While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

Over the past decade, we have witnessed some early signs of progress in the battle against international bribery and corruption, a problem that throughout the history of commerce had previously been ignored. We present a model that we then use to assess progress in reducing bribery. The model components include both hard law and soft law legislation components and enforcement and compliance components. We begin by summarizing the literature that convincingly argues that bribery is an immoral and unethical practice and (...) that the economic harm it causes falls most heavily on those least able to absorb it. The next section summarizes the main provisions of anti-bribery legislation including the Foreign Corrupt Practices Act (FCPA), the Organization for Eco nomic Development's Convention on Combating Bribery of Foreign Officials in International Business Transactions, the United Nations Convention Against Corruption and the laws of selected countries. We conclude this section with a discussion of the "moral imperialism" argument for not imposing Western laws and values on other cultures. The next section focuses on the roles played by NGOs including Transparency International (TI), the World Economic Forum (WEF), and the International Chamber of Commerce. We review trends in enforcement and prosecution, including a review of the United States' enforcement processes, mechanisms for cross-border legal assistance, a discussion of the distinctive nature of FCPA cases, and an assessment of what the future holds for enforcement. The final section focuses on compliance processes for corporations aimed at reducing the risk of FCPA and related violations. This section also addresses the ethics of gift giving and "grease" payments. The article concludes with a summary and suggestions for further research. Throughout the article, we reference important bribery cases and include comments from several authorities who are on the front lines of the battle against international bribery. (shrink)

Decisions related to births in the “gray zone” of periviability are particularly challenging. Despite published management guidelines, clinicians and families struggle to negotiate care management plans. Stakeholders must reconcile conflicting values in the context of evolving circumstances with a high degree of uncertainty within a short time period. Even skilled clinicians may struggle to guide the patient in making value–laden decisions without imposing their own values. Exploring the experiences of one pregnant woman and her caregivers, this case study highlights how (...) bias may undermine caregivers’ ability to meet their obligation to enhance patient autonomy and the moral distress they may experience when a patient’s values do not align with their own. Management strategies to mitigate the potential impact of bias and related moral distress are identified. The authors then describe one management strategy used in this case, facilitated ethics consultation, which is focused on thoughtful consideration of the patient’s perspective. (shrink)

Abstract:Comparatively few studies have analyzed the social behavior of multinational corporations (MNCs) at a cross-national level. To address this gap in the literature, we propose a “transnational” model of corporate social responsibility (CSR) that permits identification of universal domains, yet incorporates the flexibility and adaptability demanded by international research. The model is tri-dimensional in that it juxtaposes: 1) Bartlett and Ghoshal’s (1998, 2000) typology of MNC strategies (multinational, global, “international,” and transnational); 2) the three conceptual domains of CSR (human rights, (...) labor, and the environment) proposed by the UN Global Compact (Compact 2003); and 3) Zenisek’s (1979) description of three CSR perspectives (ideological, societal, and operational). The end result is a multidimensional typology that permits the organization and development of empirical CSR research in an international setting. (shrink)

Abstract:Comparatively few studies have analyzed the social behavior of multinational corporations (MNCs) at a cross-national level. To address this gap in the literature, we propose a “transnational” model of corporate social responsibility (CSR) that permits identification of universal domains, yet incorporates the flexibility and adaptability demanded by international research. The model is tri-dimensional in that it juxtaposes: 1) Bartlett and Ghoshal’s (1998, 2000) typology of MNC strategies (multinational, global, “international,” and transnational); 2) the three conceptual domains of CSR (human rights, (...) labor, and the environment) proposed by the UN Global Compact (Compact 2003); and 3) Zenisek’s (1979) description of three CSR perspectives (ideological, societal, and operational). The end result is a multidimensional typology that permits the organization and development of empirical CSR research in an international setting. (shrink)

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

The evidence of high cognitive abilities in cetaceans does not stand up to close scrutiny under the standards established by laboratory researchers. This is likely to lead to a sterile debate between laboratory and field researchers unless fresh ways of taking the debate forward are found. A few suggestions as to how to do this are proposed.

Volume 19, Issue 11, November 2019, Page 42-44.

