Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

The purpose of this study was to develop a Physician's Spiritual Well-Being Scale (PSpWBS). The significance of a physician's spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physician's characteristics; medical practice challenges; response to changes; and overall well-being. The explainable (...) total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician. (shrink)

Research investigating the underlying mechanisms and boundary conditions under which leader humility influences employee voice remains underdeveloped. Drawing from approach–inhibition theory of power and leader humility literature, we developed a moderated-mediation model in which personal sense of power was theorized as a unique mechanism underlining why employees feel motivated to speak up under the supervision of humble leaders. Additionally, the cultural value of power distance was proposed to be a relevant boundary condition to influence such relationship. We tested the model (...) using time-lagged supervisor–subordinate matched data. Results of mixed models analyses provided support for our hypotheses confirming that employees’ personal sense of power mediates the relationship between leader humility and employee voice, and such relationship was found to be stronger when employees’ power distance was lower rather than higher. (shrink)

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes (...) emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel. (shrink)

Research investigating the underlying mechanisms and boundary conditions under which leader humility influences employee voice remains underdeveloped. Drawing from approach–inhibition theory of power and leader humility literature, we developed a moderated-mediation model in which personal sense of power (i.e., employees’ ability to influence other individuals such as their leader) was theorized as a unique mechanism underlining why employees feel motivated to speak up under the supervision of humble leaders. Additionally, the cultural value of power distance was proposed to be a (...) relevant boundary condition to influence such relationship. We tested the model using time-lagged supervisor–subordinate matched data. Results of mixed models analyses provided support for our hypotheses confirming that employees’ personal sense of power mediates the relationship between leader humility and employee voice, and such relationship was found to be stronger when employees’ power distance was lower rather than higher. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

No apology, I imagine, is necessary for the appearance of this translation\nof Marx's "Misere de la Philosophic" On the contrary it is strange\nthat it should not have been published in England before, anu that\nthe translation of his monumental work, the "Capital," tardy as that\nwas, should have yet been made before that of a work which was originally\npublished some twenty years before "Capital" first appeared.\n\n\nIt may be that the translators and editors of the latter work were\nof opinion that in view of (...) the comprehensiveness of "Capital," a\npublication of an English edition of the "Misere de la Philosophic"\nwould be a work of supererogation. Or it may be that they thought\na book so distinctly French—as the "Capital" may be said to be distinctly\nEnglish—and which was, further, exclusively a criticism of a work\nof Proudhon's little known in England—would have slight interest\nfor English readers. On the other hand, the groundwork of the theories\nso fully elaborated in "Capital," apart from its exhaustive analysis\nof the capitalist system of production and distribution, will be\nfound in "Misere." In addition, there are several subjects—notably\nthat of rent—dealt with in this volume which are barely touched upon\nin the single book of " Capital " which has been translated into\nEnglish.\n\n\nMarx's criticism of Proudhon's theory that " the time which is necessary\nto create a commodity indicates exactly its degree of utility," so\nthat " the things of which the production costs the least time are\nthe things which are the most immediately useful," has been matched\nby H. M. Hyndman's crushing refutation of the theory of Final Utility.\nThe subject of rent, too, has been fully dealt with by the latter\nin the same book, " The Economics of Socialism," published, as the\nauthor says, in the hope of furnishing " the rapidly-increasing number\nof students of sociology with a concise and readable statement of\nthe main theories of the scientific school of political economy founded\nby Karl Marx and Friedrich Engels." Neither of these facts, however,\nnecessarily detracts from the value of this older work of Marx's.\nOn the question of rent, after reviewing the Ricardian theory and\nthe many objections which present themselves to that theory, Hyndman\nsays: " It seems, therefore, that a wider definition of the rent\nof land under capitalism is needed than that given by Ricardo, and\nthe following is suggested: — Rent of land is that portion of the\ntotal net revenue which is paid to the landlord for the use of plots\nof land after the average profit on the capital embarked in developing\nsuch land has been deducted." On the question of confiscating rent\nhe says it " would not affect the position of the working portion\nof the community unless the money so obtained were devoted to giving\nthem more amusement, to providing them with better surroundings and\nthe like. ... In fact, the attack upon competitive rents is merely\na capitalist attack. That class sees a considerable income going\noff to a set of people who take no part in the direct exploitation\nof labor; and its representatives are naturally anxious to stop this\nleakage, as they consider it, and to reduce their own taxation for\npublic purposes by appropriating rent to the service of the State.\nThat is all very well for them."\n\n\nOn this point Marx says: " We can understand such economists as Mill,\nCherbulliez, Hilditch and others, demanding that rent should be handed\nover to the State to be used for the remission of taxation. That\nis only the frank expression of the hate which the industrial capitalist\nfeels for the landed proprietor, who appears to him as a useless\nincumbrance, a superfluity in the otherwise harmonious whole of bourgeois\nproduction."\n\n\n" Rent," says Marx, " results from the social relations in which exploitation\nis carried on. It cannot result from the nature, more or less fixed,\nmore or less durable, of land. Rent proceeds from society and not\nfrom the soil."\n\n\nThe criticism of Proudhon's appreciation of gold and silver as the\nfirst manifestation of this theory of " constituted value" should\nbe interesting reading to those admirers of the French Anarchist\nwho yet profess their profound detestation of money and its function.\nSo, too, should his declaration against strikes and combinations\nof workmen. In this we see once more how extremes meet. This declaration\nof Proudhon's would not be out of place in the organ of the Liberty\nand Property Defence League.\n\n\nIn this matter of trade union combination, Marx was scarcely accurate\nin his perception of its development. He clearly did not foresee\nthat the great English trade unions would become fossilised, as it\nwere; and that instead of being a revolutionary force they would\nbecome a reactionary mass, opposing the progress of the mere proletarian\noutside their ranks, as they have done. With the spread of Socialist\nideas among them, however, their exclusive character is being modified,\nand they may even yet take that place in the revolutionary working-class\nmovement which Marx anticipated they would occupy. Given this change\nof attitude, the development must inevitably be along the lines he\npredicted. We are seeing "in face of constantly united capital, the\nmaintenance of the association [becoming] more important and necessary\nfor them than the maintenance of wages," and, further, that the combinations\nof capital are forcing the trade unions to that point where "association\ntakes a political character."\n\n\nIt is scarcely necessary to point out that in this work, written in\n1847, some words have a meaning quite other than that which they\nbear to-day. Thus, for instance, the words "Socialists" and "Socialism,"\nwhere they occur, refer to the utopians—who formulated theories of\na social system independent of the industrial evolution— and to these\ntheories themselves.\n\n\nIn most cases the numerous quotations have been verified and reproduced\nin the original. In some instances, however, they are summaries rather\nthan quotations, and appear ^is translated.\n\n\nA translation jn* necessarily an imperfect presentation of the thoughts,\nideas, and conclusions of the author. In this work I have endeavored\nto adhere as closely as possible to the form and letter, as well\nas the spirit of the original, and to this the indulgent reader is\nasked to ascribe such faults of language as would otherwise merit\nhis censure. (shrink)

