Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA KimberlyGarchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)
The philosophy of Josiah Royce has recently begun to regain attention; Griffin Trotter, in particular, has utilized Royce in questions concerning medical ethics. This resurgence in attention is for good reason—Royce's philosophies of loyalty and community provide both a descriptively accurate picture of the self and a prescriptively solid ethical system. Royce recognized, as do all pragmatic philosophers, that persons only exist socially, and this sociality will necessarily influence the individual ethically, but also epistemologically. What we know, how we act, (...) how we think we ought to act are not individual questions, but rather questions that arise for individuals only in the context of a larger community. (shrink)
Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, (...) regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored. (shrink)
Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the number of available organs, including increasing the number of registered donors and procuring organs in uncontrolled environments, are crucial but unlikely to address the shortage in the near future and will not improve donor/recipient compatibility or organ quality. If successful, organ bioengineering can solve the shortage and improve functional outcomes. Studying (...) manufactured organs in animal models has produced valuable data, but is not sufficient to understand viability in humans. Before risking manufactured organ experimentation in living humans, study of bioengineered organs in recently deceased humans would facilitate evaluation of the function of engineered tissues and the complex interactions between the host and the transplanted tissue. Although such studies do not pose risk to human subjects, they pose unique ethical challenges concerning the previous wishes of the deceased, rights of surviving family members, effective operation and fair distribution of medical services, and public transparency. This article investigates the ethical, legal and social considerations in performing engineered organ research on the recently deceased. (shrink)
In November of 1893, Richard Cabot euthanized his brother Ted, who was suffering from the effects of untreated diabetes. Richard assumed responsibility of Ted’s care in June of that year and administered many treatments to ease the suffering and symptoms of his brother. These treatments, however, were ultimately ineffective to stave off the pain of renal failure and infection. Richard adored his older brother, and according to him, was the one that Richard “loved best.” As the date of Ted’s euthanization (...) approached, Richard shuttled from Ted’s bed to his father’s study, begging the elder Cabot for the permission to end Ted’s life. His father, at last, according to Richard, gave the permission. Ted, however, was .. (shrink)
:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury (...) in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation. (shrink)
Toward A Sociological Imagination builds on the ideas C. Wright Mills expressed in The Sociological Imagination for an approach to the scientific method broad enough to open up to the full range of knowledge within the sociology discipline. In this book, nine sociologists and one philosopher provide detailed tests of the utility of the approach within diverse substantive sociological areas.
Uterus transplantation is an emerging technology adding to the arsenal of treatments for infertility; specifically the only available treatment for uterine factor infertility. Ethical investigations concerning risks to uteri donors and transplant recipients have been discussed in the literature. However, missing from the discourse is the potential of uterus transplantation in other groups of genetically XY women who experience uterine factor infertility. There have been philosophical inquiries concerning uterus transplantation in genetically XY women, which includes transgender women and women with (...) complete androgen insufficiency syndrome. We discuss the potential medical steps necessary and associated risks for uterus transplantation in genetically XY women. Presently, the medical technology does not exist to make uterus transplantation a safe and effective option for genetically XY women, however this group should not be summarily excluded from participation in trials. Laboratory research is needed to better understand and reduce medical risk and widen the field to all women who face uterine factor infertility. (shrink)
This forthcoming edited volume is written by expert women in philosophy for younger women and girls ages 16-20. It features a range of ethical, metaphysical, social and political, and other philosophical chapters divided into four main sections. Each chapter features an opening anecdote involving women and/or girls from historical, literary, artistic, scientific, mythic, and other sources to lead into the main topic of the chapter.
Kimberly Chuang’s detailed and very helpful reply to my article concerns Jon Elster’s struggle to develop a mechanistic account that sheds light on explanation in social science. I argue that a problem exists with Elster’s current conception of mechanistic explanation in social contexts. Chuang defends Elster’s conception against my critique. I still believe I have identified a problem with Elster’s conception. In this reply I want to recapitulate briefly Elster’s idea, as I understand it, and then use some of (...) Chuang’s critical points to advance the position I advocate. (shrink)
One of the first things striking readers of Criminal Law Conversations is its unusual methodology. The editors of this volume have put together 31 conversations around as many cutting edge and influential articles. This article considers critically some discussions representative of each of the book’s three parts: Principles, Doctrine, Administration and provide a glimpse of the richness and variety of Criminal Law Conversations.
