Myriad Genetics holds a patent on testing for the hereditary breast and ovarian cancer genes, BRCA1 and BRCA2, and therefore has a forced monopoly on this critical genetic test. Myriad launched a Direct-to-Consumer (DTC) marketing campaign in the Northeast United States in September 2007 and plans to expand that campaign to Florida and Texas in 2008. The ethics of Myriad's patent, forced monopoly and DTC campaign will be reviewed, as well as the impact of this situation on patient access and (...) care, physician liability, and the future of DTC campaigns for genetic testing. (shrink)

We are living at the dawn of the first truly scientific picture of the universe-as-a-whole, yet people are still dragging along prescientific ideas about God that cannot be true and are even meaningless in the universe we now know we live in. This makes it impossible to have a coherent big picture of the modern world that includes God. But we don't have to accept an impossible God or else no God. We can have a real God if we redefine (...) God in light of knowledge no one ever had before. The key question is, “Could anything actually exist in the scientific universe that is worthy of the name, God?” My answer is yes: God is an “emergent phenomenon,” as real as the global economy or the government or the worldwide web, which are all emergent phenomena. But God arose from something deeper: the complex interactions of all humanity's aspirations. An emerging God has enormous implications. (shrink)

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence‐based and theoretically informed competencies for this component of the nursing role and proposes how these might be incorporated into nursing curricula. This is necessary so that at the point of registration nurses have the expertise to realise their potential as both providers and organisers of patient care (...) and are better able to articulate and develop this aspect of nursing practice. (shrink)

Humans are experts in cooperating with each other when trying to accomplish tasks they cannot achieve alone. Recent studies of joint action have shown that when performing tasks together people strongly rely on the neurocognitive mechanisms that they also use when performing actions individually, that is, they predict the consequences of their co‐actor’s behavior through internal action simulation. Context‐sensitive action monitoring and action selection processes, however, are relatively underrated but crucial ingredients of joint action. In the present paper, we try (...) to correct the somewhat simplified view on joint action by reviewing recent studies of joint action simulation, monitoring, and selection while emphasizing the intricate interrelationships between these processes. We complement our review by defining the contours of a neurologically plausible computational framework of joint action. (shrink)

This study investigated the relationship between supervisor personality and subordinate reports of exposure to bullying and harassment at work. Three research questions were examined: Is there a direct relationship between supervisor personality and reports of workplace bullying? Is there an interaction between supervisor personality and supervisors’ perceived stress as predictors of workplace bullying? Will subordinates who experience bullying at their workplace rate their supervisor’s personality more negatively? The sample consisted of 207 supervisors and employees within 70 Norwegian restaurants. Supervisors low (...) on conscientiousness, high on neuroticism and portraying high levels of exposure to stress were the subject of significantly more reports from subordinates of exposure to workplace bullying. An interaction between agreeableness and stress was found showing that agreeableness is related to bullying under low levels of stress. In addition, subordinates who perceived their supervisor as being low on agreeableness and high on introversion reported significantly more workplace bullying, supporting a negative halo effect hypothesis. (shrink)

Although there is a significant amount of research on organizational citizenship behavior and its importance to individual and organizational outcomes, relatively little research has explored the process by which such behavior emerges and is established within an organization. Against this backdrop, we combine the perspectives offered by contextualist inquiry and actor–network theory to propose an integrative framework for investigating how organizational citizenship behavior develops in a large, heterogeneous organization. In order to illustrate the framework, we present a detailed case study (...) of recycling at a large university. Like many other organizations, the university does not have a formal organizational structure to address sustainability concerns and the initiatives are therefore mainly voluntary and emerging in nature, and outcomes are, as a consequence, highly uncertain, and fragile. We argue that contextualist inquiry in combination with actor–network theory provides new and important insights into the emergence and establishment of organizational citizenship behaviors, and that outcomes are contingent upon interactions between the context, process, and content of the behaviors in question and the related networks of human and non-human actors. (shrink)

