Clinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot‐test approaches to train, credential, privilege, and evaluate consultants.

In “Surmounting Elusive Barriers: The Case for Bioethics Mediation,” Bergman argues that professionals trained in bioethics, reluctant to acquire the skills of mediation, would better be replaced by a cadre of mediators with some bioethics knowledge, to which I respond, “yes . . . but.”.

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

At a time when even a brief hospital stay means becoming terrifyingly dependent on the kindness of strangers, this compassionate and practical book by a prominent medical ethicist gives power back to patients while providing invaluable guidance to their friends and families. "A cutting-edge book about cutting-edge issues (that) every American must know. . . ".--Alan Dershowitz.

The use of logico-semiotic and systems-structural approaches in the analysis of types of abstraction and forms of generalization of concepts was begun in the '50s and '60s by D. P. Gorskii, who at that time introduced the concept of idealization into the terminology. In the early '70s he continued his analysis of the problem of scientific understanding, delineating the specific features of definitions in the theories of natural sciences and in the social science disciplines. In the book under review, Gorskii (...) in a certain sense sums up his results and develops them further. (shrink)

This paper is devoted to computer modelling of the development and regeneration of multicellular biological structures. Some species are able to regenerate parts of their body after amputation damage, but the global rules governing cooperative cell behaviour during morphogenesis are not known. Here, we consider a simplified model organism, which consists of tissues formed around special cells that can be interpreted as stem cells. We assume that stem cells communicate with each other by a set of signals, and that the (...) values of these signals depend on the distance between cells. Thus the signal distribution characterizes location of stem cells. If the signal distribution is changed, then the difference between the initial and the current signal distribution affects the behaviour of stem cells—e.g. as a result of an amputation of a part of tissue the signal distribution changes which stimulates stem cells to migrate to new locations, appropriate for regeneration of the proper pattern. Moreover, as stem cells divide and form tissues around them, they control the form and the size of regenerating tissues. This two-level organization of the model organism, with global regulation of stem cells and local regulation of tissues, allows its reproducible development and regeneration. (shrink)

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the “QI tool”, to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work. Although the process was marked by resistance and disagreement, it (...) was also noteworthy for the sustained engagement by participants over the year of the project, and a high level of acceptance by its conclusion. (shrink)

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the QI tool , to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work. Although the process was marked by resistance and disagreement, (...) it was also noteworthy for the sustained engagement by participants over the year of the project, and a high level of acceptance by its conclusion. (shrink)

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a ninestep algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased initiatives conducted (...) in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment. (shrink)

Presented alongside these seminal essays are aphoristic fragments from Simmel’s last journal, providing a beguiling look into the mind of one of the twentieth century’s greatest thinkers.

In his final work, Donald N. Levine, one of the great late-twentieth-century sociological theorists, brings together diverse social thinkers. Simmel, Weber, Durkheim, Parsons, and Merton are set into a dialogue with philosophers such as Hobbes, Smith, Montesquieu, Comte, Kant, and Hegel and pragmatists such as Peirce, James, Dewey, and McKeon to describe and analyze dialogical social theory. This volume is one of Levine's most important contributions to social theory and a worthy summation of his life's work. Levine (...) demonstrates that approaching social theory with a cooperative, peaceful dialogue is a superior tactic in theorizing about society. He illustrates the advantages of the dialogical model with case studies drawn from the French Philosophes, the Russian Intelligentsia, Freudian psychology, Ushiba's aikido, and Levine's own ethnographic work in Ethiopia. Incorporating themes that run through his lifetime's work, such as conflict resolution, ambiguity, and varying forms of social knowledge, Levine suggests that while dialogue is an important basis for sociological theorizing, it still vies with more combative forms of discourse that lend themselves to controversy rather than cooperation, often giving theory a sense of standing still as the world moves forward. The book was nearly finished when Levine died in April 2015, but it has been brought to thoughtful and thought-provoking completion by his friend and colleague Howard G. Schneiderman. This volume will be of great interest to students and teachers of social theory and philosophy. (shrink)

Published in 1918, _The View of Life_ is Georg Simmel’s final work. Famously deemed “the brightest man in Europe” by George Santayana, Simmel addressed a variety of topics across his essayistic writings, which have influenced scholars in aesthetics, ethics, epistemology, and sociology. Nevertheless, a set of core issues emerged over the course of his career, most centrally the genesis, structure, and transcendence of social and cultural forms and the nature and genesis of authentic individuality. Composed in the years before his (...) death, _The View of Life_ was, according to Simmel, his “testament,” a capstone work of profound metaphysical inquiry intended to formulate his conception of life in its entirety. Now Anglophone readers can at last read in full the work that shaped the argument of Heidegger’s _Being and Time_ and whose extraordinary impact on European intellectual life between the wars was extolled by Jürgen Habermas. Presented alongside these seminal essays are aphoristic fragments from Simmel’s last journal, providing a beguiling look into the mind of one of the twentieth century’s greatest thinkers. (shrink)

