Smart cities build on the idea of collecting data about the city in order for city administration to be operated more efficiently. Within a research project gathering an interdisciplinary team of researchers – engineers, designers, gender scholars and human geographers – we have been working together using participatory design approaches to explore how paying attention to the diversity of human needs may contribute to making urban spaces comfortable and safe for more people. The project team has deployed sensors collecting data (...) on air quality, sound and mobility in a smart city testbed in Norrköping, Sweden. While these sensors are meant to capture an accurate ‘map’ of the street and what is going on along it, our interdisciplinary conversations around the sensors have revealed the heterogeneity both of smart city planning and spatial formulations of the city. The discussions have given rise to questions regarding the work that goes into constructing the sensor box itself, as well as the work of deploying it, and how these influence the ‘map’ that the sensors produce. In this paper, we draw on Lefebvre to explore how the sensors themselves produce smart spaces. We analyze how the box depends on perceived space to function (e.g. requiring electricity), and simultaneously it produces conceptualizations of space that are influenced by the materiality of the box itself (e.g. sensors being affected by heat and noise). Further, we explore how the (in)visibility of sensor technology influences lived space. (shrink)

What constitutes a just war? How does race matter in America? Are the interests of corporations the same as those of the public when it comes to the environment or public health? Middle and high school history, literature, and science classes abound with important moral, social, and political questions. But under pressure to cover required materials and out of fear of raising controversy, teachers often avoid classroom discussions of questions of profound importance to students and to society. This book investigates (...) how schools can responsibly take an active role in moral education while honoring their academic mission. Using extensive observations in public, Catholic, and Jewish high schools, Katherine Simon analyzes the ways in which teachers avoid or address moral questions raised by students and implicit in course materials. She examines how morally charged issues may be taught responsibly in a diverse democracy. And in an afterword that teachers and teacher educators will find particularly useful, Simon provides practical tools and strategies for structuring discussion and designing units to help teachers explore moral issues more deeply with their middle and high school students. (shrink)

What constitutes a just war? How does race matter in America? Are the interests of corporations the same as those of the public when it comes to the environment or public health? Middle and high school history, literature, and science classes abound with important moral, social, and political questions. But under pressure to cover required materials and out of fear of raising controversy, teachers often avoid classroom discussions of questions of profound importance to students and to society. This book investigates (...) how schools can responsibly take an active role in moral education while honoring their academic mission. Using extensive observations in public, Catholic, and Jewish high schools, Katherine Simon analyzes the ways in which teachers avoid or address moral questions raised by students and implicit in course materials. She examines how morally charged issues may be taught responsibly in a diverse democracy. And in an afterword that teachers and teacher educators will find particularly useful, Simon provides practical tools and strategies for structuring discussion and designing units to help teachers explore moral issues more deeply with their middle and high school students. (shrink)

Animal and human studies suggest that parenting style is transmitted from one generation to the next. The hypotheses of this study were that a mother’s rearing experiences would predict her own parenting resources and current maternal mood, motivation to care for her offspring, and relationship with her parents would underlie this association. In a subsample of 201 first-time mothers participating in the longitudinal Maternal Adversity, Vulnerability and Neurodevelopment project, we assessed a mother’s own childhood maltreatment and rearing experiences using the (...) Childhood Trauma Questionnaire and the Parental Bonding Instrument. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, maternal motivation, and current relationship with their own parents. The sample consisted of mostly high socioeconomic status mothers recruited from Montréal or Hamilton, Canada, with an age range from 18 to 43 years. More severe maltreatment and less supportive rearing by the mother’s parents predicted increased parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: maltreatment on parenting stress through symptoms of depression ; maternal rearing on parenting stress through maternal motivation and symptoms of depression ; and paternal rearing on parenting stress through current relationship with the father. Maternal rearing experiences predict a mother’s own parenting resources though distinct psychosocial pathways, including depressed mood, maternal motivation, and social support. (shrink)

