Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

The increasing gap between organ supply and demand has opened the door for illegal organ sale, trafficking of human organs, tissues and cells, as well as transplant tourism. Currently, underprivileged and vulnerable populations in resource-poor countries are a major source of organs for rich patient-tourists who can afford to purchase organs at home or abroad. This paper presents a summary of international initiatives, such as World Health Organization’s Principle Guidelines, The Declaration of Istanbul, Asian Task Force Recommendations, (...) as well as UNESCO’s and the United Nation’s initiatives against trafficking of human organs, tissues, cells, and transplant tourism. Beyond the summary, it calls for more practical measures to be taken to implement the existing guidelines and recommendations, in order to prevent exploitation of the poor as organ providers. The paper suggests that an international legally binding agreement in criminalizing organ trafficking would be a step forward to bring a change in the global picture of organ trafficking and transplant tourism. (shrink)

The COVID-19 pandemic has caused a global crisis that particularly hit employment globally. Due to the economic crisis, many small businesses attempted to minimise their expenses by either closing or downsizing. During such organisational situations, the employees face negative workplace attitudes that lead to knowledge hiding and affect team performance. This study examines negative attitudes and their effect on team performance. Further, this study examines the mediating effect of knowledge hiding and moderating the role of servant leadership. Through a multi-time (...) data collection approach, the authors obtained 363 responses from the education sector in China during the COVID-19 pandemic. PROCESS Hayes model 1 and 4 were used for mediation and moderation analysis. Results show that job insecurity, cynicism, and role stress are significant forces behind knowledge-hiding behaviour. Furthermore, the knowledge hiding behaviour adversely affects task performance. Servant leadership shows a buffering effect on knowledge hiding behaviour caused by negative workplace attitudes. This is one of the first studies in the South Asian environment to examine the association between employees’ negative attitudes and task performance using knowledge hiding as a mediator and servant leadership as a moderator in the COVID-19 scenario. Lastly, the paper concludes with a consideration of its theoretical, practical implication and future direction. (shrink)

The American Academy of Pediatrics Task Force on Circumcision published its policy statement and technical report on newborn circumcision in September 2012.1 ,2 Since that time, some individuals and groups have voiced objections to the work of the Task Force, while others have conveyed their support. The AAP task force is pleased that the policy statement and technical reports on circumcision have stimulated debate on this topic and welcomes respectful discussion and dialogue about the (...) scientific and ethical issues that surround neonatal circumcision. We believe this is a complex issue that does not lend itself to simplistic solutions. The Task Force encourages those of all viewpoints to contribute to a vibrant, thoughtful and respectful evidence-based dialogue. We appreciate that the free exchange of competing ideas is a necessary component of scientific discovery. We also recognise that all clinical decisions carry ethical dimensions and that a respectful and thoughtful dialogue about these issues is important. However, the Task Force also feels strongly that this debate and the academic literature are demeaned when those with an ideological agenda disseminate inaccurate information, misapply scientific principles, make accusations that are unsupported, communicate in a vitriolic tone, and attempt to discredit and mischaracterise alternative views and those who hold them. Healthy debate and …. (shrink)

This is the first of a series of reports on the research groups of the institute: Death and Dying, Behavior Control, Genetic Engineering/Genetic Counseling, the Teaching of Medical Ethics, and the subject of this report, Population Control.

This article consists of a report submitted to the Massachusetts Commissioner of Mental Health in 1981 from the members of a citizens task force convened for the purpose of recommending policy to the Department in matters concerning privacy and human sexuality. The Chairman of the Committee was given responsibility for producing the information and resources necessary for the members to debate the issue with some intelligence, of facilitating the process and the deliberations, and of writing the final recommendations (...) and report contained in this article.The need for policy in the areas of privacy and human sexuality for persons living in our state institutions serving the handicapped is a continuing and critical one. Resolution of the issues requires informed, courageous decision making by those who are responsible for the welfare of persons with mental or developmental deficiencies. The policy suggested in this article may serve as a step forward for those decision makers. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

