Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients’ ability to comprehend (...) complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17%) would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician’s decision as to whether to comply with a patient’s AD. Conclusions Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient’s initial wishes and preferences expressed by the AD. (shrink)

The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp down (...) decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions. There are no data in this work. (shrink)

We show that under the proper forcing axiom the class of all Aronszajn lines behave like [Formula: see text]-scattered orders under the embeddability relation. In particular, we are able to show that the class of better-quasi-order labeled fragmented Aronszajn lines is itself a better-quasi-order. Moreover, we show that every better-quasi-order labeled Aronszajn line can be expressed as a finite sum of labeled types which are algebraically indecomposable. By encoding lines with finite labeled trees, we are also able to deduce a (...) decomposition result, that for every Aronszajn line [Formula: see text] there is an integer [Formula: see text] such that for any finite coloring of [Formula: see text] there is subset [Formula: see text] of [Formula: see text] isomorphic to [Formula: see text] which uses no more than [Formula: see text] colors. (shrink)

Heightened political polarization challenges civic educators seeking to prepare youth as citizens who can navigate affective boundaries. Current approaches to civic education do not yet account for the emotional basis of citizenship. This paper presents an argument for critical affective literacy in civic education classrooms. Drawing from concepts and theories in critical emotion studies, affective citizenship, and agonistic political theory, critical affective civic literacy challenges the rationalistic bent of civic education, and offers instructional strategies for educating the political emotions of (...) students. The voices of late-arrival migrant youth enacting affective citizenship are featured in order to help illuminate the contributions of critical affective literacy to social studies research and practice. (shrink)

In this study, we explore the global effect of the Internet on democracy over the period of 1992 to 2002 by observing the relationships between measures related to democracy and Internet prevalence. Our findings suggest that while Internet usage was not a very powerful predictor of democracy when examining full panel data from 1992 to 2002, it was a stronger predictor when we study data from just the years 2001 to 2002. We hypothesize that the jump in the ability of (...) Internet penetration indicators to explain variation in democratization that occurred in 2000 suggests that the Internet may have only recently come into its own as a positive force for democratization. However, these results are not globally consistent, and we show that some regions do not enjoy a positive Internet/democracy correlation suggesting that the Internet can be used both as a tool for democratization as well as an instrument for authoritarianism. (shrink)

Dubbed 'the oracle' by no less an authority than James Madison, Montesquieu stands as a theoretical founder of the liberal political tradition. But equally central to his project was his account of the relationship of law to each nation's particular customs and place, a teaching that militates against universal political solutions. This teaching has sometimes been thought to stand in tension with his liberal constitutionalism. In this book, Keegan Callanan argues that Montesquieu's political particularism and liberalism are complementary and (...) mutually reinforcing parts of a coherent whole. In developing this argument, Callanan considers Montesquieu's regime pluralism, psychological conception of liberty, approach to political reform, and account of 'the customs of a free people', including the complex interaction of religion and commerce. Callanan concludes that, by re-orienting our understanding of liberalism and redirecting our attention toward liberty's distinctive preconditions, a return to Montesquieu's political philosophy leaves us better prepared to confront liberal democracy's contested claim to universality. (shrink)

The Companion to Montesquieu provides a first port-of-call for readers new to the study of Montesquieu, even as it makes major contributions to the specialist literature. The volume will attract scholars of multiple disciplines and readers interested in concepts like liberty, cosmopolitanism, sovereignty, and slavery treated in the thematic chapters.

Our contribution in this paper is to highlight the ethical implications of workforce engagement strategies in an age of austerity. Hard or instrumentalist approaches to workforce engagement create the potential for situations where engaged employees are expected to work ever longer and harder with negative outcomes for their well-being. Our study explores these issues in an investigation of the enactment of an engagement strategy within a UK Health charity, where managers and workers face paradoxical demands to raise service quality and (...) cut costs. We integrate insights from engagement, paradox, and ethic of care literatures, to explore these paradoxical demands—illustrating ways in which engagement experiences become infused with tensions when the workforce faces competing requirements to do ‘more with less’ resources. We argue that those targeted by these paradoxical engagement strategies need to be supported and cared for, embedded in an ethic of care that provides explicit workplace resources for helping workers and managers cope with and work through corresponding tensions. Our study points to the critical importance of support from senior and frontline managers for open communications and dialogue practices. (shrink)

This chapter contains sections titled: The Language of Psychopathy Why a Moral Grounding Traits versus Behaviors Primates, Communication, and Serial Killers.