Animal and human studies suggest that parenting style is transmitted from one generation to the next. The hypotheses of this study were that a mother’s rearing experiences would predict her own parenting resources and current maternal mood, motivation to care for her offspring, and relationship with her parents would underlie this association. In a subsample of 201 first-time mothers participating in the longitudinal Maternal Adversity, Vulnerability and Neurodevelopment project, we assessed a mother’s own childhood maltreatment and rearing experiences using the (...) Childhood Trauma Questionnaire and the Parental Bonding Instrument. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, maternal motivation, and current relationship with their own parents. The sample consisted of mostly high socioeconomic status mothers recruited from Montréal or Hamilton, Canada, with an age range from 18 to 43 years. More severe maltreatment and less supportive rearing by the mother’s parents predicted increased parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: maltreatment on parenting stress through symptoms of depression ; maternal rearing on parenting stress through maternal motivation and symptoms of depression ; and paternal rearing on parenting stress through current relationship with the father. Maternal rearing experiences predict a mother’s own parenting resources though distinct psychosocial pathways, including depressed mood, maternal motivation, and social support. (shrink)

ObjectivesThe present study explores the effect of visual art training on people with dementia, utilizing a randomized control trial design, in order to investigate the effects of an 8-week visual art training program on cognition. In particular, the study examines overall cognition, delayed recall, and working memory, which show deficits in people with dementia.MethodFifty-three individuals with dementia were randomly assigned into either an art training or usual-activity waitlist control group. Overall cognition and delayed recall were assessed with the Montreal Cognitive (...) Assessment, and working memory was assessed with the Backward Digit Span task.ResultsThere were no group differences in overall cognition, or working memory, while a difference in delayed recall was undetermined, based on post-test—pre-test difference scores. Groups were comparable at baseline on all measures.ConclusionThe measures of cognition, delayed recall, and working memory used in this study were not affected by an 8-week visual art training program.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT03175822. (shrink)

The field of clinical ethics consultation has matured into a multidisciplinary profession, with clinical ethics consultants (CECs) being trained in bioethics, philosophy, theology, law, medicine, n...

Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co–curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus (...) on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three–year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co–curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician’s Vocation Program (PVP). (shrink)

Calls for public engagement on emerging agricultural technologies, including genetic engineering of farm animals, have resulted in the development of information that people can interact and engage with online, including “Frequently Asked Questions” (FAQs) developed by organizations seeking to inform or influence the debate. We conducted a frame analysis of FAQs webpages about genetic engineering of farm animals developed by different organizations to describe how questions and answers are presented. We categorized FAQs as having a regulatory frame (emphasizing or challenging (...) the adequacy of regulations), an efficiency frame (emphasizing precision and benefits), a risks and uncertainty frame (emphasizing unknown outcomes), an animal welfare frame (emphasizing benefits for animals) or an animal dignity frame (considering the inherent value of animals). Animals were often featured as the object of regulations in FAQs, and questions about animals were linked to animal welfare regulations. The public were represented using a variety of terms (public, consumer) and pronouns (I, we). Some FAQs described differences between technology terms (gene editing, genetic modification) and categorized technologies as either well-established or novel. This framing of the technology may not respond to actual public concerns on the topic. Organizations seeking to use FAQs as a public engagement tool might consider including multiple viewpoints and actual questions people have about genetic engineering. (shrink)

The Code of Ethics for Health Care Ethics Consultation (HCEC) is a pivotal step in the process of identifying and clarifying standards in our field. It draws on the Core Competencies articulated by...

Attention Restoration Theory proposes that exposure to natural environments helps to restore attention. For sustained attention—the ongoing application of focus to a task, the effect appears to be modest, and the underlying mechanisms of attention restoration remain unclear. Exposure to nature may improve attention performance through many means: modulation of alertness and one’s connection to nature were investigated here, in two separate studies. In both studies, participants performed the Sustained Attention to Response Task before and immediately after viewing a meadow, (...) ocean, or urban image for 40 s, and then completed the Perceived Restorativeness Scale. In Study 1, an eye-tracker recorded the participants’ tonic pupil diameter during the SARTs, providing a measure of alertness. In Study 2, the effects of connectedness to nature on SART performance and perceived restoration were studied. In both studies, the image viewed was not associated with participants’ sustained attention performance; both nature images were perceived as equally restorative, and more restorative than the urban image. The image viewed was not associated with changes in alertness. Connectedness to nature was not associated with sustained attention performance, but it did moderate the relation between viewing the natural images and perceived restorativeness; participants reporting a higher connection to nature also reported feeling more restored after viewing the nature, but not the urban, images. Dissociation was found between the physiological and behavioral measures and the perceived restorativeness of the images. The results suggest that restoration associated with nature exposure is not associated with modulation of alertness but is associated with connectedness with nature. (shrink)

