Each of the following papers gives an account of a different UK clinical ethics committee. The committees vary in the length of time they have been established, and also in the main focus of their work. The accounts discuss the development of the committees and some of the ethical problems that have been brought to them. The issues raised will be relevant for other National Health Service (NHS) trusts in the UK that wish to set up such a committee.

This book examines the ideology of elite lawyers and judges from the Gilded Age through the New Deal. Between 1866 and 1937, a coherent outlook shaped the way the American bar understood the sources of law, the role of the courts, and the relationship between law and the larger society. William M. Wiecek explores this outlook--often called "legal orthodoxy" or "classical legal thought"--which assumed that law was apolitical, determinate, objective, and neutral. American classical legal thought was forged in the heat (...) of the social crises that punctuated the late nineteenth century. Fearing labor unions, immigrants, and working people generally, American elites, including those on the bench and bar, sought ways to repress disorder and prevent political majorities from using democratic processes to redistribute wealth and power. Classical legal thought provided a rationale that assured the legitimacy of the extant distribution of society's resources. It enabled the legal suppression of unions and the subordination of workers to management's authority. As the twentieth-century U.S. economy grew in complexity, the antiregulatory, individualistic bias of classical legal thought became more and more distanced from reality. Brittle and dogmatic, legal ideology lost legitimacy in the eyes of both laypeople and ever-larger segments of the bar. It was at last abandoned in the "constitutional revolution of 1937", but--as Wiecek argues in this detailed analysis--nothing has arisen since to replace it as an explanation of what law is and why courts have such broad power in a democratic society. (shrink)

This book examines legal ideology in America from the height of the Gilded Age through the time of the New Deal, when the Supreme Court began to discard orthodox thought in favour of more modernist approaches to law. Wiecek places this era of legal thought in its historical context, integrating social, economic, and intellectual analyses.

The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and (...) professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted—a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option. (shrink)

Academic dishonesty is an insidious problem that besets most tertiary institutions, where considerable resources are expended to prevent and manage students' dishonest actions within academia. Using a mixed retrospective and prospective design this research investigated Gottfredson and Hirschi's self-control theory as a possible explanation for academic dishonesty in 264 university students. The relationship between academic dishonesty and general criminality was also examined. A significant but small to moderate relationship between academic dishonesty and general criminality was present, including correlations with general (...) dishonesty, violent crime and drug offending subcategories. These findings suggested that a general criminological theory may be of use in explaining academic dishonesty, but the overall ability of self-control variables to explain academic dishonesty was not strong. Controlled logistic regressions indicated that a significant positive association with academic dishonesty was only present for one of 6 self-control subscales (self-centeredness), and even this association was only present in the prospective study component. A strong relationship between past and future academic dishonesty was present. Implications of the study for institutions are discussed. (shrink)

The COVID-19 pandemic swept through New York City swiftly and with devastating effect. The crisis put enormous pressure on all hospital services, including the clinical ethics consultation team. This report describes the recent experience of the ethics consultants and Columbia University Irving Medical Center during the COVID-19 surge and compares the case load and characteristics to the corresponding period in 2019. By reporting this experience, we hope to supplement the growing body of COVID-19 scientific literature and provide details of the (...) human toll the virus took on our hospitals and communities. We also aim to highlight the role of the clinical ethics consultant as well as areas of policy and law that may need to be addressed in order to be better prepared for a future public health crisis. (shrink)

This study examined whether undergraduate students’ perceptions regarding the acceptability of cheating were influenced by the amount of ethics instruction the students had received and/or by their personality. The results, from a sample of 230 upper-level undergraduate students, indicated that simply taking a business ethics course did not have a significant influence on students’ views regarding cheating. On the other hand, Machiavellianism was positively related to perceiving that two forms of cheating were acceptable. Moreover, in testing for moderating relationships, the (...) results indicated that the extent to which taking a business ethics course influenced attitudes varied substantially across individuals. Specifically, taking a course in business ethics did result in students who scored lower on Machiavellianism holding even more negative views regarding certain forms of cheating. In addition, individuals with higher grade point averages (GPAs) who had taken a course in business ethics were also less accepting of certain forms of cheating than individuals with similar GPAs who had not taken the business ethics course. The implications of these findings are discussed. (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

