In the rapidly evolving healthcare environment, perhaps no role is in greater flux and redefinition than that of the clinical bioethicist. The discussion of ethics consultation in the bioethics literature has moved from an ambiguous concern regarding its proper place in the clinical milieu to the more provocative question of which methods and theories should best characterize the intellectual and practical work it claims to do. The American Society for Bioethics and Humanities addressed these concerns in its 1998 report, (...) CoreCompetenciesforHealthCareEthicsConsultation. The report tries to answer the question as to what disciplinary training, background experience, and levels of knowledge in ethics the clinical ethics consultant should have, and what specific skills and character traits the clinical ethics consultant should cultivate. In addition to acquiring knowledge of common bioethical issues, theoretical concepts in ethical theory and moral reasoning, and health-related law and policy, the report also recommends that ethics consultants demonstrate knowledge of the health beliefs and perspectives of patients and healthcare providers. In our opinion, this recommendation underscores a crucial aspect of the practice of ethics consultation in the increasingly multicultural settings of healthcare institutions. Clearly, the dynamic of American life and culture is permeated with diversity and variety as new groups suffuse their own beliefs and faith perspectives into the health sector. New immigrant groups force society to question traditional healthcare practices and to accommodate changing medical needs. (shrink)

Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate, or should they be considered a vulnerable group in need of protection? I discuss three cases of possible living organ donors who are developmentally disabled, from three different cultures, the United States, Germany, and India. I offer a brief discussion of three issues raised by the cases: (1) cultural diversity and cultural relativism; (2) autonomy, (...) rationality, and self-interest; and (3) the proper use and role for clinical ethics consults. (shrink)

The shared values, beliefs, and behaviors by which people interpret life events are what we call culture. More than medical science, culture determines how people react to illness and death. Science may determine which drug or surgery best treats the disease, but culture often determines how the health professional best treats a patient with the disease. Culture influences when the patient believes he is ill, which treatments he accepts, and which results he prefers. Because culture surely affects illness outcomes, health (...) professionals must not ignore it. (shrink)

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse (...) inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results: These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion: Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. (shrink)

We argue for the addition of trauma informed awareness, training, and skill in clinical ethics consultation by proposing a novel framework for Trauma Informed Ethics Consultation (TIEC). This approach expands on the American Society for Bioethics and Humanities (ASBH) framework for, and key insights from feminist approaches to, ethics consultation, and the literature on trauma informed care (TIC). TIEC keeps ethics consultation in line with the provision of TIC in other clinical settings. Most crucially, TIEC (like (...) TIC) is systematically sensitive to culture, history, difference, power, social exclusion, oppression, and marginalization. By engaging a neonatal intensive care ethics consult example, we define our TIEC approach and illustrate its application. Through TIEC we argue it is the role of ethics consultants to not only hold open moral spaces, but to furnish them in morally habitable ways for all stakeholders involved in the ethics consultation process, including patients, surrogates, and practitioners. (shrink)

Much of the work in professional ethics sees ethical problems as resulting from ethical ignorance, ethical failure or evil intent. While this approach gets at real and valid concerns, it does not capture the whole story because it does not take into account the underlying professional or institutional culture in which moral decision making is imbedded. My argument in this paper is that this culture plays a powerful and sometimes determinant role in establishing the nature of the ethical debate; i.e., (...) it helps to define what are viable action options, what is the organization’s genuine mission, and what behaviors will be rewarded or criticized. Given these conclusions, I also argue that consulting ethicists need more than an understanding of ethics theory, concepts and principles; they also need a sufficiently rich understanding of organizational culture and a willingness and an ability to critique that culture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics ConsultationPat Milmoe McCarrick (bio)(John La Puma, M.D., from the Department of Medicine at Lutheran General Hospital in Chicago, contacted the National Reference Center for Bioethics Literature and suggested bioethics consultation as a topic for the Scope Note Series. He provided an extensive list of citations about ethics consultations collected by him and by David Schiedermayer, M.D., for their new book Ethics Consultation: A Practical Guide.)In Ethics (...) Consultation in Health Care, editors John Fletcher, Norman Quist, and Albert R. Jonsen (I, 1989) define ethics consultation as "the provision of specialized help in identifying, analyzing, and resolving ethical problems that arise in clinical care. In medical ethics the area of consultation has grown rapidly since 1978 when Edmund D. Pellegrino (II, 1978) noted, "we cannot separate technical-moral decisions from the philosophic principles we use to justify them. Medicine and ethics must be engaged with each other at every level."In 1980 Albert Jonsen raised the question of whether an ethicist could be a consultant and said that the ethicist as consultant is a casuist, one whose moral reasoning is based on a system of reasoning that is applied to particular cases. He describes historical casuistry in Western culture, comparing it to modern moral philosophy, and suggests that a "new casuistry seems timely" for ethics consultation (II, Jonsen 1980). By 1984 ethicist Ruth Purtilo recorded her thoughts following an ethics consultation. She raised questions about the ethicist's place on a hospital staff and how to make that role appropriate and beneficial to all concerned, saying that "the ethicist retreats after the consultation; under no circumstances would the outcome of an ethics consultation be that the ethicist became the primary care giver or assumed ongoing responsibility for the clinical management of a case" (II, Purtilo 1984). Nevertheless, in 1992 two physician-ethicists who had been called as ethics consultants for a patient who had requested that he be removed from his ventilator reported that they became the persons who turned off the ventilator and administered the drugs that eased his dying (II, Edwards and Tolle 1992).In recognition of the growing number of persons identifying themselves as [End Page 433] consultants, the Society for Bioethics Consultation was founded in October 1985 as a professional society of persons engaged in bioethics consultation. It encourages and supports consultation, assists in establishing clinical education programs, and raises funds for consultation education. Although the Society has no permanent office, the president (currently, George Kanoti in the Cleveland Clinic Foundation's Bioethics Department) conducts its work and plans an annual meeting.The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) established new criteria concerning ethics in its 1992 Manual (III, JCAHO 1992) and in a special issue of QRB devoted to ethics consultation (I, Defining Quality 1992). These publications undoubtedly have contributed to the increased use of experts in medical ethics. The Manual notes that all organizations seeking accreditation should have some sort of "mechanism for the consideration of ethical issues arising in the care of patients and to provide education to care givers and patients on ethical issues in health care." A health care institution's eligibility for JCAHO accreditation, which is required for federal reimbursement, requires adherence to this specification (III, JCAHO 1992).The new International Directory of Bioethics Organizations provides an index of 129 different groups that indicated to the authors that they offer bioethics consultations. Of these, 83 are in the United States and 46 are in other countries. The ethics consultants included in the directory encompass a broad group of professionals who will assist patients, families, and primary care medical staff in finding solutions to ethical dilemmas resulting from use of new technologies or new treatments in health care. Consultants often come from the health fields: physicians, nurses, and other health personnel, but other professionals are also active as ethics consultants. Lawyers, pastoral counselors, philosophers, and social workers also offer bioethics consultation services (III, Nolen and Coutts 1993).Drs. Siegler, Pellegrino, and Singer wrote in 1990 that "Physician-ethicists and professional ethicists will continue to work side by side in the future. One is not likely to replace the other, nor is this desirable, because... (shrink)

Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve (...) quality of care, reduce healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differenc... (shrink)

_Demons in the Consulting Room: Echoes of Genocide, Slavery and Extreme Trauma in Psychoanalytic Practice_ isthe second of two volumes addressing the overwhelming, often unmetabolizable feelings related to mourning, both on an individual and mass scale. Authors in this volume explore the potency of ghosts, ghostliness and the darker, often grotesque aspects of these phenomena. While ghosts can be spectral presences that we feel protective of, demons haunt in a particularly virulent way, distorting experience, our sense of reality and our (...) character. Bringing together a collection of clinical and theoretical papers, _emons in the Consulting Room_, reveals how the most extreme types of trauma can continue to have effects across generations, and how these effects manifest in the consulting room. Essays in this volume consider traumas that have affected multiple generations of people, such as the Holocaust, experiences in the gulags, and the experience of slavery. Authors here consider the clinical challenges of working with the demonic force in severe childhood abuse and the effects of serious and prolonged physical injury and illness. Inevitably, there is in such difficult clinical work, the combined effects of hauntings in the analysts and in patients and often in the surrounding culture. In this book, distinguished psychoanalysts explore the myriad forms of ghosts and the demonic, which interfere and disrupt the endlessly difficult psychic work of mourning. It will be of interest to psychotherapists and psychoanalysts, as well as social workers, family therapists, psychologists, and psychiatrists. _emons in the Consulting Room _ill appeal to those specializing in bereavement and trauma and, on a broader level, to sociologists and historians interested in understanding means of coping with loss and grief on both an individual and larger scale basis. (shrink)

Stakeholder consultation is part of the democratic process, embraces respect for persons, and is necessary for upholding the principle of justice. People are more likely to uphold standards they have participated in setting, so stakeholder consultation encourages adherence to societal and institutional standards as these evolve. Stakeholder consultation is also responsive to the call to “resocialize” ethics by contextualizing dilemmas and involving the destitute in choices about their healthcare. In resource-poor settings, such consultation promotes local “ownership” (...) of, and leadership within, development programs, which enhances effectiveness and sustainability. Stakeholder consultation is, therefore, a form of capacity building. To succeed, it must be responsive to regional, national, and individual constraints, including socioeconomic, cultural, and political ones. Several such constraints impact on the demand for, and availability of, palliative healthcare in the Caribbean. (shrink)

Theories of reference have been central to analytic philosophy, and two views, the descriptivist view of reference and the causal-historical view of reference, have dominated the field. In this research tradition, theories of reference are assessed by consulting one’s intuitions about the reference of terms in hypothetical situations. However, recent work in cultural psychology (e.g., Nisbett et al. 2001) has shown systematic cognitive differences between East Asians and Westerners, and some work indicates that this extends to intuitions about philosophical (...) cases (Weinberg et al. 2001). In light of these findings on cultural differences, two experiments were conducted which explored intuitions about reference in Westerners and East Asians. Both experiments indicate that, for certain central cases, Westerners are more likely than East Asians to report intuitions that are consistent with the causal-historical view. These results constitute prima facie evidence that semantic intuitions vary from culture to culture, and the paper argues that this fact raises questions about the nature of the philosophical enterprise of developing a theory of reference. (shrink)