People with lived experience are individuals who have first-hand experience of the medical condition being considered. The value of including the viewpoints of people with lived experience in health policy, health care, and health care and systems research has been recognized at many levels, including by funding agencies. However, there is little guidance or established best practices on how to include non-academic reviewers in the grant review process. Here we describe our approach to the inclusion of people with lived experience (...) in every stage of the grant review process. After a budget was created for a specific call, a steering committee was created. This group included researchers, people with lived experience, and health systems administrators. This group developed and issued the call. After receiving proposals, stage one was scientific review by researchers. Grants were ranked by this score and a short list then reviewed by people with lived experience as stage two. Finally, for stage three, the Steering Committee convened and achieved consensus based on information drawn from stages one and two. Our approach to engage people with lived experience in the grant review process was positively reviewed by everyone involved, as it allowed for patient perspectives to be truly integrated. However, it does lengthen the review process. The proposed model offers further practical insight into including people with lived experience in the review process. (shrink)

People with lived experience are individuals who have first-hand experience of the medical condition being considered. The value of including the viewpoints of people with lived experience in health policy, health care, and health care and systems research has been recognized at many levels, including by funding agencies. However, there is little guidance or established best practices on how to include non-academic reviewers in the grant review process. Here we describe our approach to the inclusion of people with lived experience (...) in every stage of the grant review process. After a budget was created for a specific call, a steering committee was created. This group included researchers, people with lived experience, and health systems administrators. This group developed and issued the call. After receiving proposals, stage one was scientific review by researchers. Grants were ranked by this score and a short list then reviewed by people with lived experience as stage two. Finally, for stage three, the Steering Committee convened and achieved consensus based on information drawn from stages one and two. Our approach to engage people with lived experience in the grant review process was positively reviewed by everyone involved, as it allowed for patient perspectives to be truly integrated. However, it does lengthen the review process. The proposed model offers further practical insight into including people with lived experience in the review process. (shrink)

Sound moves us. Nowhere is this more apparent than in our responses to genuine emotional vocalizations, be they heartfelt distress cries or raucous laughter. Here, we present perceptual ratings and a description of a freely available, large database of natural affective vocal sounds from human infants, adults and domestic animals, the Oxford Vocal (OxVoc) Sounds database. This database consists of 173 non-verbal sounds expressing a range of happy, sad, and neutral emotional states. Ratings are presented for the sounds on a (...) range of dimensions from a number of independent participant samples. Perceptions related to valence, including distress, vocalizer mood, and listener mood are presented in Study 1. Perceptions of the arousal of the sound, listener motivation to respond and valence (positive, negative) are presented in Study 2. Perceptions of the emotional content of the stimuli in both Study 1 and 2 were consistent with the predefined categories (e.g., laugh stimuli perceived as positive). While the adult vocalizations received more extreme valence ratings, rated motivation to respond to the sounds was highest for the infant sounds. The major advantages of this database are the inclusion of vocalizations from naturalistic situations, which represent genuine expressions of emotion, and the inclusion of vocalizations from animals and infants, providing comparison stimuli for use in cross-species and developmental studies. The associated website provides a detailed description of the physical properties of each sound stimulus along with cross-category descriptions. (shrink)

Epigenetic research has brought several important technological achievements, including identifying epigenetic clocks and signatures, and developing epigenetic editing. The potential military applications of such technologies we discuss are stratifying soldiers’ health, exposure to trauma using epigenetic testing, information about biological clocks, confirming child soldiers’ minor status using epigenetic clocks, and inducing epigenetic modifications in soldiers. These uses could become a reality. This article presents a comprehensive literature review, and analysis by interdisciplinary experts of the scientific, legal, ethical, and societal issues (...) surrounding epigenetics and the military. Notwithstanding the potential benefit from these applications, our findings indicate that the current lack of scientific validation for epigenetic technologies suggests a careful scientific review and the establishment of a robust governance framework before consideration for use in the military. In this article, we highlight general concerns about the application of epigenetic technologies in the military context, especially discrimination and data privacy issues if soldiers are used as research subjects. We also highlight the potential of epigenetic clocks to support child soldiers’ rights and ethical questions about using epigenetic engineering for soldiers’ enhancement and conclude with considerations for an ethical framework for epigenetic applications in the military, defense, and security contexts. (shrink)

