Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three (...) key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” to “disclosure without the client’s knowledge or consent”. Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development. (shrink)

Editors of scientific literature rely heavily on peer reviewers to evaluate the integrity of research conduct and validity of findings in manuscript submissions. The purpose of this study was to describe the ethical concerns of reviewers of nursing journals. This descriptive cross-sectional study was an anonymous online survey. The findings reported here were part of a larger investigation of experiences of reviewers. Fifty-two editors of nursing journals (six outside the USA) agreed to invite their review panels to participate. A 69-item (...) forced-choice and open-ended survey developed by the authors based on the literature was pilot tested with 18 reviewers before being entered into SurveyMonkeyTM. A total of 1675 reviewers responded with useable surveys. Six questions elicited responses about ethical issues, such as conflict of interest, protection of human research participants, plagiarism, duplicate publication, misrepresentation of data and ‘other’. The reviewers indicated whether they had experienced such a concern and notified the editor, and how satisfied they were with the outcome. They provided specific examples. Approximately 20% of the reviewers had experienced various ethical dilemmas. Although the majority reported their concerns to the editor, not all did so, and not all were satisfied with the outcomes. The most commonly reported concern perceived was inadequate protection of human participants. The least common was plagiarism, but this was most often reported to the editor and least often led to a satisfactory outcome. Qualitative responses at the end of the survey indicate this lack of satisfaction was most commonly related to feedback provided on resolution by the editor. The findings from this study suggest several areas that editors should note, including follow up with reviewers when they identify ethical concerns about a manuscript. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

Convexity predicates and the convex hull operator continue to play an important role in theories of spatial representation and reasoning, yet their first-order axiomatization is still a matter of controversy. In this paper, we present a new approach to adding convexity to mereotopological theory with boundary elements by specifying first-order axioms for a binary segment operator s. We show that our axioms yields a convex hull operator h that supports, not only the basic properties of convex regions, but also complex (...) properties concerning region alignment. We also argue that h is stronger than convex hull operators from existing axiomatizations and show how to derive the latter from our axioms for s. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” who self-identified (...) as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

The COVID-19 pandemic has forced developmental researchers to rethink their traditional research practices. The growing need to study infant development at a distance has shifted our research paradigm to online and digital monitoring of infants and families, using electronic devices, such as smartphones. In this practical guide, we introduce the Experience Sampling Method – a research method to collect data, in the moment, on multiple occasions over time – for examining infant development at a distance. ESM is highly suited for (...) assessing dynamic processes of infant development and family dynamics, such as parent-infant interactions and parenting practices. It can also be used to track highly fluctuating family dynamics and routines. The aim of the current paper was to provide an overview by explaining what ESM is and for what types of research ESM is best suited. Next, we provide a brief step-by-step guide on how to start and run an ESM study, including preregistration, development of a questionnaire, using wearables and other hardware, planning and design considerations, and examples of possible analysis techniques. Finally, we discuss common pitfalls of ESM research and how to avoid them. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

This essay argues that Mark C. Murphy's original contribution to natural law ethics succeeds in finding a way between older metaphysical and newer purely practical approaches in this genre. Murphy's reconstruction of the function argument, critique of subjectivist theories of well-being, and rigorous formulation of a flexible welfarist theory of value deserve careful attention. I defend Kant against Murphy's critique and argue that Murphy faces the problem of showing that all his basic goods are morally inviolable. Although I endorse Murphy's (...) critique of radical virtue ethics, I raise objections to the basic moral norms he derives from his list of goods, and to the analysis of peace of mind and happiness as basic goods. (shrink)

BackgroundAdherence to widely accepted practice standards is a frequently used measure of healthcare quality. In the U.S., the most widely recognized authoritative source of practice standards for ethics consultation (EC) is the second edition of the American Society for Bioethics and Humanities’ Core Competencies for Healthcare Ethics Consultation report.MethodsTo determine the extent to which EC practices in U.S. hospitals adhere to these practice standards, we developed and analyzed 12 evaluative measures from a national survey.ResultsOnly three of the 12 standards achieved (...) over 75% adherence with reported EC practices: allowing anyone involved in a case to request an EC (100%), not requiring an attending physician’s permission to conduct an EC (97.6%), and having at least one person on the ethics consultation service (ECS) with advanced level EC proficiency (79.3%).ConclusionsImplications are discussed for achieving consensus on EC standards as they continue to evolve. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

Marion Bourbon Que l’activité philosophique chez la plupart des philosophes antiques ait prétendu disposer d’une fonction thérapeutique, psychothérapeutique, nous le savons bien, tant cette dernière s’est explicitement pensée sur le modèle médical. Il ne faut néanmoins pas oublier qu’alors, dans le même temps, c’est la médecine elle-même qui s’est trouvée apparentée à la philosophie en ce qu’elle suppose intrinsèquement un usage du logos, ce que Platon le premier pose sans ambages. Cette métaphore de la philosophie comme thérapie a aussi (...) ressurgi plus récemment en philosophie analytique, sous la plume de Wittgenstein pour lequel « la philosophie traite une question comme une maladie ». Mais jusqu’à quel point s’agit-il de dire la même chose? (shrink)

Patronizing the Public is the first detailed and comprehensive examination of how American philanthropy has transformed culture, communication, and the humanities. Drawing on an impressive range of archival and secondary sources, the chapters in the volume shed light on philanthropic foundations have shaped numerous fields, including film, television, radio, journalism, drama, local history, museums, as well as art and the humanities in general.