At the end of the nineteenth century in France, there arose a literary movement, termed le naturisme by its founder, Saint-Georges de Bouhélier. Anti-symbolist in its conception, le naturisme contained as its tenets a return to clarity and simplicity of expression and a strict avoidance of symbolist hermeticism, characteristic of Mallarmé and others. Bouhélier and his disciples triggered a polemic that raged throughout the final years of the nineteenth century and involved writers such as Emile Zola and André Gide before (...) its demise in the early twentieth century. (shrink)

Everyone knows that a tiny acorn grows into a mighty oak and a caterpillar becomes a butterfly. But in this clever, visually enchanting volume, it's also true that a cow can result in both a bottle of milk and a painting of a cow, and an ape in a jungle may become an urban King Kong. Just as day turns into night and back again, a many-tiered cake is both created and eaten down to a single piece. With simple, graphic (...) illustrations sure to appeal to even the youngest of children, this beautiful rumination on the passage of time will please the most discerning adult readers, too. (shrink)

Archéologie d'un même geste d'exclusion dont l'internement social de la folie et l'internement métaphysique de la déraison sont les effets, l'Histoire de la folie à l'âge classique décide de voir en Descartes le théoricien de cet acte violent de fondation de la raison occidentale. Après avoir exposé la polémique Foucault — Derrida, nous nous proposons, d'une part, d'identifier la « positivité » propre au discours foucaldien de la période « archéologique » et, d'autre part, de reprendre à notre compte la (...) lecture de Descartes. Nous espérons alors montrer que le « coup de force » cartésien ne vise nullement à exclure la folie mais, au contraire, à forger rationnellement la fiction d'un monde qui serait sans ordre. Le monde sensible devient le lieu d'un simulacre, et ce qui le rend fascinant c'est la catastrophe imaginaire qu'il y a derrière, savoir la nature peut-être irrationnelle de l'univers. C'est de la nécessité de cette fiction que le sujet pensant va pouvoir émerger comme le lieu de la critique.Being an archeology which, in a single excluding movement, produces the social confinement of madness and the metaphysical confinement of un-reason, The History of Madness in the Classical Age decides to see in Descartes the theoretician of this violent act of foundation of Western reason. After a presentation of the Foucault — Derrida polemic, the attempt is made, on the one hand, to identify the "positivity" proper to the Foucauldian discourse of the "archeological" period and, on the other hand, to re-read Descartes in a new light. One hopes to show that the Cartesian "revolution" in no way attempts to exclude madness but, on the contrary, to forge rationally the fiction of a world which would be without order. The sense world becomes the world of appearances, and what makes it fascinating is the imaginary catastrophe behind it, the knowledge of theperhaps irrational nature of the universe. It is by the necessity of this fiction that the thinking subject is going to be able to emerge as the place where the critique occurs. (shrink)

This essay emphasizes and explicates factors and forces that led to the creation of the Tulip futures market. It considers whether critics of that market were correct about Tulip Mania. The introductory section describes briefly the Dutch economy and states the thesis that the Dutch developed an innovative futures market. The principal section describes the forces and factors at work in the Tulip futures market. The concluding normative section assesses the bases for criticism and approves of the workings of the (...) market.Cet article met en avant et explique les facteurs et les forces qui ont conduit à la création d’un marché de futures de la Tulipe. Il examine si les analyses de ce marché étaient correctes concernant la Tulipe Mania. La section introductive décrit brièvement l’économie hollandaise et explique que les Hollandais ont développé un marché de futures innovant. La section principale décrit les forces et les facteurs qui opèrent sur le marché financier des Tulipes. La section normative de conclusion évalue les fondements des critiques et défend le fonctionnement du marché. (shrink)

L’exemple espagnol de Podemos montre comment sortir positivement des limites de l’horizontalité du mouvement, à la fois si riche et infructueuse, et comment agencer un geste politique d’autoconstitution, d’organisation et de représentation. Ce passage de l’horizontalité à la verticalité, de l’agitation et de la résistance du mouvement vers le travail de gouvernement pose non seulement des questions de spatialité, mais surtout des questions de temporalité, de durée. L’important passe par la (re)création d’un flux de mouvement politique, un système ouvert de (...) gouvernance depuis le bas qui maintient unis mouvement et gouvernement – par le débat constituant constant et par une extension de ce débat aux citoyens. (shrink)