In Brazil, every study involving human beings is required to produce an informed consent form that must be signed by study participants: this is stated in Resolution 196/96. 1 Consent must be obtained through a specific structured process. Objective: To present the opinions of women regarding how the process of obtaining informed consent should be conducted when women are invited to participate in studies on contraceptive methods. Subjects and Methods: Eight focus groups were conducted, involving a total of 51 women (...) living in the metropolitan region of Campinas. The women involved in the study were either participating in a clinical trial in the area of women's health or had participated in such a trial in the previous 12 months. A thematic guide was used to conduct the focus group discussions; the discussions were recorded, transcribed and a thematic analysis performed. Results: In general, the person who invites a woman to participate in a study should be a member of the research team but not the principal investigator. Information relating to the study should be given orally and in writing, both individually and in the group setting. Study volunteers should be informed about, among other things, the risks, possible side effects and discomforts, including long-term effects. The use of audiovisual aids to provide information was suggested. Conclusion: The process for obtaining informed consent was seen as a means of establishing a relationship between the volunteers and the investigator/research team. The information that the study participants expected to be given coincides with the requirements established under Resolution 196/96. The use of audiovisual aids would improve understanding of the information provided. (shrink)

Neuropalliative care developed to address the needs of patients living with life‐limiting neurologic disease. One critical consideration is that disease‐related changes to cognition, communication, and function challenge illness experiences and care practices. We conducted an ethnography to understand neuropalliative care as a phenomenon; how it was experienced, provided, conceptualized. Personhood served as our conceptual framework; with its long philosophical history and important place in nursing theory, we examined the extent to which it captured neuropalliative experiences and concerns. Personhood contextualized complex (...) losses, aligning the impact of functional and relational changes. Cognition, communication, and functional alterations stretched conceptions of personhood, insinuating it can be relational, fluid, adaptive. Although normative conceptions of personhood guided research and decision‐making, ethical considerations suggested personhood could be transformed, remade. We consider the implications of our findings through three themes. First, we examine how literature on illness experience fails to integrate the realities of people living with and dying from neurologic disease; we counter this by interrogating the concept of experience. Second, we turn to Ricoeur's work on recognition to illuminate relational conceptions of personhood to inform care practices. Finally, we reflect on how personhood can bridge the gap left by functional changes, enhance relational engagement, and promote dignity at the end of life. (shrink)

The comprehension of anaphoric relations may be guided not only by discourse, but also syntactic information. In the literature on online processing, however, the focus has been on audible pronouns and descriptions whose reference is resolved mainly on the former. This paper examines one relation that both lacks overt exponence, and relies almost exclusively on syntax for its resolution: adjunct control, or the dependency between the null subject of a non-finite adjunct and its antecedent in sentences such as Mickey talked (...) to Minnie before ___ eating. Using visual world eyetracking, we compare the time course of interpreting this null subject and overt pronouns (Mickey talked to Minnie before he ate). We show that when control structures are highly frequent, listeners are just as quick to resolve reference in either case. When control structures are less frequent, reference resolution based on structural information still occurs upon hearing the non-finite verb, but more slowly, especially when unaided by structural and referential predictions. This may be due to increased difficulty in recognizing that a referential dependency is necessary. These results indicate that in at least some contexts, referential expressions whose resolution depends on very different sources of information can be resolved approximately equally rapidly, and that the speed of interpretation is largely independent of whether or not the dependency is cued by an overt referring expression. (shrink)

Given the increasing use of technology and the growing blurring of the boundaries between the work and nonwork domains, decisions about when to interrupt work for family and vice versa can have critical implications for relationship satisfaction within dual-earner couples. Using a sample of 104 dual-earner couples wherein one of the partners is a member of the largest Italian smartphone-user community, this study examines how variation in boundary management permeability within dual-earner couples relates to partner relationship satisfaction, and whether the (...) effect differed by gender and partners’ agreement on caregiving roles in the family. Using actor–partner analysis, we examined the degree to which an individual and his or her partner’s level of family-interrupting work behaviors (FIWB, e.g., taking a call from the partner while at work) and work-interrupting family behaviors (WIFB, e.g., checking work emails during family dinner) was positively related to relationship satisfaction. Results show that women experienced greater relationship satisfaction than men when their partners engaged in higher levels of FIWB, and this relationship was stronger when partners had perceptual congruence on who is primarily responsible for caregiving arrangements in the family. This study advances research on dual-earner couples by showing the importance of examining boundary management permeability as a family social phenomenon capturing transforming gender roles. (shrink)