An implicit assumption in most works on change recipient reactions is that employees are self-centred and driven by a utilitarian perspective. According to large parts of the organizational change literature, employees’ reactions to organizational change are mainly driven by observations around the question ‘what will happen to me?’ We analysed change recipients’ reactions to 26 large-scale planned change projects in a policing context on the basis of 23 in-depth interviews. Our data show that change recipients drew on observations with three (...) foci to assess change, making sense of change as multidimensional and mostly ambivalent in nature. In their assessment of organizational change, recipients care not only about their own personal outcomes, but go beyond self-interested concerns to show a genuine interest in the impact of change on their colleagues and organization. Meaningful engagement of employees in organizational change processes requires recognizing that reactions are not simply ‘all about me’. We add to the organizational change literature by introducing a behavioural ethics perspective on change recipients’ reactions highlighting an ethical orientation where moral motives that trigger change reactions get more attention than is common in the change management literature. Beyond the specifics of our study, we argue that the genuine concern of change recipients for the wellbeing of others, and the impact of the organizations’ activities on internal and external stakeholders, needs to be considered more systematically in research on organizational change. (shrink)

Military personnel often perform complex cognitive operations under unique conditions of intense stress. This requirement to perform diverse physical and mental tasks under stress, often with high stakes, has led to recognition of the term ‘tactical athlete’ for these performers. Impaired cognitive performance as a result of this stress may have serious implications for the success of military operations and the well-being of military service men and women, particularly in combat scenarios. Therefore, understanding the nature of the stress experienced by (...) military personnel and the resilience of cognitive functioning to this stress is of great importance. This review synthesises the current state of the literature regarding cognitive resilience to psychological stress in tactical athletes. The experience of psychological stress in military personnel is considered through the lens of the Transactional Theory of stress, while offering contemporary updates and new insights. Models of the effects of stress on cognitive performance are then reviewed to highlight the complexity of this interaction before considering recent advancements in the preparation of military personnel for the enhancement of cognitive resilience. Several areas for future research are identified throughout the review, emphasising the need for the wider use of self-report measures and mixed methods approaches to better reflect the subjective experience of stress and its impact on the performance of cognitive operations. (shrink)

This collection addresses a post-WWII shift in the hierarchy of scientific explanations, where the highest goal moves from reductionism towards some ...

In much of the current academic and public discussion, conspiracy theories are portrayed as a negative phenomenon, linked to misinformation, mistrust in experts and institutions, and political propaganda. Rather surprisingly, however, philosophers working on this topic have been reluctant to incorporate a negatively evaluative aspect when either analyzing or engineering the concept conspiracy theory. In this paper, we present empirical data on the nature of the concept conspiracy theory from five studies designed to test the existence, prevalence and exact form (...) of an evaluative dimension to the ordinary concept conspiracy theory. These results reveal that, while there is a descriptive concept of conspiracy theory, the predominant use of conspiracy theory is deeply evaluative, encoding information about epistemic deficiency and often also derogatory and disparaging information. On the basis of these results, we present a new strategy for engineering conspiracy theory to promote theoretical investigations and institutional discussions of this phenomenon. We argue for engineering conspiracy theory to encode an epistemic evaluation, and to introduce a descriptive expression—such as ‘conspiratorial explanation’—to refer to the purely descriptive concept conspiracy theory. (shrink)

Contingency is the presence of non-actualized possibility in the world. Fatalism is a view of reality on which there is no contingency. Since it is contingency that permits agency, there has traditionally been much interest in contingency. This interest has long been embarrassed by the contention that simple and plausible assumptions about the world lead to fatalism. I begin with an Aristotelian argument as presented by Richard Taylor. Appreciation of this argument has been stultified by a question pertaining to the (...) source of necessity and possibility and a closely related one regarding the nature of metaphysics itself. Answering these questions reveals the crucial issue here, to wit, necessity and possibility in a temporal world. This issue is investigated through an important later criticism of Taylor by David Foster Wallace. Wallace’s critique is significant because it brings to the fore the pivotal notion for understanding contingency in a temporal world, that of synchronic possibility, the idea that incompatible states of affairs are possible at a single moment. This notion provides the basis of distinguishing two systematic accounts of truth, modality and time: two metaphysics of contingency. On one account, Taylor’s Aristotelian argument is straightforwardly valid and compelling; on the other, it is fallacious. In closing, I present reasons why the former account, supporting the Aristotelian views of time and truth, is correct and make some comments to ameliorate this conclusion. (shrink)