Introduction No consent for health and medical research is appropriate when the criteria for a waiver of consent are met, yet some ethics committees and data custodians still require informed consent. Methods A single-blind parallel-group randomised controlled trial: 1129 families of children born at a South Australian hospital were sent information explaining data linkage of childhood immunisation and hospital records for vaccine safety surveillance with 4 weeks to opt in or opt out by reply form, telephone or email. A subsequent (...) telephone interview gauged the intent of 1026 parents (91%) in relation to their actions and the sociodemographic differences between participants and non-participants in each arm. Results The participation rate was 21% (n=120/564) in the opt-in arm and 96% (n=540/565) in the opt-out arm (χ2 (1 df) = 567.7, p<0.001). Participants in the opt-in arm were more likely than non-participants to be older, married/de facto, university educated and of higher socioeconomic status. Participants in the opt-out arm were similar to non-participants, except men were more likely to opt out. Substantial proportions did not receive, understand or properly consider study invitations, and opting in or opting out behaviour was often at odds with parents' stated underlying intentions. Conclusions The opt-in approach resulted in low participation and a biased sample that would render any subsequent data linkage unfeasible, while the opt-out approach achieved high participation and a representative sample. The waiver of consent afforded under current privacy regulations for data linkage studies meeting all appropriate criteria should be granted by ethics committees, and supported by data custodians. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12610000332022. (shrink)

Bioethics has made remarkable progress as a scholarly and applied field. A mere fledgling in the 1960s, it is now firmly established in hospitals, medical schools, and government agencies and boasts a number of professional associations and a handsome collection of journals.

Last year marked the 20th anniversary of the Foreign Corrupt Practices Act (FCPA) of 1977. The FCPA is the first and only statute prohibiting bribery and other corrupt business practices by U.S. citizens and companies conducting business overseas. This paper provides an overview of the FCPA during the two decades of its existence. More specifically, the objectives of this paper are four-fold. First, the paper provides background information about the FCPA of 1977 and subsequent amendments in 1988. Second, the paper (...) discusses the enforcement of the FCPA since its passage by examining the number of cases prosecuted under the FCPA and the respective penalties imposed. Third, the paper discusses the economic impact of the FCPA by addressing whether the FCPA places U.S. firms at a competitive disadvantage. Fourth, the paper provides public policy recommendations to expand the reach and scope of the FCPA. It covers efforts to criminalize bribery through multilateral organizations, such as the Organization for Economic Cooperation and Development (OECD), the World Trade Organization (WTO), and the Organization of American States (OAS). It also covers bilateral arrangements and efforts by non-governmental organizations such as Transparency International. (shrink)

Several proponents of the 'buck-passing' account of value have recently attributed to G. E. Moore the implausible view that goodness is reason-providing. I argue that this attribution is unjustified. In addition to its historical significance, the discussion has an important implication for the contemporary value-theoretical debate: the plausible observation that goodness is not reason-providing does not give decisive support to the buck-passing account over its Moorean rivals. The final section of the paper is a survey of what can be said (...) for and against the buck-passing account and Moore's views about goodness and reasons. (shrink)

It is widely acknowledged that some truths or facts don’t have a minimal full ground [see e.g. Fine ]. Every full ground of them contains a smaller full ground. In this paper I’ll propose a minimality constraint on immediate grounding and I’ll show that it doesn’t fall prey to the arguments that tell against an unqualified minimality constraint. Furthermore, the assumption that all cases of grounding can be understood in terms of immediate grounding will be defended. This assumption guarantees that (...) the proposed minimality constraint is significant for all cases of grounding. With its help one can get a clear grip on the relevance of grounding, a feature that will be put to use in the penultimate section. (shrink)

According to the received view, philosophy of action took a justified turn towards causalism because anti-causalists failed the causalist challenge about efficacious reasons. This paper contests that view by examining the ways in which Georg Henrik von Wright responded to causalism in his later philosophy. First, von Wright attacked the subjectivism of causalism by arguing for an objectivist view that construes reasons not as subjective mental states but as external facts of the agent's situation. Second, von Wright fundamentally disagreed with (...) the view of philosophical inquiry that underpinned causalism. For von Wright, the task of philosophy was conceptual: to explicate what one is looking for when one is looking for the real reasons for action. In contrast, for causalists the task was ontological: to determine what kind of item in the world the real reason for action is. Examining von Wright's account contributes to contemporary assessments of the metaphilosophical dimension of the reasons/causes debate. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

In recognition memory paradigms, emotional details are often recognised better than neutral ones, but at the cost of memory for peripheral details. We previously provided evidence that, when periph...