This article describes the ethical conflicts that a sample of US nurse utilization reviewers faced in their work, and also each nurse’s self-reported ethical orientation that was used to resolve the dilemmas. Data were collected from a sample of 97 registered nurses who were working at least 20 hours per week as utilization reviewers. Respondents were recruited from three managed care organizations that conduct utilization reviews in a large midwestern city. A cross-sectional survey design was used to collect demographic data (...) and to ask closed-response, short-answer and open-ended questions. Ethical conflicts reported by nurses were similar across utilization review settings and many were justice orientated. Self-reported ethical orientations were similar across organizations, with beneficence dominating. Implications of these findings are discussed. (shrink)

This article examines the Dobsonian Telescope as an object of material culture, showing how starting with the materiality of a scientific instrument opens up new perspectives that are lost by focusing purely on its instrumentality. It argues that the simple design and homely materials of the Dobsonian telescope, as well as the gestures that it requires from its users, are at the core of its significance to the popularization of amateur astronomy and amateur telescope making.

Philosophy became known as a “man’s” profession over the past three thousand years. This is an account of how, in the case of Diotima of Mantinea, the histories of philosophy came to systematically ignore, overlook, doubt and declare false the fact that some philosophers had uteruses. The effect has been a massive hysterectomy –the removal from or ignoring of women’s contributions to Philosophy as related by the major histories and encyclopedias of Philosophy. This nearly discipline-wide hysterectomy has created the false (...) impression that women cannot think philosophically. In this PowerPoint presentation I will present historical and archeological evidence relative to Diotima of Mantinea who may have been the first woman philosopher to receive a posthumous hysterectomy by later historians of philosophy. (shrink)

Professional, Ethical, Legal, and Educational Lessons in Medicine: A Problem Based Approach provides a comprehensive review of the complex and challenging field of professional medical practice. Its problem-based format incorporates a vast pool of practical, board-exam-style multiple-choice questions for self-assessment, and is an ideal resource for exam preparation as well as ongoing clinical education among trainees and clinicians The practice of medicine is not only about clinical care of patients. Physicians must navigate ethical conundrums, legal pitfalls, and quality improvement issues (...) while maintaining scrupulous professionalism and being exemplary educators. This volume addresses common issues in the realm of professional medical practice not typically covered in other texts. Each of the 73 chapters presents a problem-based case that branches out into an oral board examination type stem questions. A discussion section with brief review articles summarizes the most recent literature. Multiple-choice questions with answers allows for comprehensive self-assessment or interactive group quizzes. This book will appeal to medical and allied health professionals in all specialties of medicine. It is an excellent and hands-on reference for the related but diverse domains associated with professional healthcare practice by students, physicians, and other healthcare providers compacted into one volume. (shrink)

Ellen Meiksins Wood is a leading contemporary political theorist who has elaborated an innovative approach to the history of political thought, the social history of political theory .

Das vorliegende Open-Access-Buch zeigt, wie Kinder im Grundschulalter auf philosophische Gedanken reagieren. Diese werden den Kindern in Form von Kürzesttexten dargeboten. Auf Veranschaulichungen wird bewusst verzichtet. Dieser Zugang zum Philosophieren erscheint ungewöhnlich, wird doch in der Regel beim Philosophieren mit Kindern auf anschauliche Zugänge zurückgegriffen. Es zeigt sich jedoch, dass Kinder auf diese ungewöhnliche Einladung auf ebenso ungewöhnliche, eigenwillige und kreative Weise reagieren. Die vorliegende empirische Studie kommt mithin zu dem Ergebnis: Der Einsatz von Kürzesttexten erweist sich als lohnend. Die (...) Autorin Ellen Franziska Möller ist ausgebildete Lehrerin (Sek I und Sek II) für die Fächer Philosophie, praktische Philosophie und Physik. Zwischen 2019 und 2022 hat sie am Philosophischen Seminar der Universität zu Köln das Forschungsprojekt "Philosophie in der Primarstufe" vertreten. (shrink)