The debate on whether and how the Internet can protect and foster human rights has become a defining issue of our time. This debate often focuses on Internet governance from a regulatory perspective, underestimating the influence and power of the governance of the Internet’s architecture. The technical decisions made by Internet Standard Developing Organisations that build and maintain the technical infrastructure of the Internet influences how information flows. They rearrange the shape of the technically mediated public sphere, including which rights (...) it protects and which practices it enables. In this article, we contribute to the debate on SDOs’ ethical responsibility to bring their work in line with human rights. We defend three theses. First, SDOs’ work is inherently political. Second, the Internet Engineering Task Force, one of the most influential SDOs, has a moral obligation to ensure its work is coherent with, and fosters, human rights. Third, the IETF should enable the actualisation of human rights through the protocols and standards it designs by implementing a responsibility-by-design approach to engineering. We conclude by presenting some initial recommendations on how to ensure that work carried out by the IETF may enable human rights. (shrink)

Vogelstein cautions medical organizations against jumping into the fray of controversial issues, yet proffers the 2012 American Academy of Pediatrics' Task Force policy position on infant male circumcision as ‘an appropriate use of position-statements.’ Only a scratch below the surface of this policy statement uncovers the Task Force's failure to consider Vogelstein's many caveats. The Task Force supported the cultural practice by putting undeserved emphasis on questionable scientific data, while ignoring or underplaying the importance (...) of valid contrary scientific data. Without any effort to quantitatively assess the risk/benefit balance, the Task Force concluded the benefits of circumcision outweighed the risks, while acknowledging that the incidence of risks was unknown. This Task Force differed from other Academy policy-forming panels by ignoring the Academy's standard quality measures and by not appointing members with extensive research experience, extensive publications, or recognized expertise directly related to this topic. Despite nearly 100 publications available at the time addressing the substantial ethical issues associated with infant male circumcision, the Task Force chose to ignore the ethical controversy. They merely stated, with minimal justification, the opinion of one of the Task Force members that the practice of infant male circumcision is morally permissible. The release of the report has fostered an explosion of academic discussion on the ethics of infant male circumcision with a number of national medical organizations now decrying the practice as a human rights violation. (shrink)

