Last year, the Joint Commission on Accreditation of Healthcare Organizations for the first time included provisions in its Hospital Accreditation Manual requiring institutions to have mechanisms in place to consider ethical issues arising in the care of patients and to educate care givers and patients on bioethical issues. This new requirement is notably vague. There is no indication of what type of mechanisms would be appropriate or how those involved in considering ethical issues should conduct themselves. This vagueness is by (...) no means accidental, but it reflects a recognition that clinical bioethics is still in its formative stages and that there are currently almost as many different mechanisms for dealing with bioethical issues in the healthcare setting as there are institutions that have such mechanisms. The Joint Commission's action, however, also implies that the time for experimentation will soon be over. (shrink)

Objective: To examine current research payment practices and to inform development of clearer guidelines for researchers and ethics committees.Design: Exploratory email based questionnaire study of current research participant reimbursement practices. A diverse sample of organisations and individuals were targeted.Setting: Australia.Participants: Contacts in 84 key research organisations and select electronic listservers across Australia. A total of 100 completed questionnaires were received with representations from a variety of research areas .Main measurements: Open-ended and fixed alternative questions about type of research agency; type (...) of research; type of population under study; whether payment is standard; amounts and mechanisms of payment; factors taken into account when deciding on payment practices; and whether payment policies exist.Results: Reimbursement practice is highly variable. Where it occurs it is largely monetary and is for time and out-of-pocket expenses. Ethics committees were reported to be often involved in decision making around reimbursement.Conclusions: Research subject payment practices vary in Australia. Researchers who do provide payments to research participants generally do so without written policy and procedures. Ethics committees have an important role in developing guidelines in this area. Specific guidelines are needed considering existing local policies and procedures; payment models and their application in diverse settings; case study examples of types and levels of reimbursement; applied definitions of incentive and inducement; and the rationale for diverse payment practices in different settings. (shrink)

This paper attempts to signal the potential relevance of A Test of the News, written by Lippmann and Merz, for Critical Discourse Analysis. It seems that the study is overlooked by CDA’s experts as a pioneering work in press analysis. In order to demonstrate links between CDA and the research, in the first part, the work of Lippmann and Merz is situated within a wider picture of the theoretical and historical background as well as common views on politics and the (...) role of the press. Then, the reasons for the choice of the Times as a medium of research and the Russian Revolution as a topic are stated. The authors’ methodological assumptions are discussed in brief. The second part begins with an attempt to define the concept of CDA. The next section presents a theoretical framework of CDA in order to indicate that Lippmann’s and Merz’s analysis demonstrates a similar theoretical approach. Additionally, the tools used by authors are compared with those used in CDA. The parallel between the central role of the media discourse in CDA and the concern of the authors of the role of the press is also discussed. Since the active role of the reader and the hearer in constructing the meaning of the text corresponds with the views of the authors on the discrepancy between the real world and its representation, the next section is devoted to this issue. Finally, readers’ abilities, discussed by Lippmann and Merz, are viewed in relation to the significance of reader’s experiences in constructing the meaning of a text. (shrink)

With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

In 2004, drug user representatives lobbied against the now stalled $17.5m Australian government Retractable Needle and Syringe Technology Initiative due to concerns about inadequate consultation and potential health risks to participants.1 Some drug user organisations have also recently withdrawn support for the Australian Illicit Drug Reporting System , ….

The identification of molecules controlling embryonic patterning and their functional analysis has revolutionized the fields of Developmental and Cell Biology. The use of new sequence information and modern bioinformatics tools has enriched the list of proteins that could potentially play a role in regulating cell behavior and function during early development. The recent application of efficient methods for gene knockout in zebrafish has accelerated the functional analysis of many proteins, some of which have been overlooked due to their small size. (...) Two recent publications report on the identification of one such protein and its role in zebrafish embryogenesis. The protein, currently designated Apela, was shown to act as a secreted protein whose absence adversely affected various early developmental processes. Additional signaling proteins that have been identified in one of the studies are likely to open the way to unraveling hitherto unknown developmental pathways and have the potential to provide a more comprehensive understanding of known developmental processes. (shrink)

The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was (...) disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as ‘moral distress’, the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse’s advocacy role for patients. (shrink)