This book presents a comprehensive overview of what the criminal law would look like if organised around the principle that those who deserve punishment should receive punishment commensurate with, but no greater than, that which they deserve. Larry Alexander and Kimberly Kessler Ferzan argue that desert is a function of the actor's culpability, and that culpability is a function of the risks of harm to protected interests that the actor believes he is imposing and his reasons for acting in (...) the face of those risks. The authors deny that resultant harms, as well as unperceived risks, affect the actor's desert. They thus reject punishment for inadvertent negligence as well as for intentions or preparatory acts that are not risky. Alexander and Ferzan discuss the reasons for imposing risks that negate or mitigate culpability, the individuation of crimes, and omissions. (shrink)
Governing Animals explores the role of the liberal state in protecting animal welfare. Examining liberal concepts such as the social contract, property rights, and representation, Kimberly K. Smith argues that liberalism properly understood can recognize the moral status and social meaning of animals and provides guidance in fashioning animal policy.
Although formal barriers to women’s social and political participation have crumbled, society remains, to a significant degree, gendered in the roles that women and men play. Women’s and men’s choices regarding work and family are largely responsible for maintaining and reinforcing the differences. While feminists recognize the need to criticize women’s choices, too often they focus on restrictive conditions rather than the choices themselves. Kimberly A. Yuracko argues instead that encouraging women to make choices in accordance with a grounded (...) and well-defined conception of perfectionism—a philosopy concerned with human flourishing—is the most effective way to redress persistent gender inequality. To this end, Yuracko seeks not only to expose the perfectionism underlying current choice critiques, but to articulate a concrete set of feminist perfectionist principles that would improve the quality of individual women’s lives and improve the social standing of women as a whole. (shrink)
The use and abuse and critique of Kant has generated a huge literature among contemporary political theorists; his work has been surreptitiously kept by some critics of the Enlightenment to exeplify starndards of modernity. Kimberly Hutchings reevaluates Kant's work in terms of its significance in the writings of Habersmas, Arendt, Lyotard and Foucault. This is not an exercise in the history of ideas; through her extremely lucid presentation of Kant's critical philosophy, Hutchings reveals the critique to be a complex, (...) ambiguous political practice. The common Kantian heritage in the thought of the four contemporary theorists challenges orthodox distinctions between modernist and postmodernist theorizing. Kant, Critique and Kant addresses why Kant's legacy is inescapable for current debates about both "critique" and politics. This reading sheds a new light on continental and political philosophy, international relations theory and feminist theory. (shrink)
Iconoclasts? Who, Us? A Reply to Dolinko Content Type Journal Article Category Original Paper Pages 1-7 DOI 10.1007/s11572-012-9143-3 Authors Larry Alexander, San Diego, CA, USA Kimberly Kessler Ferzan, Camden, NJ, USA Journal Criminal Law and Philosophy Online ISSN 1871-9805 Print ISSN 1871-9791.
