Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa. A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity (...) in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile. (shrink)

McCarthy, Homan, and Rozier’s presentation of theological anthropology and its contribution to secular bioethics suffers from three primary limitations. First, the article re...

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

Bianchi and colleagues have written an important article that proposes a harm reduction approach to eating disorders that mediates the ethical tension in the l...

The case recapitulates many of the core issues in geriatric ethics that the aging American population will increasingly present to ethics consultation services. The classic ethical dilemma: autonom...

Traditional approaches to human subjects protections in the United States focus on the ethical principles from the Belmont Report: respect for persons, beneficence, and justice. Since research regu...

The definitive book on ethics for chemical dependency treatment professionals.

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)

When patients are admitted to the hospital, they are generally expected to remain in or within close proximity to their assigned rooms in order to promote their safety and appropriate medical care. Although there are circumstances when patients may safely leave their hospital room or floor, guidance within the medical literature for the management of patient movement within the hospital are lacking. Excessive restrictions on patient movement may be seen as overly paternalistic, while lax requirements may interfere with high quality (...) care, patient safety and efficient hospital practice. As a result, guidance in the form of institutional policy is warranted. Such policy development should take into consideration the potential clinical, legal, and ethical concerns in balancing the competing values of patients’ preferences and respect for autonomy, while ensuring high quality, safe, and efficacious medical care. This paper will provide a framework for hospitals to create institution-specific patient movement policies that are fair, systematic, and transparent. (shrink)

Massively parallel sequencing, also known as next‐generation sequencing, has the potential to significantly improve newborn screening programs in the United States and around the world. Compared to genetic tests whose use is well established, sequencing allows for the analysis of large amounts of DNA, providing more comprehensive and rapid results at a lower cost. It is already being used in limited ways by some public health newborn screening laboratories in the United States and other countries—and it is under study for (...) broader and more widespread use, including as a core part of newborn screening programs. Sequencing technology has the potential to significantly improve these essential public health programs. For many of the conditions that newborns are already screened for, sequencing can return more specific and more sensitive results. The technology could also enable newborn screening programs to expand the list of rare pediatric conditions that they look for, thereby identifying more infants who can benefit from immediate care. (shrink)

Although Gloria Anzaldúa's critical categories have steadily entered discussions in the field of philosophy, a lingering skepticism remains about her works’ ability to transcend the particularity of her lived experience. In an effort to respond to this attitude, I make Anzaldúa's corpus the center of philosophical analysis and posit that immanent to this work is a logic that lends it the unity of a critical philosophy that accounts for its concrete, multilayered character and shifting, creative force. I call this an (...) “affective logic of volverse una.” Starting with the understanding of a situated modality of all subjectivity, Anzaldúa's work exhibits a logic of three moments distinguished by states of awareness. Each state of awareness is characterized by the generative degree of the subject's responses to its conditions: critical, individuating, and expansive. Led by her late concepts of conocimiento and nepantlera, I return to her earlier works and trace Anzaldúa's innovative exploration of undoing the oppressive condition of marginal subjectivities from “La Prieta” through Borderlands/La Frontera to her final published essay “now let us shift.” I find a liberatory schema of volverse una/becoming whole that is grounded in an active receptivity of sensibility and facilitated by affective technologies for transformation. (shrink)

A REFERENCE by the poet Martial to an abridged version of the history of Livy has given rise to the view that this epitome provided the main source for the transmission of Livy for those later writers of history whose requirements demanded an outline history of Rome. Such a view was first set out by Mommsen in 1861; he concluded that a large number of authors drew much of their material not from Livy directly but from a lost Epitome which (...) departed at some points from the original in its composition. Other scholars followed his general thesis; indeed they have built upon it to such an extent that the list they compile of writers of Roman history who drew upon the ‘lost Epitome’ is a formidable one. These authors range from the period of Tiberius to the end of antiquity. They include such divergent writers as Valerius Maximus, Florus, Eutropius, the Auctor de viris illustribus, and Orosius, as well as the two known abbreviations made of Livy: the Periochae of the Oxyrhynchus Papyrus and the ‘fourth-century’ Periochae. (shrink)

