Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back (...) pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

Summary Sexual communication in most species of fireflies is a male±female dialogue of precisely timed flashes of bioluminescent light. The biochemical reactions underlying firefly bioluminescence have been known for 30 years and are now exploited in biomedical assays and other commercial applications. Several aspects of flash regulation are also understood: flash rhythm is controlled by a central pattern generator, and individual flashes are neurally triggered, with octopamine serving as the transmitter. The molecular oxygen needed by the biochemical reactants is (...) delivered by a network of tracheal arborizations extending throughout the light organ (lantern).However, the actual means by which oxygen quickly reaches the reactants packaged within specialized photocytes and the specific event(s) triggered by neural action have not been identified; termination of axons away from the photocytes has exacerbated the latter problem. A recent paper(1) by a consortium of cell and evolutionary biologists, however, reports that nitric oxide (NO), manufactured and released in response to neuronal discharge, is the missing link by which neural action in the firefly lantern yields a sudden flash of light. BioEssays 23:992±995, 2001. ß 2001 John Wiley & Sons, Inc. (shrink)

Surgical Informed Consent has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients’ understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries. A hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized Hospital (...) in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon’s standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures. Forty percent of respondents were aged between 25 and 29 years. Nearly a quarter had no formal education. More than half of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used and related complications. Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators. There is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs. (shrink)

Background Clinical ethics consultants are expected to “reduce disparities, discrimination, and inequities when providing consultations,” but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them. Methods The study was (...) a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9. Results Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were strongly correlated with the intervals between admission to the hospital and request for an ethics consultation. Conclusion Our findings suggest race and gender disparities in the timing of ethics consultations that consultants may have partially mitigated. (shrink)

The efforts to prove God's existence in the history of thought have been one of the fundamental problems of philosophy and theology, and even the most important one. The evidences put furword to prove the existence of God constitute the center of philosophy of religion’s problems not only philosophy of religion, but also the disciplines such as theology-kalam and Islamic philosophy are also seriously concerned. When we look at the history of philosophy, it is clear that almost all philosophers are (...) interested in the evidence in favour of and against the existence of God. Especially in recent times, religious experience has often been regarded as evidence of the existence of God. Studies in the field of religious and mystical experience have put forward many arguments concerning the use of religious experience as evidence. However, this study has been limited to experience of sense and pure consciousness claims rather than examining all of these arguments. In this study firstly, the analogy between experience of sense and religious experience will be deal with, and then claims that conciousness can be emptied by a number of methods which are defended by mystics. In addition, it will be tried to defend the opinion that the mystical experiences which are the common point of the two approaches are valid. The main emphasis of the article will be that these arguments can be used as evidence for the existence of God.Summary: Religious experience - which has not been considered as one of the classical evidences regarding the existence of God before being popular by recent studies – is started to be called one of the arguments. The most important reason for not arguing religious experience among the evidences of God’s existence is that it is a personal experience and therefore contains subjective perspectives. However, many researchers, who refuse to accept the criticism raised against religious experience with restricting to subjectivity, emphasized the importance of religious experience by highlighting the objective aspects of such experiences. This emphasis was not only on its significance, but also on the fact that it had a cognitive feature and thus it could provide evidence for the existence of God. The argument of religious experience is generally defined as an effort for demonstrating to existence of God with reference to several feelings such as spiritual experiences of human in face of creator and sacred Being, encounter with God, uniting, and annihilating selfness in Him. The emergence of such efforts, especially after the XVIIIth century, indicates that the history of the evidence does not go back much earlier. However, even if notas evidence, it is possible to extend the traces of religious and mystical experience to the history of religions such as Buddhism and Hinduism. Considering a great amount of the previous literature focused on religious experience in the West, It is easily seen that such research is still new. The main purpose in addressing such a controversial issue is to make the argument on the religious experience more current and to show whether the religious experience would be able to use as evidence for the existence of God.First title of this study comprises many different claims such as Walter T. Stace’s The Argument from Unanimity Richard Swinburne’s The Principle of Credulity, William P. Alston’s Perceiving God, John Hick’s Experience-as. However, instead of briefly giving out very different claims, the study chooses to focus on two arguments which are less discussed and can be given in more detail. The first is the argument based on the analogy between the religious experience and the sense experience. The fundamental point of this argument is sense experience. With reference to the similarities between the sense experience and the religious experience, it can be argued that religious experience is also cognitive and may function as an evidence for the existence of God. In other words, being perceptual and noetic, namely cognitive, of sense experience is addressed as a similar side of religious experience. Whether it is imaginary or real, eventually, it is necessary for an experience to have an object and being experience of something. Therefore, the religious experience includes the perception of a Transcendent Being that is beyond and in excess of the individual who experiences. Perception of the sense experience will definitely be different from the perception of religious experience. Researchers who think that the five sense organs do not run the perception of Sacred Beings, identified broader and various meanings for the perception. Thereby, in this approach, where the semantic field of perception is expanded, it was contended that human beings were able to perceive the transcendent, eternal, and unlimited God, and this can be explained in the epistemological sense. In order to use religious experiences as an evidence for the existence of God, it is necessary to determine whether such experiences are caused by God rather than something else. This raises the issue of the validity of religious experience. The researchers in this area have propounded various criteria to identify whether religious experience is existed or not. Experiences, which do not meet the criteria, are not considered existed even if they claim to be religious experience.The second is the argument that discusses whether it is possible to suggest an evidence for the existence of God by utilizing pure consciousness events. In general, this argument claims that the consciousness gets clear, and thus, mystic or Sufi experiences the Divine One with pure consciousness by discharging consciousness from all sensual contents and removing it from secular desire and wishes. The argument, which claims the experience of Divine One is direct, therefore uninterpretable, and experienced by pure consciousness, believes clearing the consciousness of mystics from sensual qualities such as seeing, hearing, and tasting. It is stated that it is possible for mystics to empty their sensory images and get rid of them, and thus, their desires and wishes could be lost. Especially, the thinkers who are connected with the philosophy of perennialism and defend this approach, thought that people, who have distinct religion, culture, and beliefs in different parts of the world and in various time periods, had the same experience and considered such experiences were universal by suggesting that this similarity could be called as common essence.Even though the claim which offers that the events of pure consciousness are the same everywhere have been criticized in many respects, the advocates of this approach have argued that the experience has the common essence, but the interpretation is different. This relationship, which was tried to be established between experience and commentary, caused a lot of work for both the thinkers who put forward the claims of pure consciousness and the researchers who opposed it. However, examining the relationship between experience and interpretation requires serious studies in socio-psychological, cultural and religious fields. Therefore, in order not to exceed the limits of the article, the relationship between experience and interpretation is briefly mentioned.While discussing two arguments, the main claims of the arguments were addressed, and the criticisms directed to this argument were not discussed as much as possible. However, some fundamental criticisms have been mentioned shortly for a better understanding of the discussion. Since such western-oriented claims mostly were deployed in a western context, the study excluded the comparison of the claims across different cultures. (shrink)