My topic is authenticity in or perhaps as painting, not the authenticity of paintings; I know next to nothing about the problem of verifying claims of authorship. I am interested in another kind of genuineness and fraudulence, the kind at issue when we say of a person that he or she is false, not genuine, inauthentic, lacks integrity, and, especially when we say he or she is playing to the crowd, playing for effect, or is a poseur. These are not (...) quite moral distinctions (no one has a duty to be authentic), but they are robustly normative appraisals, applicable even when such falseness is not a case of straight hypocrisy but of lack of self-knowledge or of self-deceit. (A person can be quite sincere and not realize the extent of her submission to the other’s expectations and demands.) This sort of appraisal also has a long history in post-Rousseauist reflections on the dangers of uniquely modern forms of social dependence, and they are prominent worries in the modern novel. (shrink)

The history of maternal-fetal therapy is a complex and compelling one. It can be argued that the science and ethics underpinning this field evolved together, with emerging technology spurring on th...

This new edition of Charles Fried's 'Medical Experimentation' includes a general introduction by Franklin Miller and the late Alan Wertheimer, a reprint of the 1974 text, an in-depth analysis by Harvard Law School scholars I. Glenn Cohen and D. James Greiner, and a new essay by Fried reflecting on the original text and how it applies to the contemporary landscape of medicine and medical experimentation.

Artykuł stanowi próbę pokazania zagadnienia społecznej odpowiedzialności przedsiębiorstw z filozoficznej perspektywy obecnej w pismach Waltera Lippmanna. Krótko omówione zostały istotne w tym kontekście elementy biografii autora powiązane z jego twórczością. Następnie przedstawione zostało samo pojęcie społecznej odpowiedzialności i jego ewolucja w okresie, w którym powstawały pisma Lippmanna, z naciskiem na amerykański kontekst kulturowo-historyczny. W kolejnej części pokazane zostay dwa różne ujęcia problematyki charakterystycznej dla opisywanego zagadnienia, które odnaleźć można w pismach autora. Pierwsze odnosi się do postulowanej przez autora teorii ekonomii (...) społecznej, drugie powiązane jest ze specyficznym sposobem definiowania społeczeństwa. Wskazane zostały także źródła potencjalnych inspiracji we współczesnych Lippmannowi teoriach ekonomicznych, filozoficznych i społecznych. Niektóre propozycje autora są typowe dla epoki, inne zdają się nosić znamiona innowacyjności. (shrink)

Cognitive functions like perception, memory, language, or consciousness are based on highly parallel and distributed information processing by the brain. One of the major unresolved questions is how information can be integrated and how coherent representational states can be established in the distributed neuronal systems subserving these functions. It has been suggested that this so-called ''binding problem'' may be solved in the temporal domain. The hypothesis is that synchronization of neuronal discharges can serve for the integration of distributed neurons into (...) cell assemblies and that this process may underlie the selection of perceptually and behaviorally relevant information. As we intend to show here, this temporal binding hypothesis has implications for the search of the neural correlate of consciousness. We review experimental results, mainly obtained in the visual system, which support the notion of temporal binding. In particular, we discuss recent experiments on the neural mechanisms of binocular rivalry which suggest that appropriate synchronization among cortical neurons may be one of the necessary conditions for the buildup of perceptual states and awareness of sensory stimuli. (shrink)

In this article, we investigate the role of self-efficacy in intentional habit building. We analyzed event sampling data from a habit building app we created that helps define and track habit data. We used hierarchical growth curve modeling and multilevel mediation to test our hypotheses. In a first study, N = 91 university students built new study habits over a period of 6 weeks in a controlled study. We found that the trait-like general self-efficacy predicted automaticity but not the experience (...) of motivational interference. In a second study with real user data, N = 265 idiographic habits have been analyzed. The specific SE associated with these habits – habit-specific self-efficacy – was measured during habit formation. We found that lagged HSE predicted automaticity and that lagged automaticity predicted HSE, indicating a positive feedback mechanism in habit building. Furthermore, we found that lagged HSE predicted less MI during habit performance. A multilevel mediation analysis showed significant effects of lagged HSE and aggregated HSE on MI, which were both partially mediated by automaticity. These results show the importance of defining the specificity of SE beliefs and how they interact with automaticity in the habit building process. (shrink)

