The archipelago context of Maluku represents the living dynamics of Christian communities in that area, which becomes an ecclesiological foundation of the Gereja Protestan Maluku. Christianity, the embryo of the GPM, is the fruit of the evangelical works by European missionaries, particularly Dutch missions from the 18th century onwards. The Dutch-type Christianity had been adapted into models so that the form of institution and Protestant teachings in Maluku moved dynamically following socio-political and cultural changes along with the colonial and the (...) post-colonial history of Indonesian and Malukan society. It attempts to describe the manifestation of the Calvinism-model of Christianity that is continuously being contextualised through absorbing various elements of worldview, tradition, and the religiosity of the archipelago society. Cultural hermeneutics is used to interpret the socio-cultural phenomena in which the church lives in and to construct its theological understanding about Christian identity. The ecclesiological construction of GPM, in turn, is structured by plural social orders. The reality also influences the perspective about GPM from many different worldviews of the Malukan archipelago society. The contextual ecclesiological perspective, therefore, is constructed based on intermingled understandings that theology of the church can only be built by considering multifold dimensions of a particular society. The result of this research pertains to the constructive understanding of a specific ecclesial context of the GPM in their struggles for theologising their existence as God’s people and, at the same time, as an integral part of certain society in Maluku and Indonesia.Contribution: As the living contextual church that struggles for proclaiming God’s love, the GPM has a theological responsibility to conduct its church mission based on its ecclesiological understanding and practices contextually. The article contributes to the enrichment of the theological discourse on the crucial roles of a church in Maluku, in the eastern part of Indonesia. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

At a time when even a brief hospital stay means becoming terrifyingly dependent on the kindness of strangers, this compassionate and practical book by a prominent medical ethicist gives power back to patients while providing invaluable guidance to their friends and families. "A cutting-edge book about cutting-edge issues (that) every American must know. . . ".--Alan Dershowitz.

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the QI tool , to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work. Although the process was marked by resistance and disagreement, (...) it was also noteworthy for the sustained engagement by participants over the year of the project, and a high level of acceptance by its conclusion. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a ninestep algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased initiatives conducted (...) in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

In this study, 191 subjects, 93 male and 98 female undergraduate business students, were asked to respond to a 51 item questionnaire to examine their perception of what constituted a "just society". The subjects agreed on 16 characteristics which a just society would have. Out of 51 there were only 10 statements whereon average responses showed significant differences based on gender.

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the “QI tool”, to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work. Although the process was marked by resistance and disagreement, it (...) was also noteworthy for the sustained engagement by participants over the year of the project, and a high level of acceptance by its conclusion. (shrink)

In this introduction to part 4 of the Common Knowledge symposium “Peace by Other Means,” the journal's editor assesses the argument made by Peace, the spokesperson of Erasmus in his Querela Pacis, that the desire to impute and avenge wrongs against oneself is insatiable and at the root of both individual and social enmities. He notes that, in a symposium about how to resolve and prevent enmity, most contributions have to date expressed caveats about how justice and truth must take (...) precedence over peace, how recovery from ill treatment may be impossible, how quietism is not a moral option, and how realism demands a national policy and a personal strategy of, at best, contingent forgiveness. He concedes that the attitudes of those opposed to quietism are healthy but suggests that there may be goods worthier than health of human devotion. This essay concludes that the main differences between what it terms “judgmental” and “irenic” regimes are disagreements over anthropology and metaphysics. The presumptions that truths are objectively knowable and that human beings are moral and rational agents characterize judgmental regimes; irenic regimes are characterized by disillusionment with those assumptions. (shrink)

Introduction [Nancy L. Rosenblum] I. Varieties of Liberalism Today 1. The Liberalism of Fear [Judith N. Shklar] 2. Humanist Liberalism [Susan Moller Okin] 3. Liberal Democracy and the Costs of Consent [Benjamin R. Barber] II. Education and the Moral Life 4. Undemocratic Education [Amy Gutmann] 5. Civic Education in the Liberal State [William Galston] III. Moral Conflict 6. Class Conflict and Constitutionalism in J. S. Mill’s Thought [Richard Ashcraft] 7. Making Sense of Moral Conflict [Steven Lukes] 8. Liberal Dialogue (...) Versus a Critical Theory of Discursive Legitimation [Seyla Benhabib] IV. Repairing Individualist and Communitarian Failings 9. Cross-Purposes: The Liberal--Communitarian Debate [Charles Taylor] 10. Democratic Individuality and the Meaning of Rights [George Kateb] 11. Pluralism and Self-Defense [Nancy L. Rosenblum] 12. The Permanent Structure of Antiliberal Thought [Stephen Holmes]. (shrink)

During the coronavirus disease 2019 (COVID‐19) pandemic, bioethical analyses often emphasized population health and societal benefit. Hospital policies frequently focused on reducing risk of transmitting SARS‐CoV‐2 by restricting visitors; requiring protective equipment; and screening staff, patients and visitors. While restrictions can be burdensome, they are often justified as essential measures to protect the whole population against a virus with high rates of transmission, morbidity and mortality. Yet communities are not monolithic, and the impacts of these restrictions affect different groups differently. (...) An ophthalmological unit outreach program in Ethiopia serves to illustrate. Pre‐operative screening policies were designed to protect as many patients as possible but had adverse impacts on underserved communities. As this case study demonstrates, creating hospital policies that truly serve the good of the society may require a more holistic review of impacts on inequitably positioned communities. (shrink)

