As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities has published core knowledge (...) competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent (...) that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (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)

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)

This paper discusses the ethical issues related to hemicorporectomy surgery, a radical procedure that removes the lower half of the body in order to prolong life. The literature on hemicorporectomy (HC), also called translumbar amputation, has been nearly silent on the ethical considerations relevant to this rare procedure. We explore five aspects of the complex landscape of hemicorporectomy to illustrate the broader ethical questions related to this extraordinary procedure: benefits, risks, informed consent, resource allocation and justice, and loss and the (...) lived body. (shrink)

Benchmarks against which healthcare ethics consultation (HCEC) services can assess their performance are needed. As first-generation benchmarks continue to be developed, it is the obligation of the field to continually evaluate how these measures reflect the performance of any single HCEC service. This will be possible only with widespread reporting of standardized data points. In their article in this issue of The Journal of Clinical Ethics, Glover and colleagues provide a valuable preliminary approach for assessing appropriate consult volumes for a (...) HCEC service. The limitations of their study read as a call to action for the field of clinical ethics to expand and standardize data reporting so that more robust metrics can be developed. In response to this call by Glover and colleagues, the Cleveland Clinic HCEC service provides consult data from 2015 through 2019 for one of its medical centers, and offers an additional volumebased metric, consult-to-ICU-to-bed ratio (CiBR), that may add nuance to any normative assessment of HCEC service consult volume. Given that volume-based metrics are the native language of the clinical environment, efforts to improve such metrics in the field through transparency and standardization are warranted. However, the expositive power of volume-based metrics is limited; additional domains related to quality and outcomes are needed. (shrink)

For Lack of a Better Plan: A Framework for Ethical, Legal, and Clinical Challenges in Complex Inpatient Discharge Planning Content Type Journal Article Pages 311-326 DOI 10.1007/s10730-009-9117-6 Authors Jane Jankowski, Albany Medical Center Albany NY 12208 USA Terese Seastrum, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Robert N. Swidler, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Wayne Shelton, Alden March Bioethics Institute, Albany Medical College 47 New Scotland Avenue, MC 153 Albany NY 12208-3478 USA (...) Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

This article presents the case of a mother who is planning a home birth with a midwife with the shared knowledge that the fetus would have congenital anomalies of unknown severity. We discuss the right of women to choose home birth, the caregivers’ duty to the infant, and the careproviders’ dilemma about how to respond to this request. The ethical duties of concerned careproviders are explored and reframed as professional obligations to the mother, infant, and their profession at large. Recommendations (...) are offered based on this case in order to clarify the considerations surrounding not only home birth of a fetus with anticipated anomalies, but also to address the ethical obligations of caregivers who must navigate the unique tension between respecting the mother’s wishes and the duty of the careproviders to deliver optimal care. (shrink)

The nurse asks the ethics consultant what can be done to stop the patient’s blogging. R.J.’s messages on the public forum are taking their toll on the care environment and the health care providers...

Volume 20, Issue 3, March 2020, Page 21-24.

The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

Volume 20, Issue 6, June 2020, Page 75-77.

Despite an abundance of academic conferences, clinical ethicists lacked a forum to share innovative practices with peers and to generate solutions to common challenges. Organizers of the first Clinical Ethics Un-Conference developed a working event centered on active participation and problem solving through peer learning, with the goal of improving realworld practice. Registrants included 95 individuals from 64 institutions. Attendees were surveyed immediately after the Un-Conference, and again eight months later. After eight months, 85 percent (n = 33/39) of the (...) survey respondents reported that they found the event “highly impactful” or “some-what impactful” to their clinical practice, and 23 attendees reported that they had implemented ideas or projects inspired by the event. Three sets of best practice guidelines and four white papers were published from the event. As the field of clinical ethics continues to advance and evolve, this working event format offers an innovative, disruptive alternative to a traditional conference format and may serve as a model for future efforts aimed at improving real-world clinical ethics practice. (shrink)

"It is well to remind ourselves, from time to time, that "Ethics" is but another word for "righteousness," that for which many men and women of every generation have hungered and thirsted, and without which life becomes meaningless. Certain forms of personal righteousness have become to a majority of the community almost automatic. But we all know that each generation has its own test, the contemporaneous and current standard by which alone it can adequately judge of its own moral achievements. (...) To attain individual morality in an age demanding social morality, to pride one's self on the results of personal effort when the time demands social adjustment, is utterly to fail to apprehend the situation. This book is a study of various types and groups who are being impelled by the newer conception of Democracy to an acceptance of social obligations involving in each instance a new line of conduct."--. (shrink)

"It is well to remind ourselves, from time to time, that "Ethics" is but another word for "righteousness," that for which many men and women of every generation have hungered and thirsted, and without which life becomes meaningless. Certain forms of personal righteousness have become to a majority of the community almost automatic. But we all know that each generation has its own test, the contemporaneous and current standard by which alone it can adequately judge of its own moral achievements. (...) To attain individual morality in an age demanding social morality, to pride one's self on the results of personal effort when the time demands social adjustment, is utterly to fail to apprehend the situation. This book is a study of various types and groups who are being impelled by the newer conception of Democracy to an acceptance of social obligations involving in each instance a new line of conduct."--. (shrink)