Pathological tremor is a common but highly complex movement disorder, affecting ~5% of population older than 65 years. Different methodologies have been proposed for its quantification. Nevertheless, the discrimination between Parkinson’s disease tremor and essential tremor remains a daunting clinical challenge, greatly impacting patient treatment and basic research. Here, we propose and compare several movement-based and electromyography-based tremor quantification metrics. For the latter, we identified individual motor unit discharge patterns from high-density surface electromyograms and characterized the neural drive to (...) a single muscle and how it relates to other affected muscles in 27 Parkinson’s disease and 27 essential tremor patients. We also computed several metrics from the literature. The most discriminative metrics were the symmetry of the neural drive to muscles, motor unit synchronization, and the mean log power of the tremor harmonics in movement recordings. Noteworthily, the first two most discriminative metrics were proposed in this study. We then used decision tree modelling to find the most discriminative combinations of individual metrics, which increased the accuracy of tremor type discrimination to 94%. In summary, the proposed neural drive-based metrics were the most accurate at discriminating and characterizing the two most common pathological tremor types. (shrink)

Background It has been suggested that researchers are obliged to offer summary findings to research participants to demonstrate respect for persons, and that this may increase public trust in, and awareness of, the research enterprise. Yet little research explores researchers' attitudes and practices regarding the range of initiatives that might serve these ends. Methods Results of an international survey of 785 eligible authors of genetics research studies in autism or cystic fibrosis are reported. Results Of 343 researchers who completed (...) the survey (44% response rate), the majority agreed that their team should (i) inform participants of summary findings (90.7%) and (ii) ensure they gain an awareness of developments in the field (86.9%). Additionally, the majority reported that in practice, their team (i) informs participants of summary findings (69.4%) and (ii) provides other types of relevant non-results information (eg, state of science in the field, opportunities for research participation) (67.9%). Conclusion Researchers endorsed the obligation of communicating with research participants by providing summary findings and other research-related information in equal measure. In light of these findings, it is suggested that while the provision of summary results may contribute to efforts to discharge the obligation of respect for persons, it may be neither a necessary nor a sufficient means to this end. (shrink)