Winner of the Premio Iberoamericano Book Award in 1997 What form does the crisis of modernity take in Latin America when societies are politically demobilized and there is no revolutionary agenda in sight? How does postmodern criticism reflect on enlightenment and utopia in a region marked by incomplete modernization, new waves of privatization, great masses of excluded peoples, and profound sociocultural heterogeneity? In _No Apocalypse, No Integration _Martín Hopenhayn examines the social and philosophical implications of the triumph of neoliberalism and (...) the collapse of leftist and state-sponsored social planning in Latin America. With the failure of utopian movements that promised social change, the rupture of the link between the production of knowledge and practical intervention, and the defeat of modernization and development policy established after World War II, Latin American intellectuals and militants have been left at an impasse without a vital program of action. Hopenhayn analyzes these crises from a theoretical perspective and calls upon Latin American intellectuals to reevaluate their objects of study, their political reality, and their society’s cultural production, as well as to seek within their own history the elements for a new collective discourse. Challenging the notion that strict adherence to a single paradigm of action can rescue intellectual and cultural movements, Hopenhayn advocates a course of epistemological pluralism, arguing that such an approach values respect for difference and for cultural and theoretical diversity and heterodoxy. This essay collection will appeal to readers of sociology, public policy, philosophy, cultural theory, and Latin American history and culture, as well as to those with an interest in Latin America’s current transition. (shrink)

Reflections on incivility and why civility matters -- The costs and consequences of incivility : rationale for change -- The inextricable link between stress and incivility -- The "dance of incivility and civility" in nursing education -- Raising awareness, naming the problem, and creating a vision for civility -- Principled leadership and the power of positive role-modeling and mentoring -- Pathway for fostering organizational civility : institutionalizing change -- Fostering effective and meaningful communication -- The first day of class : (...) co-creating a positive learning environment -- Scholarly teaching, engaged learning, and finding our joy -- The healing power of stress management and self-care -- Seeking and keeping civility in nursing education. (shrink)

BackgroundAustralian health and medical research funders support substantial research efforts, and incentives within grant funding schemes influence researcher behaviour. We aimed to determine to what extent Australian health and medical funders incentivise responsible research practices.MethodsWe conducted an audit of instructions from research grant and fellowship schemes. Eight national research grants and fellowships were purposively sampled to select schemes that awarded the largest amount of funds. The funding scheme instructions were assessed against 9 criteria to determine to what extent they incentivised (...) these responsible research and reporting practices: publicly register study protocols before starting data collection, register analysis protocols before starting data analysis, make study data openly available, make analysis code openly available, make research materials openly available, discourage use of publication metrics, conduct quality research, collaborate with a statistician, and adhere to other responsible research practices. Each criterion was answered using one of the following responses: “Instructed”, “Encouraged”, or “No mention”.ResultsAcross the 8 schemes from 5 funders, applicants were instructed or encouraged to address a median of 4 of the 9 criteria. Three criteria received no mention in any scheme. Importantly, most incentives did not seem strong as applicants were only instructed to register study protocols, discourage use of publication metrics and conduct quality research. Other criteria were encouraged but were not required.ConclusionsFunders could strengthen the incentives for responsible research practices by requiring grant and fellowship applicants to implement these practices in their proposals. Administering institutions could be required to implement these practices to be eligible for funding. Strongly rewarding researchers for implementing robust research practices could lead to sustained improvements in the quality of health and medical research. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (shrink)

Advance directives are critically important for capable individuals who wish to avoid the burdens of life-prolonging interventions in the advanced stages of dementia. However, this paper will argue that advance directives should have less application to questions about feeding patients during the clinical course of dementia than often has been presumed. The argument will be framed within the debate between Ronald Dworkin and Rebecca Dresser regarding the moral authority of precedent autonomy to determine an individual’s future end-of-life care plan. We (...) will use a brief analysis of the positions taken in two important papers that come out of the Dworkin/Dresser debate and a hypothetical patient, John, who will be followed from diagnosis of dementia to death, to show how advance directives should apply to key points in the progression of his disease, particularly in relation to food and nutrition. (shrink)

Half of the 33.2 million people living with HIV today are women. Yet, responses to the epidemic are not adequately meeting the needs of women. This article critically evaluates how prevention of mother-to-child transmission (PMTCT) programs, the principal framework under which women's health is currently addressed in the global response to AIDS, have tended to focus on the prevention of HIV transmission from HIV-positive women to their infants. This paper concludes that more than ten years after their inception, PMTCT programs (...) still do not successfully ensure the adequate treatment, care and support of HIV-infected women. Of particular concern is the continued widespread use of single-dose nevirapine despite World Health Organization recommendations to employ more effective combination therapies that do not potentially jeopardize women's future treatment outcomes. In response, the article calls for a more comprehensive approach that places women's health needs at the centre of AIDS responses. This is critical in settings where the pandemic is generalized and there is a push to greatly expand PMTCT programs, as a more effective and equitable way of meeting the needs of women in the context of HIV. Without such a comprehensive approach, women will continue to be impacted disproportionately by the pandemic, and current strategies for prevention, including PMTCT, and treatment will not be as effective and responsive as they need to be. (shrink)

