BackgroundEthics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization.MethodsThis was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical (...) methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR).ResultsFrom January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations.ConclusionsBased on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs. (shrink)

Erich Fromm was a political activist, psychologist, psychoanalyst, philosopher, and one of the most important intellectuals of the twentieth century. Known for his theories of personality and political insight, Fromm dissected the sadomasochistic appeal of brutal dictators while also eloquently championing love--which, he insisted, was nothing if it did not involve joyful contact with others and humanity at large. Admired all over the world, Fromm continues to inspire with his message of universal brotherhood and quest for lasting peace. The first (...) systematic study of Fromm's influences and achievements, this biography revisits the thinker's most important works, especially _Escape from Freedom_ and _The Art of Loving_, which conveyed important and complex ideas to millions of readers. The volume recounts Fromm's political activism as a founder and major funder of Amnesty International, the National Committee for a Sane Nuclear Policy, and other peace groups. Consulting rare archival materials across the globe, Lawrence J. Friedman reveals Fromm's support for anti-Stalinist democratic movements in Central and Eastern Europe and his efforts to revitalize American democracy. For the first time, readers learn about Fromm's direct contact with high officials in the American government on matters of war and peace while accessing a deeper understanding of his conceptual differences with Freud, his rapport with Neo-Freudians like Karen Horney and Harry Stack Sullivan, and his association with innovative artists, public intellectuals, and world leaders. Friedman elucidates Fromm's key intellectual contributions, especially his innovative concept of "social character," in which social institutions and practices shape the inner psyche, and he clarifies Fromm's conception of love as an acquired skill. Taking full stock of the thinker's historical and global accomplishments, Friedman portrays a man of immense authenticity and spirituality who made life in the twentieth century more humane than it might have been. (shrink)

Loose, unconnected, free-floating, mobile: this is the modern individual, at least in comparison with the immediate past.

Although Mr. Schrader states that "it is beyond the scope of [his] paper to examine Kant's argument in the Analytic that our empirical knowledge rests upon a priori knowledge of space and time," he does offer a hint as to how he would go about this: "[Kant] seeks to show that the categories are necessary in order to cognize events in one space and one time, and that all empirical judgments rest upon the assumption that space and time are unitary." (...) This is undeniably the foundation of Kant's theory of time. It shows, however, a bias for the special manner of the objective deduction, where emphasis falls on the unity of consciousness as the basic premiss, instead of on the conditions of representations in general, which is how the basic premiss is stated in the subjective deduction in the first edition. The two are equivalent, as Kant insists, but the formulation in the subjective deduction wears a bolder, more radical countenance, since it stresses what is less explicit in the objective deduction, that all the Analytic is derived from nothing more than the nature of a representation. For most purposes the two transcendental deductions are interchangeable, but for the theory of time we turn most profitably to that deduction which dwells more meticulously on the earliest stages, and elaborates the most primitive steps of the deduction of the categories. Accordingly we will now examine the subjective deduction in the first edition. (shrink)

The essay is an attempt to examine aspects of legal interpretation from an external, sociological point of view. “Interpretation”, in its normal juristic sense, is primarily a process in which decision‐makers with secondary legitimacy link their decisions to authority of primary legitimacy. The type of legitimacy which is dominant within the legal system greatly influences the style of interpretation ‐ in “closed” systems, where the stock of premises is fixed, “legalism” will abound. Legal interpretation is not concerned with what a (...) text really means, in any literal sense; and standards for judging legal interpretation are different from the standards of judging other forms of communication, for example, literature. Indeed, a judge can be considered great precisely because of his creative acts of misinterpretation. (shrink)

Erich Fromm was a political activist, psychologist, psychoanalyst, philosopher, and one of the most important intellectuals of the twentieth century. Known for his theories of personality and political insight, Fromm dissected the sadomasochistic appeal of brutal dictators while also eloquently championing love--which, he insisted, was nothing if it did not involve joyful contact with others and humanity at large. Admired all over the world, Fromm continues to inspire with his message of universal brotherhood and quest for lasting peace. The first (...) systematic study of Fromm's influences and achievements, this biography revisits the thinker's most important works, especially _Escape from Freedom_ and _The Art of Loving_, which conveyed important and complex ideas to millions of readers. The volume recounts Fromm's political activism as a founder and major funder of Amnesty International, the National Committee for a Sane Nuclear Policy, and other peace groups. Consulting rare archival materials across the globe, Lawrence J. Friedman reveals Fromm's support for anti-Stalinist democratic movements in Central and Eastern Europe and his efforts to revitalize American democracy. For the first time, readers learn about Fromm's direct contact with high officials in the American government on matters of war and peace while accessing a deeper understanding of his conceptual differences with Freud, his rapport with Neo-Freudians like Karen Horney and Harry Stack Sullivan, and his association with innovative artists, public intellectuals, and world leaders. Friedman elucidates Fromm's key intellectual contributions, especially his innovative concept of "social character," in which social institutions and practices shape the inner psyche, and he clarifies Fromm's conception of love as an acquired skill. Taking full stock of the thinker's historical and global accomplishments, Friedman portrays a man of immense authenticity and spirituality who made life in the twentieth century more humane than it might have been. (shrink)

This paper addresses the knowledge required for individuals to evaluate Information and Communications Technologies decisions that relate to the organization and management of cyberspace, and to hold accountable the parties responsible for those decisions, whether the responsible party is a government actor, market actor or private individual. The authors argue that the Open Systems Interconnection model, with certain modifications, should serve as a primary educational tool in helping individuals to gain the understanding of ICT necessary to protect public interests related (...) to cyberspace. (shrink)