Preterm discharge effects: Relationship between the maternal experience and newborn's psychobiological regulation The purpose of this study is to investigate how the past experiences of mothers and their potentially traumatic events during pregnancy may have influenced the processes of psychobiological self-regulation and cognitive development in a child born preterm. Eighty children who had a gestational age of < 32 weeks were examined at the 9th month of the corrected age. The mothers and children were divided in two groups: multipara (...) mothers and their children and the primipara mothers and their children. These children were examined on the basis of sleep disorders, nutritional problems and mental development. Perinatal data from clinical observations and data from standardized developmental tests were used to describe the differences. The children of primipara mothers who had unexpected preterm delivery presented major incidences of sleep disorders while the children of primipara mothers, who programmed preterm delivery, presented a major incidences of nutrition problems. The predictability of preterm delivery has a major influence on the capacity of newborns for self-regulation in the case of primipara mothers. (shrink)

Discharging a homeless patient from hospital raises ethical issues which are compounded when the patient is from outside the United Kingdom. This article begins with an extended case study of a 30-year-old homeless man from Lithuania describing his complex medical and social needs. It is best practice for all homeless patients to have their housing needs planned for prior to discharge, but this is made more difficult by the United Kingdom’s ‘hostile environment’ policy which creates a subclass of homeless (...) people who are not eligible for support. This means healthcare professionals discharge patients back to homelessness, even when this is likely to adversely affect their health and dignity both directly and indirectly through impairing access to care for chronic conditions. Policies in health and social care which compel professionals to treat some patients with second-class care undermine the ethics of healthcare professions. (shrink)

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of (...) their patients who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

Mrs. Smith's eyes filled with tears as she said, “I feel like I've done something wrong. Are they punishing me because I've been refusing therapy and won't go to a nursing home?” She acknowledged that she hadn't always listened to her doctors but said that she knew better now and wanted to go home and see if she could make it work. Many staff members at our rehabilitation hospital had explained their safety concerns to her, and some had enlisted her (...) adult daughter, with whom she lived, to convince her too. The rehabilitation team had called on the ethics consultation service, of which I am a part, to help figure out whether Mrs. Smith had the capacity to make an informed refusal of discharge recommendations. (shrink)

In this article we wonder how a person can discharge the political responsibility for supporting and benefiting from unjust social structures. Firstly, we introduce the concept of structural injustice and defend it against three possible objections: ‘explanatory nationalism’, a diachronic interpretation of the benefits of industry-led growth, being part of a social structure does not automatically mean being responsible for its negative consequences. Then, we hold that both Iris Marion Young’s ‘social connection model’ and Robin Zheng’s ‘role-ideal model’ provide (...) clear indications on how to unload responsibility for supporting/participating in unjust social structures, but fail to explain how to get rid of responsibility for unjust enrichment. We maintain that both models should be complemented with a global redistributive scheme that allows to disgorge the benefits that are unfairly obtained in the global economic system, besides undertaking collective transformative actions and assuming ideal-role responsibilities. (shrink)

A growing number of discharges at acute-care hospitals involve patients who are undocumented and lack legal status. Because such patients are ineligible for public assistance, long-term care facilities will routinely deny them admission. These discharges become complex discharges because of such financial barriers. If local family support is unavailable, discharging such patients to a safe and suitable location becomes increasingly difficult. These complex discharges implicate a number of ethical principles. We describe such complex discharge cases, apply various ethical frameworks, (...) and call for potential policy solutions to address this growing ethical concern. (shrink)

During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social (...) worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence. (shrink)

Elements of Mind (EM) has two themes, one major and one minor. The major theme is intentionality, the mind’s direction upon its objects; the other is the mind–body problem. I treat these themes separately: chapters 1, and 3–5 are concerned with intentionality, while chapter 2 is about the mind–body problem. In this summary I will first describe my view of the mind–body problem, and then describe the book’s main theme. Like many philosophers, I see the mind–body problem as containing (...) two sub–problems: the problem of mental causation and the problem of consciousness. I see these problems forming the two horns of a dilemma. Just as the problem of mental causation pushes us towards physicalism, so the problem of consciousness pushes us away from it. Each problem reveals the inadequacy of the solution to the other. Essentially the problem of mental causation is the conflict between (i) the apparent fact that mental states and events have effects in the physical world and (ii) a general principle about the causal nature of the physical world, which is sometimes called the ‘causal closure’ or the ‘causal completeness’ of the physical world. This principle says that all physical effects have physical causes which are enough to bring them about. The problem then is simple: how can a mental cause have a physical effect if that effect also has a physical cause which is enough to bring it about? Barring massive overdetermination of our actions by independent causes, it seems that the best answer is to identify the mental and the physical causes. And this is traditionally how physicalists have argued for their identity theory of mind and body. However, many physicalists reject the identity theory, and therefore they have to solve the mental causation problem in some other way. At present, there is no consensus among physicalists on which of the currently proposed solutions is correct. In chapter 2 of EM I propose an alternative, which I call ‘emergentism’. Inspired by the rejection of the identity theory, Emergentism is the idea that mental properties are genu.. (shrink)