I propose a pragmatic approach to the kind of reference-shifting occurring in indexicals as used in e.g. written notes and answering machine messages. I proceed in two steps. First, I prepare the ground by showing that the arguments against such a pragmatic approach raised in the recent literature fail. Second, I take a first few steps towards implementing this approach, by sketching a pragmatic theory of reference-shifting, and showing how it can handle cases of the relevant kind. While the immediate (...) scope of the paper is restricted to indexicals and reference-shifting, and the discussion is confined to a specific range of theories and cases, the approach proposed is compatible with a fairly broad range of more or less semantically conservative theories, and many of the conclusions drawn are significant for the evaluation of pragmatic explanations in philosophy more generally. The overall goal is to offer a new perspective on the issues under discussion, and to prompt philosophers to reconsider some of the established methods by which pragmatic explanations are evaluated. (shrink)

The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes (...) or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion. (shrink)

Volume 20, Issue 5, June 2020, Page 72-74.

The paper distinguishes between two rival views about the nature of final value (i.e. the value something has for its own sake) — intrinsicalism and conditionalism. The former view (which is the one adopted by G.E. Moore and several later writers) holds that the final value of any F supervenes solely on features intrinsic to F, while the latter view allows that the final value of F may supervene on features non-intrinsic to F. Conditionalism thus allows the final value of (...) F to vary according to the context in which F appears. Given the plausible assumption that there is an intimate tie between final values and appropriate attitudinal responses, it appears that conditionalism is the better approach for mainly the following three reasons: First, intrinsicalism is too indiscriminate, which makes it subject to what I call ‘location problems’ of final value. I illustrate this problem by discussing alleged examples of Moorean organic unities. Second, intrinsicalism evokes symptoms of ‘evaluative schizophrenia’. Third, considerations of theoretical economy tell in favour of conditionalism. Thereafter I respond to some recent challenges to conditionalism. An appendix surveys some meritorious implications that conditionalism offers for various substantial versions of such structurally different views about value as monism, pluralism, and particularism. (shrink)

The DRM paradigm produces robust false memories of non-presented critical words. After studying a thematic word list participants falsely remember the critical item “sleep.” We report two false memory experiments. Study One introduces a novel use of the lexical decision task to prime critical words. Participants see two letter-strings and make timed responses indicating whether they are both words. The word pairs Night-Bed and Dream-Thweeb both prime “sleep” but only one pair contains two words. Our primary purpose is to introduce (...) this new methodology via two pilot experiments. The results, considered preliminary, are promising as they indicate that participants were as likely to recognize critical words and presented words just as when studying thematic lists. Study Two actually employs the standard DRM lists so that semantic priming is in play there as well. The second study, however, uses functional near-infrared spectroscopy to measure activity in the prefrontal cortex during a DRM task which includes a deception phase where participants intentionally lie about critical lures. False and true memories occurred at high levels and activated many of the same brain regions but, compared to true memories, cortical activity was higher for false memories and lies. Accuracy findings are accompanied by confidence and reaction time results. Both investigations suggest that it is difficult to distinguish accurate from inaccurate memories. We explain results in terms of activation-monitoring theory and Fuzzy Trace Theory. We provide real world implications and suggest extending the present research to varying age groups and special populations. A nagging question has not been satisfactorily answered: Could neural pathways exist that signal the presence of false memories and lies? Answering this question will require imaging experiments that focus on regions of distinction such as the anterior prefrontal cortex. (shrink)

Subjects and Simulations presents essays focused on suffering and sublimity, representation and subjectivity, and the relation of truth and appearance through engagement with the legacies of Jean Baudrillard and Philippe Lacoue-Labarthe.

Philosophy of the Social Sciences, Volume 52, Issue 3, Page 150-174, June 2022. This article offers a reassessment of the main import of Peter Winch’s philosophy of the social sciences. Critics argue that Winch presented a flawed methodology for the social sciences, while his supporters deny that Winch’s work is about methodology at all. Contrary to both, the author argues that Winch deals with fundamental questions about methodology, and that there is something substantial to learn from his account. Winch engages (...) methodological questions without being committed to social ontology. Instead, Winch’s work on methodology is best described as a descriptive metaphysics of social inquiry. This alternative reading clarifies the close link between Winch’s argument for the autonomy of the social sciences and R. G. Collingwood’s philosophy of history. (shrink)

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)