Healthcare workers who are on the front line of coronavirus disease 2019 and are also undergoing shift schedules face long work hours with few pauses, experience desynchronization of their circadian rhythm, and an imbalance between work hours effort and reward in saving lives, resulting in an impact on work capacity, aggravated by the lack of personal protective equipment, few resources and precarious infrastructure, and fear of contracting the virus and contaminating family members. Some consequences are sleep deprivation, chronic insomnia, stress-related (...) sleep disorders, and post-traumatic stress disorder. These sleep alterations critically affect mental health, precipitating or perpetuating anxiety, stress, and depression, resulting in the inability to regulate positive and negative emotions. Pre-existing sleep disorders are an important risk factor for the development and maintenance of PSTD when individuals are exposed to an important stressor such as a COVID-19 pandemic. At the same time, how an individual regulates the emotion associated with worries during daytime functioning impacts nighttime sleep, precipitating and perpetuating difficulties in sleeping. All of these changes in sleep and emotional regulation also alter the immune system. Sleep deprivation is commonly associated with chronic inflammatory diseases, due to the desynchronizations in circadian rhythms, causing possible psychophysiological disorders and impaired neuroimmune-endocrine homeostasis. From this perspective, we clarify in this article how sleep disorders affect the immune system and emotional regulation, explaining their phenomenological and neurobiological mechanisms, and discussing elements of cognitive and behavioral coping for health professionals to adopt and manage a healthier sleep pattern in the COVID-19 outbreak. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Working on the Clinton Administration's Health Care Reform Task ForceNancy Neveloff Dubler (bio)This narrative is based on my understanding of the elements of the Health Security Act that may have ethical implications. I have reconstructed these elements from my experience on the Health Care Reform Task Force and they are part of the health care plan that the President presented to Congress. (At the time this (...) article went to press, the actual legislation, which should answer my remaining specific questions more clearly, had not yet been released.) I perceive the most important features of the plan to be:• The legislation will create a "right" to health care for all citizens—access to care will be universal;• The plan will involve some form of managed competition in which groups of providers (called Approved or Accredited Health Plans (AHPs)) will offer comparable benefit packages at slightly (or widely) different costs;• The AHPs will negotiate with the Health Alliance (HA) to determine the price that they will charge their consumer-patients;• There will be open enrollment with no barriers to coverage, such as exclusions for pre-existing conditions;• Community rating will be in effect in different localities and enrolled persons in any AHP will pay the same premium;• The coverage for any enrolled person will be portable;• The overall structure will be a cooperative federal/state enterprise in which the states will have quite extensive abilities to fashion variations of the basic plan to meet their particular needs;• Primary care will be encouraged and incentives for physicians to train in primary care specialties provided;• Non-physician providers will be central to the functioning of the health care plans;• Efforts will be made to develop a "person power" pool so that people with an abstract "right" to health care will have real access to providers, in their localities, who can fulfill the promise that the right creates; [End Page 421]• The goal of cost containment will be central to the organization and regulation of the system;• Administrative simplicity and quality protections will be central.Co-chairing the Bioethics Working Group (BWG) of the White House Task Force on Health Care Reform was a unique experience. Approximately 40 Task Force working groups were established by Hillary Rodham Clinton, the President, and the senior Task Force staff. Various members of the President's office and other knowledgeable members of the Executive Branch selected the participants. In our group, appointments were made largely on the recommendations of the co-chairs. The BWG, among the last of the groups formed, carried the official name "The Working Group on the Ethical Foundations of the New System" and was jointly led by me and Marion Gray Secundy, a Professor of Bioethics at Howard University. The fact that the leadership of the Task Force saw fit to establish such a group, thereby confirming that bioethics is a player in the arena of health care policy, was in itself significant and was made no less so by the lack of clarity regarding the group's aims and goals.The working groups of the Task Force were organized into clusters, determined by the relatedness of the somewhat distinct, but always overlapping, content of their investigations. Separate clusters and working groups, for example, looked at mental health, long term care, and the benefit package and coverage for low-income and non-working families. On this last issue there was also a working group that explored health policy initiatives for underserved populations. This multiple focus on related issues proved to be an excellent method for ensuring that the complexity of these topics was sufficiently explored. There was a published schedule for when these groups met together, and members of other groups who had similar or overlapping concerns were invited to attend and to participate.Every week or so, all of the working groups reported to the Task Force leadership, under the direction of Ira Magaziner, in a process called a "tollgate." Prior to the tollgate, the working groups were required to submit formal written analyses of the problems they had most recently been considering. Copies of these documents were placed in a special room so that those who were interested could review... (shrink)

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum “system” it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need.

The Human Genome Project is expected to increase dramatically our ability to predict the likelihood of genetic disease in an individual. It is important to reject the myth of genetic determinism—i.e., the simple-minded belief that such complex outcomes as heart disease, cancer, or autoimmune diseases are caused exclusively by particular genes. But it is equally important to acknowledge that genes may play a role in making a person more or less susceptible to such diseases. The ever-increasing prospect of genetic prediction, (...) spurred by the Human Genome Project, has implications for social practices such as insurance, in which predicting the risk of disease or death plays a crucial role. Concerned that improved genetic prediction might have unfortunate social consequences unless the impact of such predictions were anticipated, the U.S. Human Genome Project's Working Group on Ethical, Legal, and Social Issues established a Task Force on Genetic Information and Insurance in May 1991. -/- The Task Force met seven times over its two-year life. By the end of the first year, it had reached several tentative conclusions. Most importantly, we became convinced that the problem posed by increased genetic prediction in insurance was a genuine and important one. When we began, the danger seemed plausible but far from certain. The information we gathered in the first year persuaded us that genetic prediction of disease was in one sense already with us and, in another sense, likely to grow massively in the foreseeable future. (shrink)