This is a summary of “Toward a Global Media Ethics: Theoretical Perspectives,” which appeared in Ecquid Novi: African Journalism Studies , 29(2), 2008, 135-172. The article was written by Clifford G. Christians, University of Illinois at Urbana-Champaign; Shakuntala Rao, State University of New York-Plattsburgh; Stephen J. A. Ward, University of Wisconsin-Madison; and Herman Wasserman, University of Sheffield. It was the result of a workshop on global media ethics by the article's authors hosted by the Stellenbosch Institute for Advanced Study (...) (STIAS) at the University of Stellenbosch, South Africa. The authors brought to the discussion the different perspectives of contractualism, communitarianism, and critical theory. The intention of the summary is to the draw the attention of scholars and ethicists outside the readership of Ecquid Novi to this leading-edge theoretical work. It is hoped the summary will stimulate comment and further work in global media ethics. The summary is not intended to replace the original article. Readers should consult the original for the full argument. (shrink)

Pratt, Zion, and Loff (2012) correctly point out that most international clinical research (ICR) is not intended to address the vast inequities in access to health care between developed and develo...

Making Things Up By BennettKarenOxford University Press, 2018. xii + 260 pp.

Summary of my book, Writing the Book of the World, for a symposium. The book defends realism about structure, the view that there is a privileged way to describe the world.

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the (...) perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care. (shrink)

Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients’ readiness can conflict with perceptions of what readiness means (...) for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families. (shrink)

In February 2016 a twelve-month-old asylum seeker, who came to be know as Baby Asha, was transferred from Nauru and hospitalized in Brisbane. This case came to public attention after Doctors refused to discharge Asha as she would have been returned to detention on Nauru. What in other circumstances would have been considered routine clinical care, quickly turned into an act of civil disobedience. This paper will discuss the ethical aspects of this case, along with its implications for clinicians (...) and the broader healthcare community. (shrink)

‘Terminal discharges’ are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It (...) is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world. (shrink)

Discharge planning for vulnerable infants and children is a collaborative, inter-disciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process (...) may be concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations. (shrink)

In this summary I introduce the interpretive framework for Hegel's Conscience and then provide an overview of the book’s six chapters.

How do we respond to the patient who no longer needs inpatient care but refuses to leave the hospital? Complex hospital discharges commonly involve consideration of legal, financial, clinical, and practical issues. Yet, the ethical and contextual issues embedded in complex inpatient discharges are of concern and have not received adequate attention by medical ethicists. The aim of this work is to encourage clinicians and administrators to incorporate a justice rubric when approaching inpatient discharge dilemmas. This paper presents justice (...) as the ethical principle most neglected in situations involving complex discharges and suggests that a justice focused lens allows clinicians and administrators to move beyond notions of patient autonomy in crafting morally responsible hospital discharge decisions that reflect efficient stewardship of an appropriate share of medically indicated services. This issue deserves additional attention from medical ethicists in the future. (shrink)

In response to a competitive environment, hospital administrators are pressuring physicians to discharge Medicare patients “sicker and quicker” and to transfer indigent patients from their emergency rooms. This paper compares health administrators' ethics to public expectations regarding financially motivated hospital transfers and discharges. Health administrators use balancing strategies: code morality, survivalism, mission dependency, and tithing. Public expectations, exemplified in P.L. 99–272, P.L. 99–509, and recent case law, are based on norms of potential for patient harm and patient occupancy. These (...) norms are morally preferable to those of health administrators; they reinforce the value of identified lives and the reliability of the health care system. (shrink)

The hypothesis of group selection fell victim to a seemingly devastating critique in 1960s evolutionary biology. In Unto Others (1998), we argue to the contrary, that group selection is a conceptually coherent and empirically well documented cause of evolution. We suggest, in addition, that it has been especially important in human evolution. In the second part of Unto Others, we consider the issue of psychological egoism and altruism -- do human beings have ultimate motives concerning the well-being of others? We (...) argue that previous psychological and philosophical work on this question has been inconclusive. We propose an evolutionary argument for the claim that human beings have altruistic ultimate motives. (shrink)