Background: Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time. Methods: This study examines data collected from a busy ethics consultation service over a period of more than two decades. Results: We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient (...) population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity. Conclusions: We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores. (shrink)

We examine the embodiment of one foundational aspect of human cognition, language, through its bodily association with the gestures that accompany its expression in speech. Gesture is a universal feature of human communication. Gestures are produced by all speakers in every culture . They are tightly timed with speech . Gestures convey important communicative information to the listener, but even blind speakers gesture while talking to blind listeners , so the mutual co-occurrence of speech and gesture reflects a deep association (...) between the two modes that transcends the intentions of the speaker to communicate. Indeed, we believe that this linkage of the vocal expression of language and the arm movements produced with it are a manifestation of the embodiment of thought: that human mental activities arise through bodily interactions with the world and remain linked with them throughout the lifespan. In particular, we propose that speech and gesture have their developmental origins in early hand-mouth linkages, such that as oral activities become gradually used for meaningful speech, these linkages are maintained and strengthened. Both hand and mouth are tightly coupled in the mutual cognitive activity of language. In short, it is the initial sensorimotor linkages of these systems that form the bases for their later cognitive interdependence. (shrink)

The evolutionary scenario described in this target article parallels developmental patterns observed in human infants. Early vocalizations are largely expressive, manual control develops more rapidly than intentional vocal articulation, and vocal and manual activity are linked. In ontogenetic development, language is strongly rooted in bodily action and gesture.

Pedagogy in moral theology follows some of the particular concerns Catholic theologians have had since the Second Vatican Council as well as the aftermath of John Paul II’s encyclical on moral theology, Veritatis splendor. Most of the textbooks reviewed here teach virtue, Christian practice, and Thomas Aquinas’s theology, as largely positive responses to the Council and John Paul II. Catholic moral theology thus appears as a relatively stable field, though the authors use multiple approaches. There are, however, some moral theologians (...) offering alternative perspectives on moral theology. One book reviewed here contends with Humanae vitae and resists both Thomas Aquinas’s authoritative voice and Veritatis splendor’s argument against proportionalist thought. The textbooks offer a range of pedagogical tools for varying student levels. Two of the overall gaps in the field, as indicated by these textbooks, might be more direct engagement with Scripture, and a proper locating of Catholic social teaching within moral theology. (shrink)

The purpose of this study was to extend the previous research on ethics in retailing. Prior research of Dornoff and Tankersley, Gifford and Norris, Norris and Gifford, and Burns and Rayman examined the ethics orientation of retail sales persons, sales managers, and business school students. These studies found the college students less ethically-oriented than retail sales people and retail managers. The present study attempts to extend the research on ethics formation to a geographically and academically diverse sample, and to determine (...) if retail management experience in the form of a professional practicum or internship, or entry level management training programs, such as experienced by recent graduates, are critical factors in the formation of business ethics. The sample consisted of thirty-three students majoring in Human Ecology with a concentration in Retail Merchandising and 51 recent graduates of the retail Merchandising program. The series of fourteen vignettes developed by Dornoff and Tankersley was used. An acknowledged limitation of this study is the validity of the questionnaire developed by Dornoff and Tankersley due to the method of development and new laws concerning warranties and credit etc. which have occurred since 1976. The instrument was used, however, to maintain consistency with earlier studies for the purpose of comparison of groups. No significant differences were found in the students' perceptions of the fourteen actions presented in the vignettes, but the range of the responses in the post-internship tests increased in many cases. The alumni appeared to be slightly more ethical than the students but not as ethical as the managers surveyed in 1986 by Norris and Gifford. Indications are that the critical point of ethics formation may be at the mid-management level and that internships and management training programs have little effect on the ethical perceptions of participants. These findings are consistent with studies such as Gable and Topol, and Jordan and Davis which showed high Machiavellian scores among young retailing executives, often buyers, as opposed to upper level retailing management. Scales with measure Machiavellianism, or manipulativeness, have been used as an alternative method of examining business ethics. (shrink)

Pedagogy in moral theology follows some of the particular concerns Catholic theologians have had since the Second Vatican Council as well as the aftermath of John Paul II’s encyclical on moral theology, Veritatis splendor. Most of the textbooks reviewed here teach virtue, Christian practice, and Thomas Aquinas’s theology, as largely positive responses to the Council and John Paul II. Catholic moral theology thus appears as a relatively stable field, though the authors use multiple approaches. There are, however, some moral theologians (...) offering alternative perspectives on moral theology. One book reviewed here contends with Humanae vitae and resists both Thomas Aquinas’s authoritative voice and Veritatis splendor’s argument against proportionalist thought. The textbooks offer a range of pedagogical tools for varying student levels. Two of the overall gaps in the field, as indicated by these textbooks, might be more direct engagement with Scripture, and a proper locating of Catholic social teaching within moral theology. (shrink)