Interest in spirituality in the workplace and in leaders’ spirituality has grown in the last two decades, paralleled by the emergence of spiritual leadership theories and research. Despite evidence that spirituality is important to many leaders, the literature fails to adequately address the intersections of spiritual, leader, and moral development. A whole person and integrated approach to these three types of development seems beneficial to individual leaders, businesses, and society. In this article we first review spiritual, moral, and leader development (...) literature. Then, drawing on the theory of being-centered leadership, we present a framework which addresses the parallel and intertwined nature of spiritual, leader, and moral development. Our proposed framework includes markers of the three types of development and is inclusive of multiple spiritual development traditions. Four practices and processes of spiritual development are also explored and related to leader and moral development processes. Implications for theory, research, and practice are presented. (shrink)

Contract as Promise is a study of the philosophical foundations of contract law in which Professor Fried effectively answers some of the most common assumptions about contract law and strongly proposes a moral basis for it while defending the classical theory of contract. This book provides two purposes regarding the complex legal institution of the contract. The first is the theoretical purpose to demonstrate how contract law can be traced to and is determined by a small number of basic (...) moral principles. At the theory level the author shows that contract law does have an underlying, and unifying structure. The second is a pedagogic purpose to provide for students the underlying structure of contract law. At this level of doctrinal exposition the author shows that structure can be referred to moral principles. Together the two purposes support each other in an effective and comprehensive study of contract law. This second edition retains the original text, and includes a new Preface. It also includes a substantial new essay entitled Contract as Promise in the Light of Subsequent Scholarship--Especially Law and Economics which serves as a retrospective of the work accomplished in the last thirty years, while responding to present and future work in the field. (shrink)

Gregory Fried offers in this book a careful investigation of Martin Heidegger's understanding of politics. Disturbing issues surround Heidegger's commitment to National Socialism, his disdain for liberal democracy, and his rejection of the Enlightenment. Fried confronts these issues, focusing not on the historical debate over Heidegger's personal involvement with Nazism, but on whether and how the formulation of Heidegger's ontology relates to his political thinking as expressed in his philosophical works. The inquiry begins with Heidegger's interpretation of Heraclitus, (...) particularly the term polemos ("war," or, in Heidegger's usage, "confrontation"). Fried contends that Heidegger invests polemos with broad ontological significance and that his appropriation of the word provides important insights into major strands of his thinking--his conception of the human being, understanding of truth, and interpretation of history--as well as the meaning of the so-called turn in his thought. Although Fried finds that Heidegger's politics are continuous with his thought, he also argues that Heidegger's work raises important questions about contemporary identity politics. Fried also shows that many postmodernists, despite attempts to distance themselves from Heidegger, fail to avoid some of the same political pitfalls his thinking entailed. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Ethics education is recognized as an integral component of health professionals’ education and has been occurring in various guises in the curricula of health professional training in many countries since at least the 1970s. However, there are a number of different aims and approaches adopted by individual educators, programs, and, importantly, different health professions that may be characterized according to strands or trends in ethics education.

Martin Heidegger’s Introduction to Metaphysics, first published in 1953, is a highly significant work by a towering figure in twentieth-century philosophy. The volume is known for its incisive analysis of the Western understanding of Being, its original interpretations of Greek philosophy and poetry, and its vehement political statements. This new companion to the Introduction to Metaphysics presents an overview of Heidegger’s text and a variety of perspectives on its interpretation from more than a dozen highly respected contributors.

Despite recent increasing support for the brain disease model of alcohol and drug addiction, the extent to which the model may clinically impact addiction treatment and client behaviour remains unclear. This qualitative study explored the views of community-based clinicians in Australia and examined: whether Australian community-based clinicians support the BDM of addiction; their attitudes on the impact the model may have on clinical treatment; and their views on how framing addiction as a brain disease may impact addicted clients’ behaviour. Six (...) Australian community-based clinicians participated in semi-structured in-depth interviews that were analysed using thematic analysis. Whilst the BDM was not fully supported by this purposive sample of Australian community-based clinicians, there was acceptance that addiction neuroscience formed a key part of a wider addiction framework. Participants believed the BDM ignored key social, psychological and environmental factors important for successful treatment. The BDM was seen as potentially irrelevant for certain client types, however the model was believed to integrate with particular therapies. Participants believed that for clients viewing their addiction in terms of a brain disease, there were potential positive and negative impacts on client behaviour. Implications for addiction treatment practice and public health policy are discussed. (shrink)