One of the hallmarks of virtue is reliably acting well. Such reliable success presupposes that an agent is able to recognize the morally salient features of a situation, and the appropriate response to those features and is motivated to act on this knowledge without internal conflict. Furthermore, it is often claimed that the virtuous person can do this in a spontaneous or intuitive manner. While these claims represent an ideal of what it is to have a virtue, it is less (...) clear how to make good on them. That is, how is it actually possible to spontaneously and reliably act well? In this paper, we will lay out a framework for understanding how it is that one could reliably act well in an intuitive manner. We will do this by developing the concept of an action schema, which draws on the philosophical and psychological literature on skill acquisition and self-regulation. In short, we will give an account of how self-regulation, grounded in skillful structures, can allow for the accurate intuitions and flexible expertise required for virtue. While our primary goal in this paper is to provide a positive theory of how virtuous intuitions might be accounted for, we also take ourselves to be raising the bar for what counts as an explanation of reliable and intuitive action in general. (shrink)

All Christians read the Bible differently, pray differently, value their traditions differently, and give different weight to individual and corporate judgment. These differences are the basis of conflict. The question Christian ethics must answer, then, is, "What does the good life look like in the context of conflict?" In this new introductory text, Ellen Ott Marshall uses the inevitable reality of difference to center and organize her exploration of the system of Christian morality. What can we learn from Jesus' (...) creative use of conflict in situations that were especially attuned to questions of power? What does the image of God look like when we are trying to recognize the divine image within those with whom we are in conflict? How can we better explore and understand the complicated work of reconciliation and justice? This innovative approach to Christian ethics will benefit a new generation of students who wish to engage the perennial questions of what constitutes a faithful Christian life and a just society. (shrink)

Pendant l’été 2012, les artistes Ellen Rothenberg et Délia Popa participèrent à un projet d’échange culturel avec une famille rom vivant dans une petite communauté agraire du comté de Sibiu, vieille région de Transylvanie. Le deuxième volet de ce projet comprenait une exposition des œuvres inspirées par cette expérience, dans les Galeries d’Art Contemporain du Musée National de Brukenthal, à l’automne 2013. Intitulée « Chelen Amenca (Danse avec nous) », cette exposition fut organisée par la c...

In this article, Ellen Bliss Talbot affirms the reality of both time and change in individual human lives, asserting that moral growth is possible because an individual is a unity in and through time.

This book examines puzzles about the arts wherever their provenance - as long as there is empirical research using the methods of social science that can shed light on these questions. The examined research reveals how ordinary people think about these questions, and why they think the way they do - an inquiry referred to as intuitive aesthetics. The book shows how psychological research on the arts has shed light on and often offered surprising answers to such questions.

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

Satirical news is often characterized as a hybrid genre that consists of three important communicative functions: it is (1) humoristic, (2) informative, and (3) evaluative. The Humoristic Metaphors in Satirical News (HMSN) typology demonstrates that metaphors can be utilized by satirists to express this hybridity by consisting of a combination of one or more of satire’s core communicative functions. Nevertheless, the underlying principles through which metaphors are capable of humorously explaining and/or criticizing current affairs are less clear. To broaden our (...) understanding of how metaphorical humor is used in satirical news to fulfill these functions, we integrate the HMSN typology with the General Theory of Verbal Humor (GTVH). The GTVH assumes that all verbal humor must draw from six interdependent Knowledge Resources (KRs). Through a content analysis of metaphorical humor used across various American satirical news shows, we investigated how these KRs are used to fulfill satire’s core communicative functions across the various metaphorical sub-types of the HSMN typology. We found that: (1) some KRs can help fulfill the communicative function(s) of metaphorical jokes, while (2) some KRs constrain the options available for the expression of certain communicative function(s) or other KRs. (shrink)