Most businesses in India undergo disproportionate development as their focus is on making more and more profit. They seem to have no concern for the environment, the welfare of their employees or the unethical practices they follow. This has resulted in problems such as an increase in business rivalry, a widening employer–employee gap, a disconnect with environmental concerns as well as a general disinterest in the well-being of the world. The need of the hour therefore is to weave value-based business (...) models for India based on its rich philosophical thought, deep culture and evolved knowledge systems. This paper proposes to meet this need by initiating value-based consultancy based on ancient Indian philosophical thought. It proposes that it should be done with a focus on the human values approach as reflected in the theory of Purusarthas, different dimensions of Yoga and Vedanta philosophy to improve businesses and business practices from a holistic perspective. This philosophical intervention will certainly help businesses to develop more clarity about unethical practices and the ways to control them. (shrink)

_Conscience and Corporate Culture_ advances the constructive dialogue on a moral conscience for corporations. Written for educators in the field of business ethics and practicing corporate executives, the book serves as a platform on a subject profoundly difficult and timely. Written from the unique vantage point of an author who is a philosopher, professor of business administration, and a corporate consultant A vital resource for both educators in the field of business ethics and practicing corporate executives Forwards the constructive dialogue (...) on a moral conscience for corporations Offers a philosophical and practical approach to considering business ethics. (shrink)

Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of end of life decisions, experiences with (...) newly developed or well established ethics consultation services, and the expectations of physicians in various clinical fields who are still unfamiliar with clinical ethics consultation. The papers included illustrate the interface between different socio-cultural contexts and their ways of dealing with clinical ethics consultation. They deepen the dialogue on clinical ethics consultation that has emerged at the European and International level. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Womanist-Buddhist Consultation as a Reading CommunityCarolyn M. Jones MedineIn Breaking the Fall, the late Robert Detweiler (1932-2008) imagines what a reading community, "a contemporary version of the old storytelling cultures,"1 might look like. He suggests that in such a community, "The accent on community itself would offer a balance to our excessively privatizing tendencies; the communal interaction could counter our relentless drive to interpret... with attitudes of (...) play and Gelassenheit (abandonment, chance, and relaxation); the writing and reading community especially as a liminal entity, could nurture a respect for the incomprehensibility of form and a reverence for mystery."2 This description offers an entry to the work of the Womanist-Buddhist Consultations. To reach a provisional understanding of the meaning of that work, I shall reflect on first what we mean when we say that we want to read something. Second, I turn to a conversation with Robert Detweiler, who was one of my mentors, as a way to address the form of reading that we do and the form of community that we make in the Womanist-Buddhist Consultations. Third, I want to draw on the thought of the consultations themselves, using Emmanuel Levinas's work on reading and ethics, to examine the capacity the consultations have to hold tensions creatively and to allow multiple meanings to be part of them. Finally, I want to address the goals for the consultations. I am thinking specifically of Melanie Harris's desire to see the consultations as generating practices that promote peace, compassion, and justice, and Charlie Hallisey's desire to generate a more complex reading of Buddhist texts in and of themselves.The Womanist-Buddhist Consultations have met three times between 2009 and 2011. We met at Harvard Divinity School and at Texas Christian University for sessions of four days each, and for an evening at the University of Georgia between the two longer meetings. The Texas Christian meeting included some previous members from the Harvard meeting, and added new ones. The University of Georgia meeting consisted primarily of students who participated in the reading practice.In the meeting at the University of Georgia, Charles Hallisey looked askance at me when I said that Buddhism offers an entry into peace and compassion; yet Melanie Harris, when she constructed the later session at Texas Christian University, deployed the terms "peace" and "justice" as descriptors for the work of the group. Hallisey's ironic glance occurred right before we read, at the University of Georgia, a text that contained magic and murder. His glance and the content of that text have prompted [End Page 47] me to think through Harris's claims and to see how our group achieves both a reading of Buddhism and an ethical practice that generates peace and points to justice.The instructions that Hallisey gives for the reading process describe a practice of "being and reading together" as we encounter a variety of Buddhist texts.3 The group's guide is the bodhisattva Manjushri, who has overseen our work through an image gracing the wall at all our meetings. Manjushri has a sword to cut through obstacles, and holds a book, signifying wisdom. The practice of reading with friends, Hallisey told us, comes from Jewish tradition: we need a friend to help us overcome what we can and to begin to see what we cannot. The work involves three steps:1. To read passages individually.2. To read the same passages together in small groups.3. To gather again as a large group and discuss what we have discovered.The major goal of reading is to encounter levels of ourselves to which we ordinarily have no access, by examining a text that becomes "generous" to us. Reading together, Hallisey asserts, makes the generosity of the text visible to us.This process of reading, I would argue, is different from what we usually do when we read and different from what we mean when we tell students to read. Patricia O'Connell Killen, an AAR Teaching Award winner, has delineated some of what we mean when we say to our students: "Read chapter 2 of 'X' and come to class prepared."4... (shrink)

In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. (...) Finally, I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation. (shrink)