That brings me to the crux of my disagreement with Hillis Miller. The central contention is not simply that I am sometimes, or always, wrong in my interpretation, but instead that I—like other traditional historians—can never be right in my interpretation. For Miller assents to Nietzsche's challenge of "the concept of 'rightness' in interpretation," and to Nietzsche's assertion that "the same text authorizes innumerable interpretations : there is no 'correct' interpretation."1 Nietzsche's views of interpretation, as Miller says, are relevant to (...) the recent deconstructive theorists, including Jacques Derrida and himself, who have "reinterpreted Nietzsche" or have written "directly or indirectly under his aegis." He goes on to quote a number of statements from Nietzsche's The Will to Power to the effect, as Miller puts it, "that reading is never the objective identifying of a sense but the importation of meaning into a text which had no meaning 'in itself.'" For example: "Ultimately, man finds in things nothing but what he himself has imported into them." "In fact interpretation is itself a means of becoming master of something."2 On the face of it, such sweeping deconstructive claims might suggest those of Lewis Carroll's linguistic philosopher, who asserted that meaning is imported into a text by the interpreter's will to power: "The question is," said Alice, "whether you can make words mean so many different things.""The question is," said Humpty Dumpty, "which is to be master—that's all." But of course I don't believe that such deconstructive claims are, in Humpty Dumpty fashion, simply dogmatic assertions. Instead, they are conclusions which are derived from particular linguistic premises. I want, in the time remaining, to present what I make out to be the elected linguistic premises, first of Jacques Derrida, then of Hillis Miller, in the confidence that if I misinterpret these theories, my errors will soon be challenged and corrected. Let me eliminate suspense by saying at the beginning that I don't think that their radically skeptical conclusions from these premises are wrong. On the contrary, I believe that their conclusions are right—in fact, they are infallibly right, and that's where the trouble lies. · 1. "Tradition and Difference," Diacritics 2 : 8, 12.· 2. Ibid. M. H. Abrams’s contributions to Critical Inquiry include "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)

Let us call an integer part of an ordered field any subring such that every element of the field lies at distance less than 1 from a unique element of the ring. We show that every real closed field has an integer part.