On the Life of Abraham displays Philo's philosophical, exegetical, and literary genius at its best. Philo begins by introducing the biblical figures Enos, Enoch, Noah, Abraham, Isaac, and Jacob as unwritten laws. Then, interweaving literal, ethical, and allegorical interpretations, Philo presents the life and achievements of Abraham, founder of the Jewish nation, in the form of a Greco-Roman bios, or biography. Ellen Birnbaum and John Dillon explain why and how this work is important within the context of Philo's own (...) oeuvre, early Jewish and Christian exegesis, and ancient philosophy. They also offer a new English translation and detailed analyses, in which they elucidate the meaning of Philo's thought, including his perplexing notion that Israel's ancestors were laws in themselves. (shrink)

In this groundbreaking work, Ellen Meiksins Wood rewrites the history of political theory, from Plato to Rousseau. Treating canonical thinkers as passionately engaged human beings, Wood examines their ideas not simply in the context of political languages but as creative responses to the social relations and conflicts of their time and place. She identifies a distinctive relation between property and state in Western history and shows how the canon, while largely the work of members or clients of dominant classes, (...) was shaped by complex interactions among proprietors, labourers and states. Western political theory, Wood argues, owes much of its vigour, and also many ambiguities, to these complex and often contradictory relations. In this new edition, incorporating both volumes, the book takes us from classical antiquity to the age of enlightenement. In the first volume, Wood traces the development of the Western tradition from classical antiquity through to the Middle Ages in the perspective of social history--a significant departure not only from the standard abstract history of ideas but also from other contextual methods. In the second volume, Wood moves on to explore the formation of the modern state, the rise of capitalism, the Renaissance and Reformation, the scientific revolution and the Age of Enlightenment. In her focus on canonical thinkers through the ages, Wood illuminates a rich and provocative legacy of political ideas unmatched in Western history"--Publisher's website. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

It is not rare in philosophy and psychology to see theorists fall into dichotomous thinking about mental phenomena. On one side of the dichotomy there are processes that I will label “unintelligent.” These processes are thought to be unconscious, implicit, automatic, unintentional, involuntary, procedural, and non-cognitive. On the other side, there are “intelligent” processes that are conscious, explicit, controlled, intentional, voluntary, declarative, and cognitive. Often, if a process or behavior is characterized by one of the features from either of the (...) above lists, the process or behavior is classified as falling under the category to which the feature belongs. For example, if a process is implicit this is usually considered sufficient for classifying it as “unintelligent” and for assuming that the remaining features that fall under the “unintelligent” grouping will apply to it as well. Accordingly, if a process or behavior is automatic, philosophers often consider it to be unintelligent. It is my goal in this paper to challenge the conceptual slip from “automatic” to “unintelligent”. I will argue that there are a whole range of properties highlighted by the existing psychological literature that make automaticity a much more complex phenomenon than is usually appreciated. I will then go on to discuss two further important relationships between automatic processes and controlled processes that arise when we think about automatic processes in the context of skilled behavior. These interactions should add to our resistance to classifying automaticity as unintelligent or mindless. In Sect. 1, I present a few representative cases of philosophers classifying automatic processes and behaviors as mindless or unintelligent. In Sect. 2, I review trends in the psychology of automaticity in order highlight a complex set of features that are characteristic, though not definitive, of automatic processes and behaviors. In Sect. 3, I argue that at least some automatic processes are likely cognitively penetrable. In Sect. 4, I argue that the structure of skilled automatic processes is shaped diachronically by practice, training and learning. Taken together, these considerations should dislodge the temptation to equate “automatic” with “unintelligent”. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer and Papineau, which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: ballistic, invariant, independent of general action trajectories, Insensitive to semantic content, and independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer (Front Hum Neurosci, 2013. doi:10.3389/fnhum.2013.0050) and Papineau (R Inst Philos Suppl 73:175–196, 2013), which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: (1) ballistic, (2) invariant, (3) independent of general action trajectories, (4) Insensitive to semantic content, and (5) independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