Abstract While agreeing that dynamical models play a major role in cognitive science, we reject Stepp, Chemero, and Turvey's contention that they constitute an alternative to mechanistic explanations. We review several problems dynamical models face as putative explanations when they are not grounded in mechanisms. Further, we argue that the opposition of dynamical models and mechanisms is a false one and that those dynamical models that characterize the operations of mechanisms overcome these problems. By briefly considering examples involving the generation (...) of action potentials and circadian rhythms, we show how decomposing a mechanism and modeling its dynamics are complementary endeavors. (shrink)

We argued in our joint article that the facilitated consensus model of clinical ethics consultation is incomplete because it does not address the problem of what we have called “unsettled cases.” Sabrina Derrington and April Dworetz, Mark Aulisio, and Al Jonsen have each usefully challenged our claims and conclusions. In this brief article we respond to some of their arguments.

The contention that abortion harms women constitutes a new strategy employed by the pro-life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post-abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of (...) trauma are only selectively investigated. We argue that there is no such thing as post-abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites. (shrink)

Corporate philanthropy describes the action when a corporation voluntarily donates a portion of its resources to a societal cause. Although the thought of philanthropy invokes feelings of altruism, there are many objectives for corporate giving beyond altruism. Meeting strategic corporate objectives can be an important if not primary goal of philanthropy. The purpose of this paper is to share insights from a strategic corporate philanthropic initiative aimed at increasing the pool of frontline customer contact employees who are performance-ready, while supporting (...) curriculum development and infrastructure improvement for selected university business programs, creating a win-win situation for the company and the universities. This paper will address three objectives. First, we will examine the evolution of strategic philanthropy from the traditional view to its current position as a strategic option. Second, we will address the recruitment of front line talent needs (customer facing jobs in sales, customer service, and marketing) based on the profit maximization model of strategic philanthropy. Finally, we will offer conclusions and issues for future research. (shrink)

In this paper we will argue in favor of federal funding of elective abortion, more specifically in support of Medicaid funding. To do so, we will address the restrictions on public funding presently in place and demonstrate that the various justifications offered in their defense are in­adequate. We will then suggest that the ‘failure to enable’ represented by a ban on Federal funding is morally equivalent to an outright prohibition on abortion for the target population. Just as a moral equivalence (...) can be established between killing and letting die in symmetrical cases, like criteria for equivalence can be established that help to identify those failures to make possible that are morally indistinguishable from proscriptions. On this basis, it can be shown that restrictions on Federal funding in such contexts can be thought to carry the same moral liability as prohibitions. (shrink)

IntroductionThe pelvic floor muscles are active during motor tasks that increase intra-abdominal pressure, but little is known about how the PFM respond to dynamic activities, such as gait. The purpose of this study was to characterize and compare PFM activity during walking and jogging in continent adults across the entire gait cycle.Methods17 able-bodied individuals with no history of incontinence participated in this study. We recorded electromyography from the abdominal muscles, gluteus maximus, and PFM while participants performed attempted maximum voluntary contractions (...) of all muscles and completed 60–70 strides in four gait conditions: slow walk ; regular walk ; transition walk ; jog. We quantified activity throughout the whole gait cycle and during periods of bursting for each participant, and analyzed the timing of PFM bursting periods to explore when the PFM were most active in the gait cycle. We also conducted a phase metric analysis on the PFM and GM burst timings. We performed a Spearman's rank-order correlation to examine the effect of speed on %aMVCGC, %aMVCBR, and phase metric score, and used the Wilcoxon Signed-Rank test to evaluate the effect of gait modality, matched for speed, on these variables.ResultsThe PFM were active throughout the gait cycle, with bursts typically occurring during single-leg support. The PFM and GM were in phase for 44–69% of the gait cycle, depending on condition. There was a positive correlation between gait speed and both %aMVCGC and %aMVCBR. Phase metric scores were significantly higher during jogging than transition walking, but there was no difference between gait modality on %aMVCGC or %aMVCBR. Where possible we disaggregated data by sex, although were unable to make statistical comparisons due to low sample sizes.ConclusionThe PFM are active during walking and jogging, with greater activity at faster speeds and with bursts in activity around single-leg support. The PFM and GM co-activate during gait, but are not completely in phase with each other. (shrink)