Yarkoni's analysis clearly articulates a number of concerns limiting the generalizability and explanatory power of psychological findings, many of which are compounded in infancy research. ManyBabies addresses these concerns via a radically collaborative, large-scale and open approach to research that is grounded in theory-building, committed to diversification, and focused on understanding sources of variation.

Cette livraison de Corpus propose de s’intéresser aux faits phraséologiques, c’est-à-dire à cet ensemble de « prêts-à-dire », de « déjà-là », de formules « clef-en-main » aux fonctions communicationnelles variées : zones de confort pour les uns, les faits phraséologiques peuvent faciliter la prise de parole ou les tâches rédactionnelles (Née, Sitri, Veniard 2014 ; Cislaru, Sitri, Pugnière-Saavedra 2013), contribuer à marquer une identité sociale ou professionnelle (Römer 2010 ; Née, Sitri, Ve...

La notion de témoignage est au cœur d’une branche de la théorie de la connaissance, appelée « épistémologie du témoignage », qui s’interroge sur le bien-fondé des croyances acquises par le biais d’autrui – par opposition aux seules capacités sensorielles et intellectuelles de l’individu. Le témoignage est aussi un des modes de preuve les plus importants dans le cadre judiciaire, aussi bien au cours de l’enquête et de l’instruction que du procès, et a fait l’objet de nombreuses réflexions de la (...) part de juristes, en particulier dans les pays de common law. Par-delà les différences disciplinaires, les distinctions des juristes sont à même d’apporter un éclairage nouveau à la réflexion épistémologique, laquelle invite à reconsidérer certaines définitions juridiques. (shrink)

Captatio benevolentiae Le « Reich », c’est à la fois le Royaume et l’Empire, le Royaume des cieux et les royaumes terrestres. Dans ces « Reiche », le pouvoir terrestre est intrinsèquement lié à l’autorité divine. Mais le « Reich » nous permet également d’en percevoir l’autre face : le Royaume des cieux, tel qu’il s’imagine, s’espère et s’anticipe, s’étaye sur la notion du pouvoir politique terrestre ; en ce sens, il en est également indissociable. Cette problématique que la notion (...) de « Reich... (shrink)

This superb new translation of Nietzsche's mature masterpiece, Beyond Good and Evil, offers the most comprehensively annotated text, complemented by a lucid introduction by one of the most eminent of Nietzsche scholars, Robert C. Holub.

Cet article vise à comprendre la théorie stoïcienne de la deixis afin d’expliquer l’importance accordée par les stoïciens aux pronoms démonstratifs et aux énoncés qu’ils composent, c’est-à-dire les propositions dites définitives. Nous montrons que ces propositions sont privilégiées pour des raisons à la fois ontologiques et épistémologiques en raison des propriétés sémantiques de leur sujet. Elles sont privilégiées d’un point de vue ontologique parce que la deixis grâce à laquelle leur sujet fait référence au réel crée une relation privilégiée à (...) la matière, la catégorie ontologique stoïcienne fondamentale. De plus, ces sujets requièrent que leur référent existe et soit présent et saisissable. Ces énoncés sont d’autre part privilégiés d’un point de vue épistémologique parce qu’ils sont fondamentaux dans l’acquisition de la connaissance. Nous suggérons enfin que tous les énoncés apparemment définis ne le sont pas en effet, et considérons quand et sous quelles conditions une référence déictique est réussie. (shrink)

Le corps constitue un axe fort de la pensée de Michel Foucault. En 1963, déjà, La Naissance de la clinique se présente comme une histoire des distributions spatiales que le regard médical effectue sur les corps. Mais c’est dans les années 1970, plus encore, que le tournant généalogique opéré par Foucault confère au corps une importance primordiale : celui-ci forme alors le point de départ d’une enquête qui s’ancre dans l’expérience corporelle de la prison, en même temps qu’il apparaît, au (...) ter... (shrink)