In the early 1980s, a new category of crime appeared in the criminal law lexicon. In response to concerted advocacy-group lobbying, Congress and many state legislatures passed a wave of "hate crime" laws requiring the collection of statistics on, and enhancing the punishment for, crimes motivated by certain prejudices. This book places the evolution of the hate crime concept in socio-legal perspective. James B. Jacobs and Kimberly Potter adopt a skeptical if not critical stance, maintaining that legal definitions of (...) hate crime are riddled with ambiguity and subjectivity. No matter how hate crime is defined, and despite an apparent media consensus to the contrary, the authors find no evidence to support the claim that the United States is experiencing a hate crime epidemic--instead, they cast doubt on whether the number of hate crimes is even increasing. The authors further assert that, while the federal effort to establish a reliable hate crime accounting system has failed, data collected for this purpose have led to widespread misinterpretation of the state of intergroup relations in this country. The book contends that hate crime as a socio-legal category represents the elaboration of an identity politics now manifesting itself in many areas of the law. But the attempt to apply the anti-discrimination paradigm to criminal law generates problems and anomalies. For one thing, members of minority groups are frequently hate crime perpetrators. Moreover, the underlying conduct prohibited by hate crime law is already subject to criminal punishment. Jacobs and Potter question whether hate crimes are worse or more serious than similar crimes attributable to other anti-social motivations. They also argue that the effort to single out hate crime for greater punishment is, in effect, an effort to punish some offenders more seriously simply because of their beliefs, opinions, or values, thus implicating the First Amendment. Advancing a provocative argument in clear and persuasive terms, Jacobs and Potter show how the recriminalization of hate crime has little value with respect to law enforcement or criminal justice. Indeed, enforcement of such laws may exacerbate intergroup tensions rather than eradicate prejudice. (shrink)
Starting with the first time they turned on a television or saw a billboard, this generation of teens, more than any generation before, has been inundated with the message, "If I can have that or look more like that, then I will be happy." Get Happy is a breath of fresh air for teenagers to help them become happy with who they are and what they have today rather than waiting for the next big thing. Teen advocate and author (...) class='Hi'>Kimberly Kirberger, along with her son, Jesse, enlightens readers with the idea that happiness is a choice, and it is available to us whenever we decide we want it. Kirberger uncovers the lies the media, our educational system, and even our well-intentioned friends and family tell us about happiness. Happiness can only be found in the here and now, not in what the future may bring. Get Happy Guide is all about letting go of our past and stepping into our present. It's about not being a victim and about learning how to gain control over our emotions. Poems, cartoons, and insightful stories are peppered throughout with examples of how other teenagers have found their own sense of happiness. (shrink)
The current assessment of behaviors in the inventories to diagnose autism spectrum disorders (ASD) focus on observation and discrete categorizations. Behaviors require movements, yet measurements of physical movements are seldom included. Their inclusion however, could provide an objective characterization of behavior to help unveil interactions between the peripheral and the central nervous systems. Such interactions are critical for the development and maintenance of spontaneous autonomy, self-regulation and voluntary control. At present, current approaches cannot deal with the heterogeneous, dynamic and stochastic (...) nature of development. Accordingly, they leave no avenues for real-time or longitudinal assessments of change in a coping system continuously adapting and developing compensatory mechanisms. We offer a new unifying statistical framework to reveal re-afferent kinesthetic features of the individual with ASD. The new methodology is based on the non-stationary stochastic patterns of minute fluctuations (micro-movements) inherent to our natural actions. Such patterns of behavioral variability provide re-entrant sensory feedback contributing to the autonomous regulation and coordination of the motor output. From an early age, this feedback supports centrally driven volitional control and fluid, flexible transitions between intentional and spontaneous behaviors. We show that in ASD there is a disruption in the maturation of this form of proprioception. Despite this disturbance, each individual has unique adaptive compensatory capabilities that we can unveil and exploit to evoke faster and more accurate decisions. Measuring the kinesthetic re-afference in tandem with stimuli variations we can detect changes in their micro-movements indicative of a more predictive and reliable kinesthetic percept. Our methods address the heterogeneity of ASD with a personalized approach grounded in the inherent sensory-motor abilities that the individual has already developed. (shrink)