In _Vibrant Matter_ the political theorist Jane Bennett, renowned for her work on nature, ethics, and affect, shifts her focus from the human experience of things to things themselves. Bennett argues that political theory needs to do a better job of recognizing the active participation of nonhuman forces in events. Toward that end, she theorizes a “vital materiality” that runs through and across bodies, both human and nonhuman. Bennett explores how political analyses of public events might change were we (...) to acknowledge that agency always emerges as the_ _effect of ad hoc configurations of human and nonhuman forces. She suggests that recognizing that agency is distributed this way, and is not solely the province of humans, might spur the cultivation of a more responsible, ecologically sound politics: a politics less devoted to blaming and condemning individuals than to discerning the web of forces affecting situations and events. Bennett examines the political and theoretical implications of vital materialism through extended discussions of commonplace things and physical phenomena including stem cells, fish oils, electricity, metal, and trash. She reflects on the vital power of material formations such as landfills, which generate lively streams of chemicals, and omega-3 fatty acids, which can transform brain chemistry and mood. Along the way, she engages with the concepts and claims of Spinoza, Nietzsche, Thoreau, Darwin, Adorno, and Deleuze, disclosing a long history of thinking about vibrant matter in Western philosophy, including attempts by Kant, Bergson, and the embryologist Hans Driesch to name the “vital force” inherent in material forms. Bennett concludes by sketching the contours of a “green materialist” ecophilosophy. (shrink)

A paradigm for peace discovered in the cosmopolitan neighborhoods of poor urban immigrants.

The Aesthetics of Design offers the first full treatment of design in the field of philosophical aesthetics, challenging the discipline to broaden its scope to include the quotidian objects and experiences of our everyday lives and concerns ...

This is part of a complete set of Jane Austen's novels collating the editions published during the author's lifetime and previously unpublished manuscripts. The books are illustrated with 19th century plates and incorporate revisions by experts in the light of subsequent research.

The main theorem says that a consequence operator is an effective part of the consequence operator for the classical prepositional calculus iff it is a consequence operator for a logic satisfying the compactness theorem, and in which every finitely axiomatizable theory is decidable.

The aim of the present study was to investigate the relationship between positive orientation defined as a basic predisposition to perceive and evaluate positive aspects of life, the future and oneself and the Five-Factor Model of personality. Hypotheses postulated positive correlations between PO and extraversion, conscientiousness, agreeableness and openness; a negative correlation was predicted between PO and neuroticism. Two hundred Polish students completed the following measures: SES, SWLS, LOT-R and NEOFFI. The results confirmed correlations between PO and extraversion, conscientiousness, and (...) neuroticism; correlations with openness and agreeableness were not supported. According to canonical correlations, PO shows a clear affinity to the FFM. (shrink)

The article presents the results of research on relationships between types of social participation and emotion regulation. In the study, Gratz’ and Roemer’s perspective on emotion regulation and Reinders’ and Butz’s concept of types of social participation were applied. Participants were 1151 students from three types of vocational schools: basic vocational school, technical upper secondary school, and specialized upper secondary school. The results of studies conducted with the use of Difficulties in Emotion Regulation Scale and Social Participation Questionnaire indicate that (...) there are small, however, significant, differences in the levels of social participation dimensions and the frequency of particular types of social participation between students from the three investigated types of vocational schools. The level of transitive orientation turned out to be higher among students from the basic vocational schools than among students from the specialized upper secondary schools and the technical upper secondary schools. In each educational group, the level of transitive orientation was significantly higher than the level of moratorium orientation. The hypothesis about the relationship between dimensions of emotion regulation and types of social participation, particularly with respect to the dimension of “lack of emotional awareness”, was confirmed. The most effective style in terms of emotion regulation turned out to be the assimilation type. The highest level of emotion dysregulation proved to be connected with the segregation type. (shrink)

A longstanding problem in the teacher workforce, internationally and in the UK, is the continuing and substantial numbers of qualified teachers who leave the profession within five years. This paper uses data collected from a survey to the last five years of teacher education graduates of UCL Institute of Education (IOE) in London, to explore what originally motivated them to teach, and the reasons why they have left or may consider leaving in the future. We discovered that despite claiming to (...) be aware of the challenges of workload before entering teaching, workload was the most frequently cited reason for having left, or for leaving in the future. The data spoke to the reality of teaching being worse than expected, and the nature (rather than the quantity) of the workload, linked to notions of performativity and accountability, being a crucial factor. This paper draws on a substantial new source of data and explores reasons for leaving in the context of reported initial motivation of individuals who have left teaching, individuals who are planning to leave and individuals who are planning to stay in teaching. (shrink)

The tales they shared with Addams in the wake of the Devil Baby were more personal and revealing than any they had previously told her: stories of abusive mates ...

In _influx & efflux_ Jane Bennett pursues a question that was bracketed in her book _Vibrant Matter_: how to think about human agency in a world teeming with powerful nonhuman influences? “Influx _& _efflux”—a phrase borrowed from Whitman's "Song of Myself"—refers to everyday movements whereby outside influences enter bodies, infuse and confuse their organization, and then exit, themselves having been transformed into something new. How to describe the human efforts involved in that process? What kinds of “I” and “we” (...) can live well and act effectively in a world of so many other lively materialities? Drawing upon Whitman, Thoreau, Caillois, Whitehead, and other poetic writers, Bennett links a nonanthropocentric model of self to a radically egalitarian pluralism and also to a syntax and style of writing appropriate to the entangled world in which we live. The book tries to enact the uncanny process by which we “write up” influences that pervade, enable, and disrupt us. (shrink)

A comforting, gentle introduction to the concept of God for young children.