Cet article entend défaire une apparence de contradiction : comment Condillac, dans l’Essai sur l’origine des connaissances humaines, peut-il à la fois placer la sensation à l’origine de la connaissance et attribuer à la « liaison des idées » un statut principiel? Faut-il comprendre que la connaissance, loin de commencer avec des atomes sensibles reçus passivement par l’esprit, constitue d’emblée une activité? Après avoir écarté une telle lecture, l’article établit que la « liaison des idées » est certes dérivée dans (...) l’ordre de la connaissance, mais bel et bien première dans celui de l’expérience actuelle : l’analyse de l’entendement ne saurait remonter au-delà des idées liées – ce qui précède de telles liaisons, à savoir la perception réduite à sa dimension de sensation, est irrémédiablement perdu pour l’esprit. Non seulement il est impossible de remonter plus haut que les idées liées entre elles, mais ces liaisons d’idées sont toujours en même temps des liaisons de mots. Ce serait là faire de Dieu l’origine de la connaissance, si Condillac, comme Malebranche, faisait du langage un présent divin. Mais parce que l’arbitraire du signe est une institution humaine, c’est bien l’homme, et non Dieu, qui est in fine le créateur des idées. (shrink)

Robert Yerkes is a pivotal figure in American psychology and primatology in the first half of the twentieth century. As is well known, Yerkes first studied ape intelligence in 1915, on a visit to the private California laboratory of the psychiatrist Gilbert Hamilton, a former student. Less widely appreciated is how far the work done at the Hamilton lab, in its aims and ambitions as well as its techniques, served as a template for much of Yerkes’s research thereafter. This paper (...) uses the Hamilton–Yerkes relationship to re-examine Yerkes’s career and, more generally, that of American psychology in the early twentieth century. Three points especially are emphasized: first, the role of Freudian psychoanalysis as a spur to Hamilton’s experimental studies of ape intelligence; second, the importance of Hamilton’s laboratory, with its semi-wild population of monkeys and ape, as a model for Yerkes’s efforts to create a laboratory of his own; and third, the influence on Yerkes of Hamilton’s optimism about experimental psychological studies of nonhuman primates as a source of lessons beneficial to a troubled human world. (shrink)

For X a separable metric space and $\alpha$ an infinite ordinal, consider the following three games of length $\alpha$ : In $G^{\alpha}_1$ ONE chooses in inning $\gamma$ an $\omega$ –cover $O_{\gamma}$ of X; TWO responds with a $T_{\gamma}\in O_{\gamma}$ . TWO wins if $\{T_{\gamma}:\gamma<\alpha\}$ is an $\omega$ –cover of X; ONE wins otherwise. In $G^{\alpha}_2$ ONE chooses in inning $\gamma$ a subset $O_{\gamma}$ of ${\sf C}_p(X)$ which has the zero function $\underline{0}$ in its closure, and TWO responds with a function (...) $T_{\gamma}\in O_{\gamma}$ . TWO wins if $\underline{0}$ is in the closure of $\{T_{\gamma}:\gamma<\alpha\}$ ; otherwise, ONE wins. In $G^{\alpha}_3$ ONE chooses in inning $\gamma$ a dense subset $O_{\gamma}$ of ${\sf C}_p(X)$ , and TWO responds with a $T_{\gamma}\in O_{\gamma}$ . TWO wins if $\{T_{\gamma}:\gamma<\alpha\}$ is dense in ${\sf C}_p(X)$ ; otherwise, ONE wins. After a brief survey we prove: 1. If $\alpha$ is minimal such that TWO has a winning strategy in $G^{\alpha}_1$ , then $\alpha$ is additively indecomposable (Theorem 4) 2. For $\alpha$ countable and minimal such that TWO has a winning strategy in $G^{\alpha}_1$ on X, the following statements are equivalent (Theorem 9): a) TWO has a winning strategy in $G^{\alpha}_2$ on ${\sf C}_p(X)$ . b) TWO has a winning strategy in $G^{\alpha}_3$ on ${\sf C}_p(X)$ . 3. The Continuum Hypothesis implies that there is an uncountable set X of real numbers such that TWO has a winning strategy in $G^{\omega^2}_1$ on X (Theorem 10). (shrink)

Nous défendons ici l’hypothèse que l’irruption de la langue du vouloir ( uelle ) chez Sénèque n’est pas sans effet sur la représentation stoïcienne du telos, contre un certain nombre d’interprétations qui dénient à cette innovation lexicale la moindre originalité par rapport à la psychologie stoïcienne hellénistique. Le telos est réinscrit dans la perspective de la traversée de la conflictualité psychique dont le vouloir ( uelle ), dans sa constance, constitue la résolution. C’est dire combien la subjectivation engage le destin (...) du désir, celui d’un conflit porté par la uoluntas, envisagée donc dans toute son historicité, et à ce titre devenue principe d’identité personnelle. Le telos fait apparaître plus explicitement qu’avant un sujet du vouloir, tout à la fois comme principe et comme effet du processus de subjectivation. (shrink)

Sixième ouvrage de l’auteur, ce livre exhausse l’idée de méthode au rang d’objet plein et entier non seulement de l’histoire de la philosophie, mais de la philosophie elle-même. André Charrak signale ainsi dès l’introduction (sur laquelle nous reviendrons, tant elle offre, de par la réflexivité dont elle fait preuve, tous les outils nécessaires à la lecture du texte) : « Ce livre propose un cheminement dans l’œuvre de Rousseau » (p. 7). Aussi l’ouvrage est-il un hodos, c’est-à-dire littéralem...