Is bioethics consultation a profession? Withfew exceptions, the arguments andcounterarguments about whether healthcareethics consultation is a profession haveignored the historical and cultural developmentof professions in the United States, the wayssocial changes have altered the work andboundaries of all professions, and theprofessionalization theories that explain howmodern societies institutionalize expertise inprofessions. This interdisciplinary analysisbegins to fill this gap by framing the debatewithin a larger theoretical context heretoforemissing from the bioethics literature. Specifically, the question of whether ethicsconsultation is a profession (...) is examined fromthe perspectives of trait theory, Wilensky''sfive-stage process of professionalization,Abbott''s interdependent system of professions,and Haug''s deprofessionalization thesis. Whilehealthcare ethics consultation does not meetthe criteria to claim professional status,neither could most professions pass these idealtheoretical standards. Instead of a yes or nodichotomous response to the question, it ismore helpful to envision a professionalizationcontinuum with sales clerks or carpenters atone end and medicine or law at the other. During the past decade healthcare ethicsconsultation has been moving along thiscontinuum toward greater professional status. (shrink)

ObjectiveThe objective of the study was to explore the power of stakeholder consultation on employee engagement during a cross-border acquisition in a multi-cultural context. Further, to describe the psychosocial factors at play during the employee involvement process towards enhancing employee engagement.MethodsThis qualitative study presents the results from data collected in Tanzania through semi-structured interviews and analyzed in accordance with the hermeneutic circle and Tesch’s content analysis method.ResultsThe results of this study contribute to the body of knowledge to better (...) understand the psychosocial factors at play within a multi-cultural environment which inform stakeholder consultation and will enable or hinder employee engagement. A transitional space should be created, fostering mature stakeholder engagement, promoting employee inclusion, engagement, and knowledge sharing.ConclusionBringing together two worlds requires building bridges to cross the cliff between contexts and overcoming diversity challenges, while incorporating diversity management in the consulting process. A multi-cultural team should be established, incorporating diversity management, applying the principles of respect, participation and transparent communication, with regular feedback on decisions made. External stakeholders in authoritative positions are not well received and should consider traditional superiority versus business hierarchy when establishing leader-follower relationships. (shrink)

The latest research in Spain indicates that the most advanced neuromarketing consulting companies in the sector are those that have been able to innovate in the development of their own technologies and methodologies. Despite their reduced volume of business compared to total investment in Marketing and market research in our country, there are signs that suggest these companies have great potential to improve this sector, which is still to be explored. For this reason, this research straddling the ethnographic method and (...) the theoretical-descriptive method, aims to help us better understand the characteristic features of this sector by actively listening to the professional voices that lead it. Its epistemological value lies in its contribution to understanding the business culture related to the professional development of neuromarketing in our country today. The study shows that the main human resources strategy of neuromarketing consulting companies is based on the creation of multidisciplinary work teams. In addition, most of them develop data analysis software, which they can safeguard under various types of copy right, and on other occasions they manage to patent them, to later apply them to the objectives and purposes of their company. This would also explain the widespread use of certain procedures and resources by the vast majority of the consulting companies investigated. Thus, the trend in the market is the implementation of different synchronization software to the available technological and methodological resources. Others have even gone so far as to create a new technological support to incorporate methodologies already in use. Therefore, this gives them exclusivity in their services and the necessary competitive advantage over their competitors. Among other factors, these inferences about how this sector really works are very likely to be very useful in the academic field, which will constitute a further step in generating critical thinking and in expanding the frontiers of knowledge around this disciplin. (shrink)

This workbook is a companion to Clinical Ethics Consultation: A Practical Guide to Changing Culture, Building Capacity and Solving Problems Case by Case. The Toolkit lays out the process for clinical ethics consultation in a series of steps within five phases: Pre-Consult, Interviews, Mid-Consult, Consult meeting(s), and Post-Consult. For each step, the Toolkit provides directions for how to complete it, tips for success, and worksheets for capturing data and analysis. The Clinical Ethics Consultation Toolkit is the playbook (...) from which clinical ethics consultants can draw methods and strategies for effectively delivering ethics consultation. (shrink)

BackgroundThis study aims to quantitatively and qualitatively evaluate the activities of a Bioethics Unit (BU) 5 years since its implementation (2016–2020). The BU is a research unit providing empirical research on ethical issues related to clinical practice, clinical ethics consultation, and ethical education for health care professionals (HPS).MethodsWe performed an explanatory, sequential, mixed-method, observational study, using the subsequent qualitative data to explain the initial quantitative findings. Quantitative data were collected from an internal database and analyzed by descriptive analysis. Qualitative (...) evaluation was performed by semi-structured interviews with 18 HPs who were differently involved in the BU’s activities and analyzed by framework analysis.ResultsQuantitative results showed an extensive increment of the number of BU research projects over the years and the number of work collaborations with other units and wards. Qualitative findings revealed four main themes, concerning: 1. the reasons for contacting the BU and the type of collaboration; 2. the role of the bioethicist; 3. the impact of BU activities on HPs, in terms of developing deeper and more mature thinking; 4. the need to extend ethics support to other settings. Overall, our results showed that performing both empirical bioethics research and more traditional clinical ethics activities at the same unit would produce an impetus to increase collaboration and spread an 'ethical culture' among local HPs.ConclusionsOur findings contribute to a growing body of literature on the models of clinical ethics support services and the role of empirical research in bioethics internationally. They also prepare the ground for the implementation of a multidisciplinary Clinical Ethics Committee (CEC) that aims to support the BU’s ethics consultation service within the local context. (shrink)