The purpose of this study was to extend the previous research on ethics in retailing. Prior research of Dornoff and Tankersley (1985–1976), Gifford and Norris (1987), Norris and Gifford (1988), and Burns and Rayman (1989) examined the ethics orientation of retail sales persons, sales managers, and business school students. These studies found the college students less ethically-oriented than retail sales people and retail managers. The present study attempts to extend the research on ethics formation to a geographically and academically diverse (...) sample, and to determine if retail management experience in the form of a professional practicum or internship, or entry level management training programs, such as experienced by recent graduates, are critical factors in the formation of business ethics. The sample consisted of thirty-three students majoring in Human Ecology with a concentration in Retail Merchandising and 51 recent graduates of the retail Merchandising program. The series of fourteen vignettes developed by Dornoff and Tankersley (1975–1976) was used. An acknowledged limitation of this study is the validity of the questionnaire developed by Dornoff and Tankersley due to the method of development and new laws concerning warranties and credit etc. which have occurred since 1976. The instrument was used, however, to maintain consistency with earlier studies for the purpose of comparison of groups. No significant differences were found in the students' perceptions of the fourteen actions presented in the vignettes, but the range of the responses in the post-internship tests increased in many cases. The alumni appeared to be slightly more ethical than the students but not as ethical as the managers surveyed in 1986 by Norris and Gifford. Indications are that the critical point of ethics formation may be at the mid-management level and that internships and management training programs have little effect on the ethical perceptions of participants. These findings are consistent with studies such as Gable and Topol (1988), and Jordan and Davis (1990) which showed high Machiavellian scores among young retailing executives, often buyers, as opposed to upper level retailing management. Scales with measure Machiavellianism, or manipulativeness, have been used as an alternative method of examining business ethics. (shrink)

Despite the promise of international collaboration and sharing by bringing together bioethicists from throughout the world at the 2024 IAB conference in Qatar, I will not be attending. The authors...

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, (...) digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care. (shrink)

In “Artificial Intelligence, Social Media and Depression: A New Concept of Health-Related Digital Autonomy,” Laacke and colleagues posit a revised model of autonomy when using digital algori...

This paper draws from the fields of history, sociology, psychology, moral philosophy, and organizational theory to establish a theoretical connection between a social/organizational influence (ethical work climate) and an individual cognitive element of moral behavior (moral awareness). The research was designed to help to fill a gap in the existing literature by providing empirical evidence of the connection between organizational influences and individual moral awareness and subsequent ethical choices, which has heretofore largely been merely assumed. Results of the study provide (...) evidence that ethical work climate (EWC) is a primary predictor of individual moral awareness, and that the influence of social factors often overrides the effects of individual differences in a work group setting. Implications for future research are provided. (shrink)

In October 2021, the Allen Institute for Artificial Intelligence publicly released Delphi, an artificial intelligence system trained to make general moral decisions (Allen Institute for Artifi...

Volume 20, Issue 10, October 2020, Page 29-31.

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities (...) content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

In the last decade, the humanities have been shrinking in number of students, percent of faculty, and in number of degrees awarded. Humanities students also earn lower salaries than their STEM-prepared peers. At the same time, the health humanities have been in ascendance over the last fifteen years. The number of majors, minors and certificates has increased 266% in that time frame, attracting large numbers of students and preparing future patients, lay caregivers, and health care providers to interact with a (...) complicated and dehumanized medical system. In 1982, British philosopher and educator Stephen Toulmin declared that medicine saved philosophy from irrelevance and possibly extinction. I propose that the health humanities can serve a similar function to stave off the decline of the broader humanities. The health humanities can model an applied approach for the broader humanities to attract student interest; develop students’ capacity for critical reading, writing and reflection about health and medicine in society, practice, and their own lives and inoculate all students against the influence of medicine, whether through preparing pre-health students to navigate the hidden medical curriculum or preparing future patients to navigate the health care system. (shrink)