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Aldous Huxley’s Brave New World is a famous dystopia, frequently called upon in public discussions about new biotechnology. It is less well known that 30 years later Huxley also wrote a utopian novel, called Island. This paper will discuss both novels focussing especially on the role of psychopharmacological substances. If we see fiction as a way of imagining what the world could look like, then what can we learn from Huxley’s novels about psychopharmacology and how does that relate to the (...) discussion in the ethical and philosophical literature on this subject? The paper argues that in the current ethical discussion the dystopian vision on psychopharmacology is dominant, but that a comparison between Brave New World and Island shows that a more utopian view is possible as well. This is illustrated by a discussion of the issue of psychopharmacology and authenticity. The second part of the paper draws some further conclusions for the ethical debate on psychopharmacology and human enhancement, by comparing the novels not only with each other, but also with our present reality. It is claimed that the debate should not get stuck in an opposition of dystopian and utopian views, but should address important issues that demand attention in our real world: those of evaluation and governance of enhancing psychopharmacological substances in democratic, pluralistic societies. (shrink)

Peckham claims that my "behavior" in dealing with the quotations in Natural Supernaturalism is the same, in methodology and validity, as the interpretative behavior of Booth's waiter. But the great bulk of the utterances in my quotations—and no less, of the utterances constituting Peckham's own essay—do not consist of orders, requests, or commands. Instead, they consist of assertions, descriptions, judgments, exclamations, approbations, condemnations, and many other kinds of speech-acts, the meanings of which are not related to my interpretative behavior, even (...) in the indirect way in which the meaning of Booth's order is related to the future behavior of his waiter. M. H. Abrams, author of Natural Supernaturalism and The Mirror and the Lamp and Class of 1916 Professor of English at Cornell University, responds in this essay to Morse Peckham's "The Infinitude of Pluralism" . Morse Peckham, in his Critical Response, was commenting on issues raised by the forum on "The Limits of Pluralism" , to which M. H. Abrams contributed. Previous contributions to Critical Inquiry are "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "The Deconstructive Angel". (shrink)

In retrospect, I think I was right to compose Natural Supernaturalism by relying on taste, tact, and intuition rather than on a controlling method. A book of this kind, which deals with the history of human intellection, feeling, and imagination, employs special vocabularies, procedures, and modes of demonstration which, over many centuries of development, have shown their profitability when applied to matters of this sort. I agree with Booth that these procedures, when valid, are in a broad sense rational, and (...) subject to analysis and some degree of definition. But the rules underlying such a discourse are complex, elusive, unsystematic, and subject to innovative modification; they manifest themselves in the intuitive expertise of the historian; and the specification of these rules should not precede, but follow practice. . . . After the fact, nevertheless, a book like Natural Supernaturalism is subject to close critical inquiry about its methods and rationale. I am grateful to Booth for opening up such an inquiry, and for doing so in a way that is not only disarming, but seems to me to be the most promising of useful results. That is, instead of adopting a prosecutorial stance, demanding: "Justify the rationality and probative force of what you have done; it looks dammed suspicious to me," he has adopted the friendly tactic of saying: "Your book, in my experience of it, has yielded discoveries that I want to call knowledge, by methods, however deviant from standard rubrics of valid reasoning, that it seems irrational to call non-rational. Let's set out to clarify what these methods are, and to see what grounds we can find for the claim that they provide warranted knowledge." M.H. Abrams' contributions to Critical Inquiry are "The Deconstructive Angel" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)

Clinicians' work depends on sincere and complete disclosures from their patients; they honour this candidness by confidentially safeguarding the information received. Breaching confidentiality causes harms that are not commensurable with the possible benefits gained. Limitations or exceptions put on confidentiality would destroy it, for the confider would become suspicious and un-co-operative, the confidant would become untrustworthy and the whole climate of the clinical encounter would suffer irreversible erosion. Excusing breaches of confidence on grounds of superior moral values introduces arbitrariness and (...) ethical unreliability into the medical context. Physicians who breach the agreement of confidentiality are being unfair, thus opening the way for, and becoming vulnerable to, the morally obtuse conduct of others. Confidentiality should not be seen as the cosy but dispensable atmosphere of clinical settings; rather, it constitutes a guarantee of fairness in medical actions. Possible perils that might accrue to society are no greater than those accepted when granting inviolable custody of information to priests, lawyers and bankers. To jeopardize the integrity of confidential medical relationships is too high a price to pay for the hypothetical benefits this might bring to the prevailing social order. (shrink)