Clinical ethics committees have existed in Norway since 1996. By now all hospital trusts have one. An evaluation of these committees’ work was started in 2004. This paper presents results from an interview study of eight clinicians who evaluated six committees’ deliberations on 10 clinical cases. The study indicates that the clinicians found the clinical ethics consultations useful and worth while doing. However, a systematic approach to case consultations is vital. Procedures and mandate of the committees should be known to (...) clinicians in advance to ensure that they know what to expect. Equally important is bringing all relevant facts, medical as well as psychosocial, into the discussion. A written report from the deliberation is also important for the committees to be taken seriously by the clinicians. This study indicates that the clinicians want to be included in the deliberation, and not only in the preparation or follow-up. Obstacles for referring a case to the committee are the medical culture’s conflict aversion and its anxiety of being judged by outsiders. The committees were described as a court by some of the clinicians. This is a challenge for the committees in their attempt to balance support and critique in their consultation services. (shrink)

BackgroundAmidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality (...) of CECons.MethodsGuided by Levac et al’s (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings.ResultsNine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified – the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations.ConclusionThis review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy.To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards. (shrink)

Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in (...) the face of manifestly plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society. (shrink)

The relevance of context has been acknowledged also recently as a fundamental element for the correct evaluation of argumentative moves within institutional fields of interaction. Indeed, not considering the larger culture-specific and social features of the context within which the interactions take place poses problems of interpretation of the data and comparability of results. Starting from these considerations, the paper aims at discussing a model for the description of the social context of interaction that may allow for a better interpretation (...) and evaluation of argumentative moves within medical consultations. The efficacy of the model is shown by applying it to the description and analysis of examples of real-life consultations recorded in the Italian region of Lombardy. In the first section, the model for the description of the social context of interaction is presented and discussed. In the second section, examples of argumentative passages from a selection of consultations are presented and commented on by relying on the model. Some concluding remarks and further developments of the research are proposed in the final section Keywords: communication context, argumentation in context, situated discourse, medical consultation. (shrink)

At the outset of this chapter, I want to echo the praise offered by all of the contributors to this volume for Finder’s outstanding, thoughtful and self-critical narrative of the case of 83 year old Mrs. Hamadani and her fiercely devoted children. The brocade account is carefully woven, like a fine Persian tapestry, to convey the rich complexity of an actual ethics consultation as it transpires not over hours, but rather over days, weeks, months and even, as in this (...) case, years. Mrs. Hamadani’s narrative so told is replete with questions worthy of critical reflection. What is an appropriate role for ethics consultation in healthcare? How can an autonomy-centric culture accommodate community-centric cultural difference? How can or should the voice of the patient be heard when she cannot speak for herself and the much louder and anguished voices of others demand to be heard? What are the bounds of acceptable medical treatment and how should care teams respond when patient or family demands threaten to push care givers to cross those bounds? What is an appropriate response for ethics consultants when they are asked to take over a case or prevent a colleague from interacting with an unwilling family? Do the motivations of patients, family, or members of the care team in calling ethics consultants necessarily shape the consultant’s role? And so the list goes on, as the variety of commentaries which comprise the majority of this volume, as well as the multitude of discussions that you, the readers, will inevitably have with colleagues, students, and friends make abundantly clear. (shrink)

Alfred Schutz’s scattered remarks about cultural anthropology can be related to the rubrics of disciplinary definition, basic concepts, and distinctive methods and also to his notion of the theoretical level in social science by consulting current textbooks. This shows a way in which a theory of this particular science can be developed that would fit into a general Schutzian Wissenschaftslehre of the cultural sciences.

We use content analysis to show that the diagnosis of the financial crisis of 2007–2009 shifted significantly from a focus on the need for structural change in the banking industry to an emphasis on culture and reform at the organizational level. We consider four overlapping subsystems in which this shift in problem–solution clusters played out—political, regulatory, legal, and consulting—and show that the “structural reform agenda,” which was initially strong and publicly prominent in the political arena, lost attention. Over time it (...) was displaced by a neoliberal managerialist turn, which watered down or abandoned structural solutions and instead played up a new “culture and conduct reform agenda.” We explain this shift in terms of the marketization of regulation, which—following Mautner (_Language and the market society_, 1st ed. Routledge, 2010)’s model of interdiscursive alignment—we detect in the shifting language of financial-services reform across the four subsystems in scope. We argue that a neoliberal turn took place with a _discursive closure_ that made the structural reform alternative gradually unsayable and, in the end, unthinkable. At the same time, the discourse turned to embrace the neoliberal agenda, built on the myth of self-regulating actors and markets, manifest in the culture problematic. This managerialist turn was able to mobilise, and be operationalised by, an industry of consultants, whereas structural change came to be seen by regulators as too risky to implement. We claim that these dynamics reveal how a form of “collective strategic ignorance,” based on powerful institutional myths, was systematically oriented to ignore and reject structural sources of crisis. Finally, we suggest that the observed pattern of displacement—whereby initial calls for structural change become later displaced by managerial and procedural solutions—is common to other social issues, such as audit reform and corporate social responsibility. (shrink)