Cascades of transcriptional regulation are the common source of the forward drive in all developmental systems. Increases in complexity and specificity of gene expression at successive stages are based on the collaboration of varied combinations of transcription factors already expressed in the cells to turn on new genes, and the logical relationships between the transcription factors acting and becoming newly expressed from stage to stage are best visualized as gene regulatory networks. However, gene regulatory networks used in different developmental contexts (...) underlie processes that actually operate through different sets of rules, which affect the kinetics, synchronicity, and logical properties of individual network nodes. Contrasting early embryonic development in flies and sea urchins with adult mammalian hematopoietic development from stem cells, major differences are seen in transcription factor dosage dependence, the silencing or damping impacts of repression, and the impact of cellular regulatory history on the parts of the genome that are accessible to transcription factor action in a given cell type. These different features not only affect the kinds of models that can illuminate developmental mechanisms in the respective biological systems, but also reflect the evolutionary needs of these biological systems to optimize different aspects of development. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided—some commentators are sceptical as to whether an agreement will ever be reached—and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient’s family regarding care and treatment options. Although living in (...) a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements—including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost—interact. Nevertheless, the global medical community has seen the development of two distinctly different approaches to medical futility: one in which the autonomy of patients is of paramount importance in the decision whether or not to pursue a treatment; and one in which beneficence and primum non nocere—first do no harm—are almost entirely the clinician’s prerogative, and whereby he/she has a duty to refuse any treatment for which the potential risks outweigh the potential benefits for the patient. Recently, however, there has been a rejection of this dichotomous view of medical futility and the apparent “power struggle” between physician and patient, and a positive movement towards a more collaborative decision-making process that highlights the necessity of communication, aiming to result in the obtainment of the best possible outcome for each patient as an individual. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

This article is the result of a mutual interest in the radical philosophical dialogue discussed by Martin Buber. The radical dialogue is rooted in western European values of humanism, values that are challenged because they exclude women, people with disabilities, non-western, indigenous people and sexual minorities. With our basis in radical dialogue we are discussing flaws within the very concept of dialogue, how dialogue is challenged in encounters between people with severe disabilities and their helpers, and we are proposing a (...) new interpretation of dialogue in a posthuman area. To illuminate what might be at stake in relations where power is clearly imbalanced we use Pierre Bourdieus theory of the gift when asking ourselves: “How can we understand dialogue when there apparently is one dominant giver and one receiver unable to return the gift?” Discussing this question, we draw on Rosi Braidotti and her Posthuman Critical Theory to see if we can find new grounds to build dialogue on. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

Darwin’s classic ‘Origin of Species’ (Darwin 1859) described forces of selection acting upon individuals, but there remains a great deal of controversy about what exactly the status and definition of a biological individual is. Recently some authors have argued that the individual is dispensable – that an inability to pin it down is not problematic because little rests on it anyway. The aim of this paper is to show that there is a real problem of biological individuality, and an urgent (...) need to arbitrate over the current plethora of solutions to it. (shrink)

This commentary responds to the suggestion that we can humanize online university education through the design decisions we make about it. It offers several reasons why the suggestion may be unrealistic, given that choice in online course design is increasingly narrowed by the prevalence of relatively powerless part-time instructors, student preference for convenient online offerings, and the use of learning management systems. However, if our design decisions are constrained, it becomes all the more important that we engage in critical conversations (...) about what we gain and lose when technology is used to automate or mediate university education. (shrink)

Interacting with others frequently involves making common-sense inferences linking context, background knowledge, and beliefs to utterances in the dialogue. As language users we are generally good at this kind of dialogical reasoning, and might not even be aware we are involved in it while we engage in a conversation. However, sometimes it is not obvious how a particular contribution should be interpreted in terms of the underpinning assumptions warranting an inference. In dialogue involving participants who demonstrate atypical linguistic behavior, such (...) as patients with schizophrenia, the effects may be even more marked. (shrink)