In this issue, Ellen Fox and colleagues report on their national study on ethics consultation in U.S. hospitals, following up on the previous 1999–2000 landmark study. Th...

Volume 20, Issue 3, March 2020, Page 1-5.

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and (...) Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and (...) Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed (...) in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

This article reviews the history of medical and research abuses experienced by American Indians since European colonization. This article examines the unethical research of American Indians/Alaska Natives in light of the Tuskegee Study of Untreated Syphilis in the Negro Male. Literature citations indicate that significant unethical research and medical care incidents occurred both before and after the Tuskegee Syphilis Study among American Indians/Alaska Natives. The majority of these unethical abuses were committed by the federal government and within the historical context (...) of a long-term contentious relationship between American Indians and the federal government. Although President Clinton issued a highly visible public apology to the African American survivors of the Tuskegee syphilis experiment in 1997, American Indians have yet to experience such visible federal acknowledgment. To ensure ethical research in which benefits outweigh risks and findings are not value-laden or misrepresented, tribes have instituted their own Institutional Review Boards coupled with community-participatory activities. (shrink)

This book constitutes the refereed proceedings of the International Conference on Spatial Information Theory, COSIT 2005, held in Elliottville, NY, USA in September 2005. The 30 revised full papers presented were carefully reviewed and selected from 82 submissions. The papers are organized in topical sections on vagueness, uncertainty, and gradation; paths and routes; ontologies and semantics; ontologies and spatial relations; spatial reasoning: cognitive maps and spatial reasoning; time, change, and dynamics; landmarks and navigation; geographic information, and spatial behaviour.

Number terms and quantifiers share a range of linguistic (syntactic, semantic, and pragmatic) properties. On the basis of these similarities, one might expect these 2 classes of linguistic expression to pose similar problems to children acquiring language. We report here the results of an experiment that explicitly compared the acquisition of numerical expressions (two, four) and quantificational (some, all) expressions in younger and older 3-year-olds. Each group showed adult-like preferences for “exact” interpretations when evaluating number terms; however they did not (...) use the corresponding upper bounded interpretation when evaluating the quantifier some. Apparently, children follow different procedures for learning and evaluating numerals and quantifiers. These findings have implications for theories of number representation in child and adult grammars. (shrink)

There is a global shortage of nurses that affects healthcare delivery, which will be exacerbated with the increasing demand for healthcare professionals by the aging population. The growing shortage requires an ethical exploration on the issue of nurse migration. In this article, we discuss how migration respects the autonomy of nurses, increases cultural diversity, and leads to improved patient satisfaction and health outcomes. We also discuss the potential for negative impacts on public health infrastructures, lack of respect for cultural diversity, (...) and ethical concerns related to autonomy and justice, including coercion and discrimination. This analysis is written from a rights-based ethics approach by referring to rights held by nurses and patient populations. Nurse migration highlights conflicts between nurses and between nurses and healthcare systems. Increased awareness of ethical challenges surrounding nurse migration must be addressed to enhance the well-being of nurses and patient populations. (shrink)

Consider these three positions about physician-assisted suicide:Physician-assisted suicide should be illegal for everyone.Physician-assisted suicide should be legal for only the terminally ill.Physician-assisted suicide should be legal for all competent adults.So far, the debate in America has been primarily between positions 1 and 2. I think it should be between positions 1 and 3. Both those positions embody reasonable viewpoints, and I will not try to decide between them in this chapter. But I will argue that the double standard embodied in (...) position 2 is morally untenable. (shrink)

What does it mean to know who you are? Is it a matter of knowing your name? The things that you’ve done? The people you love? Such indispensible knowledge is somehow not enough; I can know all of these things, and still feel puzzled about who I am. “I am not the person I once was,” “I am not myself today,” and “I am learning who I am,” are all commonplace poems of a kind: expressive sentences completely at home both (...) in literature and ordinary life. Such a poem is the sentence “I know who I am.” This last is one of the many grand and emblematic boasts of Miguel de Cervantes’s hilariously self-fashioned knight, Don Quixote de la Mancha, a boast that can seem both impossible and yet utterly sensible, part quixotic and... (shrink)

A common contention of literary criticism is that literary forms can express, reflect, shape, represent or otherwise give form to human life. Literature can seem to offer the same idea as a promise of life’s meaningfulness; where expressive form is powerful, life need not be empty. Can literary forms give form to human life? I will argue for one sense in which this is true. As will become clear, at stake in this inquiry is not simply an idea about the (...) meaningfulness of literature’s poetry, but a way of answering the question of what it means to be human. (shrink)

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as well (...) as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care. (shrink)

Current theories of knowledge, art, and power are locked into sterile debates around the question of representation. This book examines the limits of antirepresentationalism in these fields and argues that the anarchist tradition can point the way beyond our contemporary crisis of representation. The author rereads the theory and practical experiences of anarchism from the nineteenth century to the present, proposing a radical revision of received notions of the subject - from the equation of anarchy with literary decadence to the (...) interpretation of anarchism as yet another discourse founded on a notion of the human essence. What emerges, instead, is a complex portrait of anarchism as a body of thought that provides the framework for a kind of critical realism, with implications for fields ranging from aesthetics to economics, from philosophy to politics. Jesse Cohn teaches English at Purdue University North Central. (shrink)

Anyone who thinks contemporary American society is hopelessly contentious and lacking in shared values has probably not been paying attention to the way the popular media portray the hospice movement. Over and over, we are told such things as that “Humane care costs less than high-tech care and is what patients want and need,” that hospices are “the most effective and least expensive route to a dignified death,” that hospice personnel are “heroic,” that their “compassion and dedication seem inexhaustible,” and (...) that “few could argue with the powerful message that it is better [for dying patients] to leave wrapped in the love of family and care givers than locked in the cold, metallic embrace of a machine.“. (shrink)

Throughout history human beings have been preoccupied with personal survival after death. As a consequence, most world religions proclaim that life continues beyond the grave, and they have depicted the Hereafter in a variety of forms. These various conceptions constitute answers to the most perplexing spiritual questions: Will we remember our former lives in the Hereafter? Will we have bodies? Can bodiless souls recognise each other? Will we continue to have personal identity? Will we be punished or rewarded, or absorbed (...) into the Godhead? These issues serve as the basis of this collection of essays which provide a framework for understanding traditional conceptions of the Hereafter as well as new perspectives. (shrink)

Anyone who thinks contemporary American society is hopelessly contentious and lacking in shared values has probably not been paying attention to the way the popular media portray the hospice movement. Over and over, we are told such things as that “Humane care costs less than high-tech care and is what patients want and need,” that hospices are “the most effective and least expensive route to a dignified death,” that hospice personnel are “heroic,” that their “compassion and dedication seem inexhaustible,” and (...) that “few could argue with the powerful message that it is better [for dying patients] to leave wrapped in the love of family and care givers than locked in the cold, metallic embrace of a machine.“. (shrink)

This article suggests that ?evolutionary vision,? the unifying paradigm of physical, biological, and sociocultural evolution, needs to be fully embodied and deeply experienced in the human being, and that this can be effected by the experience at the heart of the ?perennial wisdom tradition,? 1 that is, that of ?non-dual perception.? The article suggests an ?action-based? experiment paralleling the method of a ?thought experiment,? based on the assumption that one way that one can experience this embodiment is by ?trying on? (...) the lens of non-dual perception, as practiced by the many traditions of perennial wisdom. (shrink)

This article explores insights of physicist David Bohm on the source of thought and the creative intelligence that emerges from this source. It highlights a link that Bohm sees between this creativ...