Biotopes and Bioethics are highly complex and adaptable systems of Bios. Individual bios is terminal, but the stream of Bios goes on. Basic properties of Bios such as communication and cooperation, competence and competition, contemplation and calculation, compassion and cultivation come in different shades of light and dark in individuals and species, in history and ecology. Hans-Martin Sass discusses the territories of Bios and Bioethics, based on his involvement in decades of consulting in academia, business and politics. Special attention is (...) given to the vision and role of Bioethics in research and training, in religious and cultural traditions, and in the survival, happiness, and health of corporate, social and political bodies. Hans-Martin Sass is Senior Research Scholar Emeritus at Georgetown University, Washington DC, and Professor Emeritus of Philosophy at Ruhr University, Bochum. (Series: Practical Ethics - Studies / Ethik in der Praxis - Studien, Vol. 40) [Subject: Bioethics]. (shrink)

This paper presents the concept of the systematisation of praxis and an operational approach to the systematisation of alternative consulting experiences. The essences of this approach have been developed in Latin America after many years of experiences with both popular urban and rural sectors. Taking departure from a concrete example we outline some of the central questions that ought to be discussed during the systematisation process. A real-life case study is proposed: the systematisation of the activities of a development centre (...) in Odsherred, Denmark, to redesign strategies and to recreate actions for the centre's future activities. This centre has carried out community work in the Odsherred region focusing on cultural activities. Finally, methodological reflections are also presented. (shrink)

Theories of reference have been central to analytic philosophy, and two views, the descriptivist view of reference and the causal-historical view of reference, have dominated the field. In this research tradition, theories of reference are assessed by consulting one's intuitions about the reference of terms in hypothetical situations. However, recent work in cultural psychology has shown systematic differences between East Asians and Westerners, and some work indicates that this extends to intuitions about philosophical cases. In light of these findings (...) on cultural differences, two experiments were conducted which explored intuitions about reference in Westerners and East Asians. Both experiments indicate that, for certain central cases, Westerners are more likely than East Asians to report intuitions that are consistent with the causal-historical view. These results constitute prima facie evidence that semantic intuitions vary from culture to culture, and that paper argues that this fact raises questions about the nature of the philosophical enterprise of developing a theory of reference. (shrink)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The (...) tool was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

This qualitative social scientific interview study delves into the ways in which professional vision is constructed in clinical ethics consultation (CEC). The data consist of 11 semi-structured interviews that were conducted with clinical ethics consultants currently working in hospitals in one major urban area in the U.S. The interviews were analyzed with the qualitative research method of critical discourse analysis, with a focus on identifying the cultural structures of knowledge that shape CEC as a professional practice. The discourses (...) were first identified as belonging to two higher discourse categories, order and agency. Order was divided into three lower categories, emotional, managerial, and rational order, and discourses of agency into the lower categories of exploration, technique, deliberation, and distancing. An additional discourse of neutral interaction was identified as a bridging discourse, activated to level tensions emerging out of conflicting goals and agencies embedded in CEC practice. This analysis brings out as its main observation that clinical ethics consultants draw on and shift between potentially ideologically conflicting social positions that can create built-in tensions within the professional domain. The study calls attention to these tensions and suggests for the professional group to discuss the possibility of defining priorities between different kinds of order, identified in this study, that shape the CEC domain. (shrink)