This study examines the influence of ethics instruction, religiosity, and intelligence on cheating behavior. A sample of 230 upper level, undergraduate business students had the opportunity to increase their chances of winning money in an experimental situation by falsely reporting their task performance. In general, the results indicate that students who attended worship services more frequently were less likely to cheat than those who attended worship services less frequently, but that students who had taken a course in business ethics were (...) no less likely to cheat than students who had not taken such a course. However, the results do indicate that the extent to which taking a business ethics course influenced cheating behavior was moderated by the religiosity and intelligence of the individual student. In particular, while students who were highly religious were unlikely to cheat whether or not they had taken a business ethics course, students who were not highly religious demonstrated less cheating if they had taken a business ethics course. In addition, the extent of cheating among highly intelligent students was significantly reduced if such students had taken a course in business ethics. Likewise, individuals who were highly intelligent displayed significantly less cheating if they were also highly religious. The implications of these findings are discussed. (shrink)

Background: There is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the (...) KEMRI-Wellcome Trust programme in Kilifi, Kenya. Methods: Following an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits. Conclusions: Research staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)

_Essays on Beauvoir’s influences, contemporary engagements, and legacy in the philosophical tradition._.

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to what (...) they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. (shrink)

The contention that abortion harms women constitutes a new strategy employed by the pro-life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post-abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of (...) trauma are only selectively investigated. We argue that there is no such thing as post-abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites. (shrink)

The great medieval philosopher Thomas Aquinas was Dominican regent master in theology at the University of Paris, where he presided over a series of questions - academic debates - on ethical topics. This volume offers translations of disputed questions on the nature of virtues in general, the fundamental or 'cardinal' virtues of practical wisdom, justice, courage, and temperateness, the divinely bestowed virtues of hope and charity, and the practical question of how, when and why one should rebuke a 'brother' for (...) wrongdoing. The introduction explains how Aquinas's theory of virtue fits into his ethics as a whole, and it illuminates Aquinas's views by explaining the institutional and intellectual context in which these disputed questions were debated. (shrink)

Although there has been critical analysis of how the informed consent process functions in relation to participation in research and particular ethical 'dilemmas', there has been little examination of consenting to more routine medical procedures. We report a qualitative study of 25 women who consented to surgery. Of these, nine were ambivalent or opposed to having an operation. When faced with a consent form, women's accounts suggest that they rarely do anything other than obey professionals' requests for a signature. An (...) interactionist analysis suggests that women's capacity to act is reduced by the hospital structure of tacit, socially-imposed rules of conduct. Bourdieu's concepts of habitus, capital and symbolic power/violence show how the practical logic that women apply confers a 'sense of place' relative to professionals. Women experience deficits in capital that constrain their ability to exercise choice. This work demonstrates the weakness of the consent process as a safeguard of autonomy. (shrink)

Canada’s commercial seal hunt has been the subject of controversy for over 40 years. Much of the debate has centered on the question of humane killing. The reality, however, is that debates about commercial sealing are political debates involving conflicting values and ethics. We argue that the time has come for conservationists, scientists, managers of free-living animals, bureaucrats, politicians, and society at large to think beyond populations and ecosystems and consider also the well-being of individual, sentient animals. The fundamental question (...) then becomes, “Can commercial seal hunts be morally justified in the twenty-first century?”. (shrink)

Scarce resource allocation policies vary across the United States. Little is known about regional variation in resource allocation protocols and variation in their application. We sought to evaluat...