Contrary to common perceptions of Simmel’s work as dividing into three stages of Darwinism, Kantianism, and Goethean/Bergsonian Life-Philosophy, consideration of the full scope of the Georg Simmel Gesamtausgabe demonstrates Simmel’s concern with both Kant and Goethe as life-long, just as was his engagement with core principles respectively associated with them: Form and Life. What changed in his mind over time was how those two principles were construed and related. In this view, Simmel’s Soziologie can be read as a treatise on (...) the properties of social forms that emerge out of vital processes – following a dynamic akin to Blumenbach’s Bildungstrieb, whereas the Lebensanschauung puts more emphasis on the ways in which forms channel, constrain, and inspire the streams of life. This opens the door for creative work pursuing lines of connection between the two disciplines – a sociology of authentic individuality and a kind of existentialized sociology – and, beyond that, to a unified theory of action and evolution. (shrink)

Although Parsons encountered the works of both Simmel and Weber during his stay at Heidelberg in the late 1920s, his appropriation of the two became increasingly asymmetrical, issuing in a lifelong devotion to Weber and a pronounced disavowal of Simmel around the time Parsons published The Structure of Social Action. This reaction deprived Parsons of the substantial support he could have found in Simmel's work for his effort to counteract `utilitarian' theories of action. Simmel not only went beyond Parsons in (...) revealing a number of perspectives that demonstrate the permeation of action by moral orientations, but he counteracted economistic thinking along a number of other dimensions. These include: showing the limits of cost-benefit calculations in social exchange; presenting strong theoretical arguments against the assumption of hedonism; presenting strong theoretical arguments against the assumption of egoism. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

In many spheres, the law takes the legal concept of causation to correspond to the folk concept (the correspondence assumption). Courts, including the US Supreme Court, tend to insist on the "common understanding" and that which is "natural to say" (Burrage v. United States) when it comes to expressions relating to causation, and frequently refuse to clarify the expression to juries. As recent work in psychology and experimental philosophy has uncovered, lay attributions of causation are susceptible to a great number (...) of unexpected factors, some of which seem rather peripheral to causation. One of those is the norm effect (Knobe & Fraser, 2008): Agents who, in acting as they do, break a salient norm, are more likely to be considered as having caused a certain consequence than when they do not violate a norm. According to some (e.g., Alicke, 1992) this constitutes a bias. According to others (e.g., Sytsma, 2020), the folk concept of causation is sensitive to normative factors, and there’s nothing wrong with that. In this paper, we explore the question whether the norm effect should be considered a bias from the legal perspective on the one hand, and from the psychological perspective on the other. To do this, we test whether norms which are nonpertinent to the consequences or outright silly also impact causation judgements. The data from two preregistered experiments (total N=593) clearly show they do. This, we argue, makes the bias interpretation plausible from the psychological perspective, and both plausible and problematic from the legal perspective. It also shows that the law should abstain from unreflectively assuming conceptual correspondence between legal and ordinary language concepts. (shrink)

Extant research has shown that ordinary causal judgments are sensitive to normative factors. For instance, agents who violate a norm are standardly deemed more causal than norm-conforming agents in identical situations. In this paper, we explore two competing explanations for the Norm Effect: the Responsibility View and the Bias View. According to the former, the Norm Effect arises because ordinary causal judgment is intimately intertwined with moral responsibility. According to the alternative view, the Norm Effect is the result of a (...) blame-driven bias. In a series of five preregistered experiments (N = 2688), we present evidence that predominantly favours the Bias View. In particular, and against predictions made by the Responsibility View, we show that participants deem agents who violate nonpertinent or silly norms – norms that do not relate to the outcome at hand – as more causal, and that this effect cannot be explained in terms of plausible mediators such as the agent’s foreknowledge and desire, or the foreseeability of harm. We close with a discussion regarding the implications of these findings, in as regards the just assessment of proximate cause in the law. (shrink)

A growing body of literature has revealed ordinary causal judgement to be sensitive to normative factors, such that a norm-violating agent is regarded more causal than their non-norm-violating counterpart. In this paper, we explore two competing explanations for this phenomenon: the Responsibility View and the Bias View. The Bias View, but not the Responsibility View, predicts features peripheral to the agent’s responsibility to impact causal attributions. In a series of three preregistered experiments (N = 1162), we present new evidence that (...) the Norm Effect arises from such peripheral features, namely from nonpertinent or entirely silly norm violations. Furthermore, we show that this effect cannot be explained by recourse to the agent’s foreknowledge or desire of the outcome, nor by its foreseeability: the Norm Effect arises even when participants judge the norm-violating agent’s doing as equally foreseeable. This, we argue, provides evidence in favour of the Bias View. (shrink)

This book taps the best American thinkers to answer the essential American question: How do we sustain our experiment in government of, by, and for the people? Authored by an extraordinary and politically diverse roster of public officials, scholars, and educators, these chapters describe our nation's civic education problem, assess its causes, offer an agenda for reform, and explain the high stakes at risk if we fail.