place, many interesting questions are raised, in metaphysics, ...

This article asserts that traditionally dominant models of health promotion in the US are fairly characterized by methodological individualism. This schema produces a focus on the individual as the node of intervention. Such emphasis results in a number of scientific and ethical problems. I identify three principal ethical deficiencies: first, the health promotions used are generally ineffective, which violates canons of distributive justice because scarce health resources are expended on interventions that are unlikely to produce health benefits. Second, the health (...) promotions used tend to expand health inequalities between the affluent and the least well-off. Third, the health promotions used are likely to intensify stigma against the least well-off, a deficiency that itself may exacerbate the ‘densely-woven patterns of disadvantage’ that characterize life on the tail of the social gradient. Because Powers and Faden’s health sufficiency model of social justice argues that the amelioration of such clusters of disadvantage should be the primary ethical goal of public health policy, methodologically individualist models of health promotion are ethically deficient and should not stand as primary approaches for health promotion in a just social order. (shrink)

Marking the 50th anniversary of one among this philosopher's most distinguished pieces, Blumenberg's Rhetoric proffers a decidedly dialogic and diversified interaction with the essay polyvalently entitled 'Anthropological Approach to the Actuality and Topicality (or Currency, Relevance) of Rhetoric' (Anthropologische Annäherung an die Aktualität der Rhetorik), first published in 1971. Following Blumenberg's lead, the contributors consider and tackle their topics rhetorically, 'in utramque partem vel in plures'--treating (inter alia) the variegated discourses of Phenomenology, the History of Philosophy, Anthropology, and the téchne (...) itself from a plurality of viewpoints. Quasi in actu--as a mise en abyme of this rhetorical method par excellence--said accent on approaching any matter polyperspectivally is reflected in the proceedings of the live(ly) discussions having taken place in preparation for the present volume. Along with the diachronically extensive, disciplinarily diverse essays, this publication of the actual academic interplay--notably in the current lingua franca--will facilitate, and is to conduce to, further scholarship with respect to Blumenberg and the art of rhetoric. (shrink)

Powers and Faden argue that social justice ‘is concerned with securing and maintaining the social conditions necessary for a sufficient level of well-being in all of its essential dimensions for everyone’ (2006: 50). Moreover, social justice is concerned with the ‘achievement of well-being, not the freedom or capability to achieve well-being’ (p. 40). Although Powers and Faden note that an agent alone cannot achieve well-being without the necessary social conditions of life (e.g. equal civil liberties and basic material resources, such (...) as food and shelter), it seems that achievement requires that an agent actually pursue the six dimensions of well-being. In this article, I question the extent to which an individual has an obligation to achieve well-being, even if he or she would choose to do otherwise. For example, can an agent choose to forgo being healthy even if all the social conditions are met in her life, thereby choosing to not achieve well-being? It remains unclear how the dimension of self-determination coheres with the remaining five dimensions of well-being and the extent of society’s obligations toward an individual’s achievement of well-being, even in those instances when society’s actions may go against an individual’s right to self-determination. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)