This volume represents the conclusions of a multidisciplinary task force established by the US National Institutes of Health and Department of Energy working groups on the ethics, legal and social implications of human genome research. It ranges across the provision of genetic testing in the USA by commercial, not-for-profit and publicly funded agencies and it seeks to establish guiding principles and make recommendations for the development of safe and effective tests and their application in ways in which are (...) helpful and that do not compromise the rights of patients and/or their families. For anyone interested in the development of …. (shrink)

Long‐range correlation is a general class of coordination pattern found to be common to the intrinsic dynamics of complex systems, including human behavior. Balasubramaniam, Hove, and Médé investigate intrinsic dynamics in repeated finger movements, and they find that different measures of movement dynamics yield different long‐range correlations. Results shed light on the way that coordination patterns are expressed as a function of measurement context.

Muscle synergy analysis via surface electromyography is useful to study muscle coordination in motor learning, clinical diagnosis, and neurorehabilitation. However, current methods to extract muscle synergies in the upper limb suffer from two major issues. First, the necessary normalization of EMG signals is performed via maximum voluntary contraction, which requires maximal isometric force production in each muscle. However, some individuals with motor impairments have difficulties producing maximal effort in the MVC task. In addition, the MVC is known to (...) be highly unreliable, with widely different forces produced in repeated measures. Second, synergy extraction in the upper limb is typically performed with a multidirection reaching task. However, some participants with motor impairments cannot perform this task because it requires precise motor control. In this study, we proposed a new isometric rotating task that does not require precise motor control or large forces. In this task, participants maintain a cursor controlled by the arm end-point force on a target that rotates at a constant angular velocity at a designated force level. To relax constraints on motor control precision, the target is widened and blurred. To obtain a reference EMG value for normalization without requiring maximal effort, we estimated a linear relationship between joint torques and muscle activations. We assessed the reliability of joint torque normalization and synergy extraction in the rotating task in young neurotypical individuals. Compared with normalization with MVC, joint torque normalization allowed reliable EMG normalization at low force levels. In addition, the extraction of synergies was as reliable and more stable than with the multidirection reaching task. The proposed rotating task can, therefore, be used in future motor learning, clinical diagnosis, and neurorehabilitation studies. (shrink)

Sustained reflection on multiple expressions of Asian American experience directs us to the coercive logic of racial identities. Noticing this logic is critical to identifying the limitations of several strategies to resist and transcend racial injustice, including the demand for racial recognition. Rereading the Parable of the Good Samaritan as one about the perils of racial identity and then taking cues from the nonviolent practice of truth force provide a blueprint that reimagines the liberative role racial identities can (...) play. (shrink)

While temporal preparation has frequently been examined through the manipulation of foreperiods, the role of force level during temporal preparation remains underexplored. In our study, we propose to manipulate mental training of attentional control in order to shed light on the role of the force level and autonomic nervous system in the temporal preparation of an action. Forty subjects, divided into mental training group (n = 20) and without mental training group (n = 20), participated in this study. (...) The influence of the attentional control and force levels on the autonomic nervous system were measured using the skin conductance response and the heart rate variability; the accuracy of the motor responses was measured using a method derived from machine learning. Behaviorally, only the mental training group reinforced its motor and attentional control. When using short foreperiod durations and high force level, motor and attentional control decreased, consistent with the dominant sympathetic system. This resulted in an increased anticipation rate of responses with a higher reaction time compared to the long foreperiods duration and low force level, in which the reaction time significantly decreased, with enhancement of the expected force level, showing consistency with the dominant parasympathetic system. Interestingly, results revealed a predictive relationship between the sympathovagal balance and motor and attentional control during the long foreperiods and low force level. Finally, results demonstrate that attentional mental training leads to the reinforcement of interactions between the autonomic nervous system and attentional processes which are involved in the temporal preparation of a force task. (shrink)