Since antiquity, opposed concepts such as the One and the Many, the Finite and the Infinite, and the Absolute and the Relative, have been a driving force in philosophical, scientific, and mathematical thought. Yet they have also given rise to perplexing problems and conceptual paradoxes which continue to haunt scientists and philosophers. In _Oppositions and Paradoxes_, John L. Bell explains and investigates the paradoxes and puzzles that arise out of conceptual oppositions in physics and mathematics. In the process, Bell not (...) only motivates abstract conceptual thinking about the paradoxes at issue, but he also offers a compelling introduction to central ideas in such otherwise-difficult topics as non-Euclidean geometry, relativity, and quantum physics. These paradoxes are often as fun as they are flabbergasting. Consider, for example, the famous Tristram Shandy paradox: an immortal man composing an autobiography so slowly as to require a year of writing to describe each day of his life — he would, if he had infinite time, presumably never complete the work, although no individual part of it would remain unwritten. Or think of an office mailbox labelled “mail for those with no mailbox”—if this is a person’s mailbox, how can they possibly have “no mailbox”? These and many other paradoxes straddle the boundary between physics and metaphysics, and demonstrate the hidden difficulty in many of our most basic concepts. (shrink)

This detailed 1990 book describes the light and dark adaptation of receptoral and post-receptoral mechanisms from a number of perspectives. The authors emphasise the importance of the study of achromatopsia, a rare congenital condition in which the visual mechanisms that mediate day vision are absent whilst those that mediate night vision remain intact.

In the course of writing this book, answers to the following questions and many others were given in both narrative and visual form. Most of them were presented rather forcefully, and not when I was expecting them. I understood that I was to share what I learned. What is in store for the geology of North America? How do we create matter every day? What is the nature of nature? How did people live more than a half million years ago? (...) What was space travel like a half million years ago? Where is God? What are our responsibilities as humans? Is Hitler in heaven? How can we go to heaven? (shrink)

Draft Chapter for Chinese Philosophy and Its Thinkers: From Ancient Times to the Present Day .

In the twenty years since the first Earth Day, the environmental movement has become increasingly “commercialized.” In this paper, I examine why many environmental organizations now offer an array of products through catalogs and magazines, or manage stores and outlets. In part one, I explore some of the economic and political influences during the 1970s and 1980s that resulted in increased organizational sophistication and an increased production of environmental products. The part two, I explore the “commercialization” of environmentalism from two (...) angles. First, in terms of a deconstructionist critique of the system of commodities and image, I demonstrate that when environmental organizations partake in this consumer culture, they actually reproduce precisely the values and institutions that they criticize. Second, from a “constructionist” perspective, I argue that environmental products can re-enchant or reconnect people with nature, and thus can help change cultural attitudes about human-naturerelationships. I conclude that environmental products are contradictory because environmental merchandise is juxtaposed uneasily between environmental ideological rhetoric and material ambition. Environmental organizations must recognize this ambiguity before they can deal with the problem effectively. (shrink)

This baseline study was conducted to find out the knowledge, attitudes and practices of medical ethics among the undergraduate medical interns who did not have structured ethics curriculum in their course. A descriptive, cross-sectional study was carried out using a self-administered structured questionnaire among the medical undergraduate interns of Maharajgunj Medical Campus, the pioneer medical college of Nepal which enrols 60 students in a year. A total of 46 interns participated in the study. The most common source of knowledge on (...) ethics was lectures/seminars (35.7%) followed by experience at work (24.5%), training (21.4%) and own reading (17.3%). The main contents of Hippocratic Oath were known to 98.8% while 60.9% knew the main contents of Nepal Medical Council (NMC) code of ethics. Great majority (91.3%) regard ethics as very important in medical profession. “Doctors know the best irrespective of patients’ opinion” was disagreed by only 39.1% indicating the paternalistic attitude. However, 78.3% were in favour of adhering to the patient’s wish. None of the participant agreed to abandon confidentiality. Only about one-fourth (26.1%) claim to encounter ethical dilemma every day while the highest number (43.5%) had once in a month. To deal with the situation of ethical dilemma, majority approached to immediate supervisor followed by head of the department and colleagues. Eighty-seven percent of participating interns were involved in research activities involving human subjects. Only one of the participants had encountered the ethical issue on end-of-life and it was do-not-resuscitate consent in a terminally ill patient. On implementation of the curriculum on medical ethics focus should be - principles of biomedical ethics, sensitive ethical dilemmas like end-of-life care and practical experiences with participation in deliberations of the ethics committee. (shrink)