As a natural result of globalization and migration from village to city, peace, ease, and happiness of people who have to coexist in cities are extremely important. Beliefs, systems, ideologies, and institutions aim to achieve this. This situation forces individuals and groups who live together, whether they want to or not, to get to know and communicate with each other within a trust environment. The most important factor that makes recognizing segments of society with different characteristics and communicate with them (...) in a healthy way is to develop a culture of coexistence among the community members. Coexistence means that people with different identities and affiliations are united around the citizenship denominator and contributing to the continuation of social life in unity and solidarity. This understanding must be transformed into a cultural consciousness in the community members. Because, polarization, marginalization, discrimination, and violence become common among individuals who live in societies where the culture of living together and the awareness of citizenship are not developed. It is not possible to ensure coexistence only by law. In societies where a culture of cohabitation develops, differences are not seen as a cause of separation, but as a richness that diversifies society and gives dynamism to social life. In societies dealing with political, social, economic, and moral problems, religion, language, race, ethnic identity, and regional sense of belonging might be more likely used as terrorization tools. The self-confidence that accurrate religious knowledge gives to individuals might weaken such a possibility. Islam anticipates a social system that facilitates a pecaful and easeful life for the people. Giving importance to principles such as love, respect, tolerance, justice, consultation, assistance, and solidarity in the Qur'an is an indication of the need for this system. The Prophet Mohammad had the opportunity to apply an example of this system in Madinah anticipatedin the Qur'an in Madinah. After the migration, some principles related to the basic rules of coexistence were included in the Madinah agreement, which the Prophet signed with representatives of different segments living in Madinah. It is very important that these principles are able to shed light on the issues happenin in the recent world. The experience of living together in the time of the Prophet Muhammad (pbuh) should be introduced to the next generations with correct information. Because, The Medina Agreement, which has an important place in the history of Muslims, is an important example of the ability to live together in peace and ease by maintaining differences in society. The Medina Agreement is the first written document that allows different groups of people residing in Medina to live together. The main purpose of this agreement, which the Prophet made with the Jewish, Christian, and polytheistic tribes in Medina after the migration, is to protect the fundamental rights stemming from the citizenship of people who live in the same city by having different faiths and cultural values. If so, the Madinah Agreement might be an example for many societies that recently experience discord and unrest due to their characteristics such as religion, language, race, political thought, and etc. In this regard, this article focuses on the importance of the culture of coexistence in the context of the Madinah Agreement and the process of formation of this culture and offers some suggestionsthat will facilitate peace and ease for different groups living in the same society. Some of these suggestions are as follows: Differences such as language, religion, race, culture, and political thought among the realities of social life should not be seen as an element of discrimination, everyone should contribute to the peace and well-being of society by combining in the common denominator of citizenship. In educational institutions, it should be taken into account values such as human love, respect for the other, tolerance, freedom of thought, empathy, and peace. In addition to educational institutions, all segments operating in the field of law, politics, economics, religion, and media should unite, and thus, should develop a consciousness of citizenship in society, where differences in race, religion, language, culture and political views are seen as richness. (shrink)

Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues (...) derived and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

RESUMEN: El presente trabajo propone un análisis de los Derechos Fundamentales de los pueblos indígenas a la luz de los principios internacionales de Libre Determinación y Consulta Previa, como fundantes y presupuestos de los demás Derechos Indígenas. En consecuencia, se analiza el Derecho a la Consulta, que debe ser previa, libre, informada, de buena fe, culturalmente adecuada y con el propósito de obtener el consentimiento; donde todas éstas características son el estándar mínimo a cumplir en cualquier proyecto de desarrollo o (...) extractivo que afecte a pueblos indígenas, por lo que debe explicarse también el extractivismo al interior de los estados-nación y su modus operandi, que ha provocado la existencia de zonas y regiones que algunos autores caracterizan como “estados de excepción” o estados de “de no-derecho”. El análisis propuesto contrasta las bases mencionadas con algunos casos llevados ante la jurisdicción del Sistema Interamericano de Derechos Humanos, cuya última fase descansa en las sentencias de la Corte IDH.ABSTRACT: The present paper proposes an analysis of the Fundamental Rights of the indigenous peoples in the light of the international principles of Free Determination and Prior Consultation, as foundations and budgets of the other Indigenous Rights. Consequently, the Right to Consultation is analyzed, which must be prior, free, informed, in good faith, culturally appropriate and with the purpose of obtaining consent; where all these characteristics are the minimum standard to be met in any development or extractive project that affects indigenous peoples, so the extractivism within the nation-states and its modus operandi, which has caused the existence of zones and regions that some authors characterize as "states of exception" or "non-right" states. The proposed analysis contrasts the mentioned basis with some cases brought before the jurisdiction of the Inter-American Human Rights System, whose last phase rests on the judgments of the Inter-American Court.PALABRAS CLAVE: Libre determinación y consulta, Derechos Fundamentales, pueblos indígenas. KEYWORDS: Free determination and consultation, Fundamental Rights, indigenous peoples. (shrink)

This article revisits the hope of the First and Fourth Missiological Institute (MI) consultations in 1965 and 1967 regarding the survival of African Spirituality as relevant to the daily life of South African churches. African Spirituality has played a significant role in the cultural context of Africans. In the African context, African Spirituality is intertwined with life, death, and health, which co-exist with material aspects and the economy as gracious gifts from God. The churches in South Africa and elsewhere (...) in Africa have been challenged by the African worldview of healing and culture. Thus, Africans mostly prefer the African-centred church with more African Christianity, instead of Western Christianity. This has been a serious challenge in African church circles for centuries, even in the current 21st century. The question therefore arises whether this is a matter for the Africanisation, indigenisation, and decolonisation of the church in Africa. CONTRIBUTION: The article analyses the two MI consultations and whether the church in the 21st century has Africanised and decolonised itself in service of its African members. The study is a historical approach given the history of the MI's contribution in South Africa. The concept of African Spirituality is unpacked and contextualised within the African Independent Churches' (AIC) Zionist type churches such as the Zion Christian Church (ZCC), the St John's Apostolic Faith Mission (AFM), and other Ethiopian type churches such as Lutheran Bapedi Church and others in South Africa and African Traditional Religions (ATR). The article engages the importance of how African Spirituality differs from other spiritualities within the context of Christian spirituality. (shrink)