The field of global ethics draws on traditions of moral theory, mostly derived from western philosophy, in order to address moral problems specific to an increasingly globalised world. This book provides an accessible introduction to the field of global ethics for students of politics, international relations and globalisation. It offers an overview and assessment of key perspectives in global ethics and their implications for substantive moral issues in global politics. These issues include the morality of state and non-state violence, the (...) obligations of rich to poor in a globalising world and the scope and nature of international human rights. The aim of the book is to help non-specialist students understand the assumptions underpinning different moral traditions and to enable them to make up their own minds about the best way of approaching moral judgment and prescription in a shared world, which is nevertheless marked by massive cultural differences and inequalities of power. (shrink)
This paper considers the implications of Hannah Arendt's criticisms of Frantz Fanon and the theories of violence and politics associated with his influence for our understanding of the relationship between those two phenomena. Fanon argues that violence is a means necessary to political action, and also is an organic force or energy. Arendt argues that violence is inherently unpredictable, which means that end reasoning is in any case anti-political, and that it is a profound error to naturalize violence. We evaluate (...) their respective arguments concluding that in her well-founded rejection of the naturalization of violence, Arendt's understanding of the embodied nature of violence is less insightful than Fanon's. (shrink)
Students using Ritalin in preparation for their exams is a hotly debated issue, while meditating or drinking coffee before those same exams is deemed uncontroversial. However, taking Ritalin, meditating and drinking coffee or even education in general, can all be considered forms of cognitive enhancement. Although social acceptance might change in the future, it is interesting to examine the current reasons that are used to distinguish cases deemed problematic or unproblematic. Why are some forms of cognitive enhancement considered problematic, while (...) others are not? In this paper, we consider cognitive enhancement as the amplification or extension of core capacities of the mind, using augmentation or improvements of our information-processing systems. We will analyse cognitive enhancement in an educational setting in order to clarify the fuzzy distinction between problematic and unproblematic forms of cognitive enhancement. We will show that the apparent distinction made by many people between problematic and unproblematic enhancement is not based on any fundamental difference between these two categories. (shrink)
: In a short and much-neglected passage in the second Critique, Kant discusses the threat posed to human freedom by theological determinism. In this paper we present an interpretation of Kant’s conception of and response to this threat. Regarding his conception, we argue that he addresses two versions of the threat: either God causes appearances directly or he does so indirectly by causing things in themselves which in turn cause appearances. Kant’s response to the first version is that God cannot (...) cause appearances directly because they depend essentially on the passive sensibility of finite beings. Kant’s response to the second version is that human beings are endowed with transcendental freedom, which blocks the causal transitivity that is presupposed by this version. We also contrast his position on this topic with Leibniz’s and Spinoza’s. (shrink)
In six experiments, we investigated the role of resource valence in intergenerational attitudes and allocations. We found that, compared to benefits, allocating burdens intergenerationally increased concern with one’s legacy, heightened ethical concerns,intensified moral emotions (e.g., guilt, shame), and led to feelings of greater responsibility for and affinity with future generations. We argue that, because of greater concern with legacies and the associated moral implications of one’s decisions, allocating burdens leads to greater intergenerational generosity as compared to benefits. Our data provide (...) support for this effect across a range of contexts. Our results also indicate that the differential effect of benefits versus burdens in intergenerational contexts depends on the presence of two important structural characteristics that help enact concerns about legacies, including (1) future impact of decisions, and (2) a self-other tradeoff. Overall, our findings highlight how considering resource valence brings to the fore a number of key psychological characteristics of intergenerational decisions—especially as they relate to legacies and ethics. (shrink)
Christine Battersby is a leading thinker in the field of philosophy, gender studies and visual and literary aesthetics. In this important new work, she undertakes an exploration of the nature of the sublime, one of the most important topics in contemporary debates about modernity, politics and art. Through a compelling examination of terror, transcendence and the ‘other’ in key European philosophers and writers, Battersby articulates a radical ‘female sublime’. A central feature of The Sublime, Terror and Human Difference is its (...) engagement with recent debates around ‘9/11’, race and Islam. Battersby shows how, since the eighteenth century, the pleasures of the sublime have been described in terms of the transcendence of terror. Linked to the ‘feminine’, the sublime was closed off to flesh-and-blood women, to ‘Orientals’ and to other supposedly ‘inferior’ human types. Engaging with Kant, Burke, the German Romantics, Nietzsche, Derrida, Lyotard, Irigaray and Arendt, as well as with women writers and artists, Battersby traces the history of these exclusions, while finding resources within the history of western culture for thinking human differences afresh The Sublime, Terror and Human Difference is essential reading for students of continental philosophy, gender studies, aesthetics, literary theory, visual culture, and race and social theory. (shrink)