At a time when mysticism is at last emerging as a respectable field of study for philosophers and religious phenomenologists, we find this new field in considerable disarray. We see, for example, Eliot Deutsch defending as philosophically intelligible and as significant śankara's non-dualistic interpretation of the mystic's experience. 1 There is R. C. Zaehner, on the other hand, labelling śankara's mysticism ‘profane’ and sharply distinguishing it from the fuller, or ‘sacred’, mysticism of the theist. 2 A third modern-day interpreter, W. (...) T. Stace, finds both the ‘monism’ of śankara and the dualism of the theist inadequate and proposes ‘pantheism’ as the most plausible interpretation of the mystic's experience. 3 Still another interpreter, Ben-Ami Scharfstein, rejects, as did Bertrand Russell much earlier, 4 every metaphysical claim put forward by the mystic; any such claim, be it monist, pantheist, or dualist, is but an ‘ontological fairy tale’. 5. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Day I Touched JesusJeffery L. DealShe deserved better. They all do.I met her early on a morning that promised to be hot and wet, as Sudan tended to be at that time of year. Hot all the time. Hot and wet in the summers. I touched her for the briefest of moments, felt her leg move against my hand and caught a fleeting glimpse of a foot that (...) was barely the size of my fingertip. I was there because a missionary asked me to come, told me stories of conditions in Sudan and convinced me that I could save lives. He was right.Her twin brother was born eight hours earlier, sometime around midnight. The birth attendants managed the delivery as well as anyone could in the same situation. The last time I had attempted to manage such a problem delivery was almost twenty years earlier when I had been a Navy Lieutenant fresh out of my surgical internship on temporary assignment to a Marine Corps battle group in the Philippines. On that deployment, a corpsman brought me to a grass hut where a woman who looked barely more than a child herself labored against a breach delivery. I spent the day examining her while her family brought me things to eat that I do not believe should be eaten. After six hours of no progress, I radioed for a helicopter to take her to Clark Air Force base where they had operating rooms and obstetricians. In South Sudan, we had no such resources.My oldest daughter, a premed student at the time who had worked with me in Sudan on other occasions, sat in the corner with her classmates and watched as I put my hand inside the mother. She was of the Dinka ethnic group and was a large, robust woman who sweated profusely and occasionally caught her breath, but otherwise seemed unmoved by her contractions. Fluids gushed over my gloved hand and the students gasped. I felt the baby's leg retract slightly as if she resented my intrusion.I could not get past the baby's hip—she was wedged tightly in the uterus. I had some medicines that were used to hasten delivery and, not really knowing if it was the right thing to do, I gave the mother some through her IV. Still I could not dislodge the child. I told the students and birth attendants that we would give her one hour while I rounded on the other patients in our remote and poorly equipped clinic. If she did not deliver by that time we would take her to a facility run by a Catholic relief agency several hours drive from us—a drive that due to war, weather, or mechanical problems we could not always complete.I saw the rest of the patients in a hurry while browsing through all of the medical texts and the few books we kept at the clinic. This child's only hope of surviving was for her mother to have a cesarean section, and as quickly as possible. After determining that none of our other patients were in imminent danger, we loaded the mother, the first-born twin, and the grandmother into our vehicle for the long ride. One of the medical students, who at the time of this writing was completing her residency in obstetrics and gynecology, asked me if I shouldn't pray for the woman while we drove. I felt guilty for not praying out loud without being prompted, so I reached back and placed my hand on the mother's abdomen and prayed while I drove. I felt a slight movement. It could have been the rough road or the mother shifting, but I believe to this [End Page 81] day that I felt the child move. I would not feel her again. I drove as fast as the rough, bomb-cratered dirt road allowed.Mother and unborn child were doing well when we finally arrived three hours later. I knew the facility and many of the workers so I drove past the guard and directly to the obstetrics ward. Two nurses rushed out to meet us with... (shrink)