Academic programs in the medical/health humanities have proliferated widely in recent years, and the professional, academic, and cultural drivers of this growth promise sustained new program development. In this article, we present the results of a survey sent to representatives of one hundred twenty-four baccalaureate and ten graduate programs in the medical/health humanities to assess the experiences and needs of existing programs. Survey results confirm the interest in and need for a descriptive toolkit as opposed to a prescriptive manual; indicate (...) what data and materials are most needed to support the successful development of new academic programs in the field; and identify areas for future research. Recognizing a need for program development resources, the Health Humanities Consortium has initiated the creation of a comprehensive online toolkit. We discuss survey results and the toolkit in relation to the drivers of new program growth. Finally, we describe resources now available through the HHC’s new online program toolkit, including existing programs; sample syllabi; sample curricula templates; program rationale; proposal templates; and graduation data. (shrink)

The Health Humanities Consortium was established in 2015 to “promote health humanities scholarship, education, and practice through transdisciplinary methods and theories that focus on the intersection of the arts and humanities, health, illness, and healthcare.” As the founding co-chairs of the HHC, we provide a history of the founding of this organization in this article, describing the journey of its creation, the choices and challenges it faced as a new organization, and our hopes for a rich future.

In 2005, President George Bush read John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History. After his experiences of 9/11 and Hurricane Katrina, Bush began the first White...

A proposal by the American Society for Bioethics and Humanities (ASBH) to identify individuals who are qualified to perform ethics consultations neglects case complexity in candidates’ portfolios. To protect patients and healthcare organizations, and to be fair to candidates, a minimum case complexity level must be clearly and publicly articulated. This proof-of-concept study supports the feasibility of assessing case complexity. Using text analytics, we developed a complexity scoring system, and retrospectively analyzed more than 500 ethics summaries of consults performed at (...) an academic medical center during 2013. We demonstrate its use with seven case summaries that range in complexity from uncomplicated to very complicated. We encourage the ASBH to require a minimum level of case complexity, and recommend that attestation portfolios include several cases of moderate complexity and at least one very complex case. (shrink)

The integration of digital phenotyping in psychiatry promises unprecedented insights into mental health, particularly in college settings where mental well-being is a growing concern. The COVID-19...

Much of the recent AI-LLM literature has been apocalyptic in pointing out the risks of AI technology, “mitigating the risk of extinction from AI should be a global priority alongside other societal...

Iraq: The Moral Reckoning is an intensive application of the six classic just war theory criteria to the 2003 Iraq war decision, weighing information available at the time from a wide range of sources and concluding that the war met just one of the six, whereas a just war should meet all. It supplements the criteria with widely used ethical principles and thoroughly refutes neoconservative arguments that the war met the criteria.

In their target article, Nelson, Lushkov, Pomerantz, and Weeks demonstrate that there has been a lack of discussion on rural bioethics issues in published, or at least indexed, literature. They con...

While heightening the nihilistic tension underlying the discourse of Richard Kearney, I highlight the positive contribution his book The God Who May Be makes to the debate concerning the need for a postmodern revitalization of religious symbolism. I argue for three qualifications of Kearney's argument, suggesting, in response to Kearney's exclusionary approach to the God who “neither is nor is not but may be,” a God whose possibility for meaningfulness arises as an “eschatological theogony” from out of the chaos (confusion (...) and openness) of contemporary religious symbolism. Arguing that such a radical reenvisioning of God must be tempered and given meaning through reentering and reaffirming onto‐theology in a qualified (hermeneutical) sense, I sketch a possible renewal of meaning for the traditional Christian parousia‐concept as a hermeneutical circle between Hegel's systematic closure of Western metaphysics and Heidegger's deconstructive appropriation of the hidden possibilities of presence within the onto‐theological tradition. (shrink)

In the fall of 2021 a news story reported of a successful experimental xenotransplant of a genetically engineered pig kidney in to the circulatory system of a research subject who was dead by neurological criteria. Although not a first of its kind, this case raises the issue of the ethics of research on those declared brain dead. Such possibilities have been discussed in the published literature since 1974, when Willard Gaylin expressed concern over human dignity when he imagined hospital wards (...) filled with “neomorts” used for education, teaching, research, and manufacturing. In this essay, the author explores the nuances of whether such subjects are considered alive, dead, or something in between. Notions of consent/ permission and risk/benefit are determined by this categorization. After discussing the 2005 Consensus Panel Guidelines on Research with the Recently Dead, the essay concludes with the need for a liminal state between living and dead that respects human dignity but also recognizes the utilitarian value of such experiments to protect fully alive humans. Having not just guidelines but oversight structures such as the University of Pittsburgh’s Committee for Oversight of Research Involving the Dead (CORID) and regulations are necessary if such work is to become more common. (shrink)