Although considerable research indicates that mental energy is an important factor in many domains, including athletic performance (Cook & Davis, 2006), athletic mental energy (AME) has never been conceptualized and measured. Therefore, the aim of this study was to conceptualize and develop a reliable and valid instrument to assess athletic mental energy. In Study 1, a focus group interview established the initial framework of athletic mental energy. Study 2 used a survey to collect athletes’ experiences of athletic mental energy and (...) develop a scale draft titled “Athletic Mental Energy Scale (AMES).” In Study 3, we examined the psychometric properties and the underlying structure of AMES via item analysis, internal consistency, and exploratory factor analysis (EFA). In Study 4, we used confirmatory factor analysis (CFA) to examine AMES’s factorial validity; and examined concurrent and discriminant validity by examining correlations with athletes’ life stress, positive state of mind, and burnout. In study 5, we examined the measurement invariance of the 6-factor, 18-item AMES with Taiwanese and Malaysian samples. Study 6 examined the predictive validity by comparing AMES scores of successful and unsuccessful martial artists. Across these phases, results showed a 6-factor, 18-item AMES had adequate content validity, factorial structure, nomological validity, discriminant validity, predictive validity, measurement invariance, and reliability. We suggest future studies may use AMES to examine its relationships with athletes’ cognition, affect, and performance. The application of AMES in sport psychology was also discussed. (shrink)

It is our privilege to be invited to write a commentary on the "Interface of Ethics and Psychiatry: A Philosophical Case Consultation on Psychiatric Ethics on the Ground." The article presents an innovative collaboration between a philosopher and a psychiatrist reasoning together through the ethical aspects of three clinical cases. The case consultation also offers a unique opportunity to reflect on the teaching of psychiatric ethics in clinical settings. This commentary explores those areas of the article from the perspective of (...) a teacher and trainee whose mentoring relationship is grounded in their shared interest in philosophy and psychiatric ethics.A quick search on PubMed and Google Scholar confirms my own... (shrink)

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

Fisher, Jin, and Scott push a central assumption of syntactic bootstrapping: that learners have a universal bias to map each noun in a sentence onto a participant role (i.e., argument of the verb). They propose two enrichments: First, that children use both semantic and syntactic information in representing nouns that accompany a verb; second, that children expect continuity across a discourse. They provide evidence for both learning mechanisms among young children, further spelling out the precise mechanisms underlying syntactic bootstrapping.

Positive public perceptions of academic quality and professional ethics are critical to the long-term legitimacy of American colleges and universities. Faculty codes of conduct are one mechanism whereby the professoriate can define acceptable practice, exercise social control, and maintain public confidence in higher education, yet the drivers of their adoption are not well understood. Building upon previous research into such organizational behavior by institutional type, this study examined the prevalence and content of publicly posted faculty codes of conduct within an (...) organizational field of institutions that share a common religious identity but differ in their institutional types and employment structures. Faculty handbooks from American member institutions of the Council for Christian Colleges & Universities, an international association of faith-based institutions, were gathered and analyzed. Although only 27% of CCCU member institutions in the U.S. publicly posted faculty codes of conduct, the average number of tenets present in each code was higher than suggested by previous research. Study findings also revealed that membership category, institutional type, and employment structures influence the content of faculty codes of conduct, indicating that isomorphic pressures operate within this particular organizational field. The piece concludes by commending publicly posted codes of conduct as an affirmation of the personal responsibility, fairness, and care exercised by ethical professionals in the academy. (shrink)

We describe the educational character and leadership development processes used by the United States Air Force Academy that other educational institutions may find useful. Our processes include an integrated educational curriculum designed to complement and integrate the experiential learning that results in achieving specific organizational outcomes, co-curricular activities in cadet living, and a specific focus on the ethical development of leaders’ respect for human dignity and cultural competency as well as the mechanisms to assess and refine our processes.

This book's importance is derived from three sources: careful conceptualization of teacher induction from historical, methodological, and international perspectives; systematic reviews of research literature relevant to various aspects of teacher induction including its social, cultural, and political contexts, program components and forms, and the range of its effects; substantial empirical studies on the important issues of teacher induction with different kinds of methodologies that exemplify future directions and approaches to the research in teacher induction.

Volume 20, Issue 7, July 2020, Page 145-147.

To test the notion that shifts in visual imagery and attention are correlated with experiences of emotion, we studied 10 dream reports using an affirmative probe of emotion and a quantitative measure of plot discontinuity. We found that emotion, especially changes in emotion, are correlated with discontinuities in visual imagery. These correlations are quantified using a new graph theoretical method for analyzing narrative reports.

Hastings Center Report, Volume 52, Issue S1, Page S83-S88, March‐April 2022.