Emergency services personnel are a high stress occupation, being frequently confronted with highly consequential stressors and expected to perform: without fault; under high pressure; and in unpredictable circumstances. Research often invokes similarities between the experiences of emergency services personnel and elite athletes, opening up the possibility of transferring learnings between these contexts. Both roles involve genuine risks to emotional wellbeing because their occupations involve significant stress. Similarly, both roles face obstacles and injury, and their “success” is dependent on high-quality execution (...) of their skills under pressure. As such, both occupations are required to have resilience and effective coping abilities to ensure psychological well-being. Researchers suggest emotional awareness may be a key variable in the management and maintenance of resilience. This study: explored the experiences of emergency services personnel; characterised connections between emotional awareness and resilience; and reflected on the ways these findings can be extrapolated to elite athletes. We analysed 11 interviews with emergency services personnel. Participants identified resilience as crucial when coping with stress, however, many defined resilience as remaining unaffected by stress rather than, for example, managing and responding to it. Participants defined emotional awareness as understanding their emotions, and they recognised associated benefits for coping, resilience, and burnout. Nevertheless, most participants did not engage in practices to improve their emotional awareness. Barriers, such as maladaptive beliefs and help-seeking stigma, interfered with participants’ ability to cultivate emotional awareness, to promote resilience. In contrast, some participants described profound improvements in resilience and coping following the cultivation of emotional awareness. This finding illustrates that systemic change must target the individual, team, and organisation to correct misperceptions about resilience, emotional awareness, and psychological help-seeking. Developing emotional awareness may help emergency services personnel and other high stress occupations like elite athletes process difficult experiences and enhance their resilience, promoting well-being, and career longevity. (shrink)

For the theorists of crisis, the revolutionary state comes into existence through violence, and due to its inability to provide an authoritative katechon (restrainer) against internal and external violence, it perpetuates violence until it self-destructs. Writing during extreme economic depression and growing social and political violence, the crisis theorists––Joseph de Maistre, Juan Donoso Cortés, and Carl Schmitt––each sought to blame the chaos of their time upon the Janus-faced postrevolutionary ideals of liberalism and socialism by urging a return to pre-revolutionary moral (...) and religious values. They are united by three counterrevolutionary principles, all of which are purported to remedy revolutionary violence: traditional constitutional fidelity, the philosophy of the decision, and opposition to bourgeois liberalism. This essay is followed by the first complete English translation and publication of Donoso’s letter of October 24, 1851, which contains Donoso’s only reference to the “discussing class,” a political entity later popularized by Schmitt in his 1922 work Political Theology. (shrink)

The X-ray and bulk densities of PdIn alloys have been determined at ambient temperature on samples annealed at 1273 and 1373 K and quenched in water-ice mixtures. From these measurements the vacancy concentrations in this intermetallic phase have been obtained as a function of In concentration at these two temperatures. In addition, a generalized thermodynamic model is presented which considers the existence of antisite and vacancy defects on both sublattices without any dilute solution approximations. This model uses three energy parameters, (...) whose values have been obtained for PdIn using the measured vacancy concentrations and the chemical potentials of In. This model is able to describe all the available vacancy data and is suitable for calculating these values at compositions and temperatures when such data are not available. In addition, the model permits the calculation of the concentrations of the minority point defects. It is shown that dilute-solution approximations, which have invariably been used in this kind of modelling, are unsatisfactory. The present results and their analysis confirm that PdIn is a near-triple-defect type of intermetallic and not a near-Schottky type, as has been claimed recently. (shrink)

Reprint of paper first published in Philosophy and Phenomenological Research in 1984.

Early in his Essays on Intellectual Powers, Reid draws a distinction between mental power, mental operation, and mental capacity (EIP 21). To the untrained eye, these terms could probably be used interchangeably, and Reid believes this is correct, up to a point. He argues that, if we are interested in understanding exactly how the human mind works, we must use these terms with more precise meanings. This is part of his more general strategy of trying to always use the words (...) with their common meanings, as much as possible, but also pointing out that certain philosophical distinctions are needed to carry out the project of laying out the foundations of the science of the mind. This paper explains what the distinction between power, operation, and capacity is, according to Reid, with the goal of understanding why it is important to draw such a distinction, not only for the Reidian project, but for action theory, more generally. (shrink)

This volume provides a philosophical introduction to and analysis of the study of metaphor. By proceeding from the concrete analysis of complex metaphors, White is able to identify a range of features which are incompatible with standard accounts of the way words function in metaphor.

In this short text, a distinguished philosopher turns his attention to one of the oldest and most fundamental philosophical problems of all: How it is that we are able to sort and classify different things as being of the same natural class? Professor Armstrong carefully sets out six major theories—ancient, modern, and contemporary—and assesses the strengths and weaknesses of each. Recognizing that there are no final victories or defeats in metaphysics, Armstrong nonetheless defends a traditional account of universals as the (...) most satisfactory theory we have.This study is written for advanced students, but as Armstrong goes considerably beyond his earlier work on this topic, it will interest professional scholars as well. Carefully plotted and clearly written, Universals is both a paradigm of exposition and a case study on the value of careful analysis of fundamental issues in philosophy. (shrink)

Bioethics has paid surprisingly little attention to the special problems faced by women and to feminist analyses of current health care issues other than ...

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)