If we ask ourselves the question, how does traditional healers, priests and priestesses know what they know? One of the ideas, amongst many, that become evident is the fact that even if they know enough to heal or help people, they are not necessarily available anytime and anywhere for anyone who seeks their help. Though the detailed procedures of some traditional healers are known to them alone, and difficult to share sometimes, it will be good for some of these procedures (...) to be readily available to people. In recent times, modern technology has completely transformed societies and proved its vitality and viability in information sharing and acquisition processes. With the aid of modern technology, people and cultures have evolved greatly. Modern technology has allowed the delivery of information in places and times that were out of reach before. Based on this, the chapter argues that aspects of African cultural practices, like traditional healer’s consultation processes, can possibly use technology to provide and deliver more reliable information to people in need. Hence, there is a need to combine some cultural practices with modern technology to make information readily available to people so that they can use it when necessary. (shrink)

Records the papers and commentaries, with an edited discussion, presented at an international consultation convened by the Council for International Organizations of Medical Sciences (CIOMS) to guide revision of the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects. The Guidelines, first issued in 1982 and then revised in 1993, are being updated and expanded to address a number of new and especially challenging ethical issues. These include issues raised by international collaborative trials of drugs in developing countries, (...) especially expensive drugs, and the use of placebo controls in randomized clinical trials. Others arise from the complexity of research in human genetics, including stem-cell research, and in reproductive biology. Throughout, particular attention is given to the difficult questions that arose during the heated debate over trials in developing countries, of short-duration zidovudine (AZT) therapy to reduce perinatal transmission of HIV. The International Ethical Guidelines for Biomedical Research Involving Human Subjects set out a code of research ethics that is widely used by ethical review committees and other bodies responsible for reviewing and overseeing the ethical design of studies and conduct of research. The revision of the Guidelines is being coordinated by CIOMS, in collaboration with WHO. The consultation centered on seven specially commissioned papers, authored by international experts that explore some of the more difficult issues in depth. Each is followed by an invited commentary, often expressing opposing views, and a summary of the issues or conclusions that emerged during the subsequent debate. The first paper, on justice in international research, deals with the question of whether proposals for research to be conducted in a developing country should make provision for future access of the population involved to the interventions under investigation. Also considered are questions that arise when research uses populations in developing countries to investigate interventions that will be of exclusive benefit to the industrialized world. Case studies of recent drug trials and their research protocols are discussed to illustrate circumstances in which use of populations in developing countries is justified or constitutes exploitation. Ethical challenges of the randomized controlled trial are considered in the second paper, which includes a discussion on the equitable distribution of benefits and risks, the use of placebo for controls, and the obligation to ensure that the participation of controls does not compromise their medical care or endanger their health. A paper on informed consent in international health research considers how cultural factors influence communication and language in the informed-consent process and respect for privacy and confidentiality in the research. Subsequent papers address issues in genetics research and reproductive biology, including the moral status of fetuses and the use of embryos in research, and examine the contribution which international human rights instruments can make in the application of the general principles of ethics to research involving human subjects. The final paper gives an overview of capacity building and the role of communities in international biomedical research. (shrink)

The globalized nature of modern organizations presents new and intimidating challenges for effective relationship building. Organizations and their employees are increasingly being asked to manage unfamiliar relationships with unfamiliar parties. These relationships not only involve working across different national cultures, but also dealing with different organizational cultures, different professional cultures and even different internal constituencies. Managing such differences demands trust. This book brings together research findings on organizational trust-building across cultures. Established trust scholars from around the world consider the development (...) and maintenance of trust between, for example, management consultants and their clients, senior international managers from different nationalities, different internal organizational groupings during times of change, international joint ventures, and service suppliers and the local communities they serve. These studies, set in a wide variety of national settings, are an important resource for academics, students and practitioners who wish to know more about the nature of cross-cultural trust-building in organizations"--Provided by publisher. (shrink)

Medical argumentation in non-Western societies has attracted little attention. In line with the pragma-dialectical approach to the study of argumentation, this article identifies a prototypical argumentative pattern in Chinese medical consultations. In addition to institutional preconditions, whose relevance to the argumentative pattern has been well cited, a factor that may be equally important has remained unnoticed: the preference for certain drugs, treatments or therapeutic measurements on the basis of folk interpretations of medical phenomena in individual ethnic groups. These preferences may (...) be seen as cultural preferences in the medical domain. In this paper, a prototypical argumentative pattern of Chinese medical consultations is provided. Two levels of the pattern are distinguished and discussed: a basic argumentative pattern as presented in the pragmatic-dialectical approach and its extensions due to cultural preferences as well as institutional constraints. Illustrated by an exemplary analysis on the basis of empirical data collected from Chinese consulting rooms, the impact of cultural preferences on physicians’ strategic maneuvering in argumentation is identified and recognized. It is argued that the existence and impact of cultural preferences require attention in medical argumentation. (shrink)

Pragmatic presupposition is analyzed in this paper as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for making a presupposition can be represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely as the conclusion of an underlying presumptive reasoning that does not or may not contain contradictions with other presumptions, including the ordering of the hierarchy of presumptions. Presumptions are in (...) turn analyzed considering their nature and their hierarchy, namely their object and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between communicative infelicities or misunderstandings deriving from presuppositional failures and the underlying system of presumptions and presumptive reasoning. This approach can be applied to the investigation of communicative problems within the medical context, and more precisely the communication in diabetes cases. (shrink)