This fine new study amalgamates catalogue-type entries for a number of illustrated manuscripts of the homilies of John Chrysostom with a cogently written thesis. Only certain manuscripts have been chosen for full analysis (to this extent the title of the book is somewhat misleading): this is a study devoted primarily to the Chrysostom manuscripts of the 11th and 12th centuries that have some anthropomorphic figural illustration (as opposed to purely vegetal or zoomorphic illustration), with a special emphasis on miniatures which (...) are text-based, i. e. correspond in some precise way to the text they accompany. Earlier homily manuscripts (there are illustrated versions from the 10th century on), and manuscripts with full-page, non-text-based frontispiece illustrations such as the magnificent, oft-discussed imperial codex Paris, B. N. Coislin gr. 79, though included, are not the central concern of this book. Despite the fact that distinctions between anthropomorphic and non-anthropomorphic figural decoration, and between text-based and non-text based imagery are not likely ones that would have been drawn by the Byzantines themselves, the author's particular focus has the advantage of bringing into the scholarly arena a considerable number of unfamiliar works, here subjected to careful codicological, paleographical and stylistic analysis, and reproduced in superb color and black and white plates. (shrink)

Dysfunctionality in socialisation is undoubtedly the most crucial characteristic of autism. For a long time, social functioning and its improvement have been considered among the most important interventions in the literature. Individuals with autism are responsive to therapist-mediated and/or peer-mediated interventions that increase their social engagement. The present study examines the impact of outdoor integrated activities, such as music therapy, equine-assisted therapy, and art therapy, in autistic individuals (n=14). The analysis was carried out on the application of a questionnaire assessing (...) three social skill domains: Joint Attention (JA), Imitation (IMI), and Turn-Taking (T-T) mediated by the therapists and by peers. The development and acquisition of these social behaviours were examined in a structured outdoor context (ASO). Data were collected by two independent observers by White's Scale questionnaire. The results revealed that the proposed interventions facilitated and led to an increase in social-behavioural experience. (shrink)

This article presents a close reading of Ibn ʿAsākir’s biography of ʿUmar II in the Tārīkh madīnat Dimashq. Although there was an earlier and substantial historiographical tradition, Ibn ʿAsākir’s biography is distinct from those of his predecessors in two major ways. First, he strategically arranged his biography to emphasize or de-emphasize certain aspects of ʿUmar II’s life, including his youth, rise to the caliphate, and reputation as a redeemer. Second, Ibn ʿAsākir’s legitimizing historiography appears to be bi-directional. Namely, where earlier (...) biographers depicted ʿUmar II as the “fifth of the Rāshidūn,” bolstering the later Umayyad’s reputation through an association with earlier authorities, in Ibn ʿAsākir’s account problematic aspects of the early civil wars and fitna-ridden Rāshidūn period are also elided through the Rāshidūn’s association with the famously pious ʿUmar II. The context for this bi-directionality is to be found in the political and social environment in which Ibn ʿAsākir compiled his Tārīkh, where dual pressure from Crusader and Shiʿite opponents contributed to his articulation of a particular Sunni vision of political and religious continuity that relied heavily on ‘Umar II’s unique persona. (shrink)

« On ne cesse de répéter que notre époque manque de sens, et qu’elle est en quête de sens. Ce livre essaie de dire que ce diagnostic n’est peut-être pas le bon. Nous avons perdu, en effet, le “sens” que les religions et les philosophies proposaient comme une “vision du monde”, avec ses valeurs et ses buts. Cette époque est révolue. Cela veut dire qu’il nous reste à découvrir comment le monde lui-même, en tant que l’espace de nos existences, et (...) selon la dimension mondiale qui devient la sienne, est le sens. Mais on ne peut le reconnaître comme tel qu’à la condition de reconnaître aussi qu’il n’y a pas à s’approprier ce sens comme une signification. Le sens de l’existence, c’est précisément qu’elle ne puisse pas maîtriser son sens. Ce qui, après tout, a peut-être toujours été le savoir fondamental de toute philosophie. ». (shrink)

« La liberté : ce singulier ne désigne pas ici une essence à laquelle rapporter toutes nos “libertés”. Il suspend au contraire toute détermination de ces “libertés”, qu’on sait bien “formelles”, sans pourtant vouloir le savoir… Il le fait au nom de l’expérience singulière de ce qui est sans essence : l’existence même. Cette expérience est un fait, lui aussi singulier, car il n’obéit pas à une logique du “fait” opposé à la “loi”. Ni fait, ni loi, mais l’être même (...) en tant que partage de l’existence. La pensée en provient, elle ne s’en empare pas. Quant elle s’ouvre à cette expérience, elle pense son possible hors d’elle-même, comme chose, force ou regard. La liberté est l’in-fini de la pensée. ». (shrink)

« “Je pense comme une fille enlève sa robe.” (Bataille.) La pensée est une mise à nu et la nudité est inachevable : elle n’est pas un état, elle est un mouvement incessant pour se porter à l’extrémité à laquelle n’atteint que ce qui se dérobe encore en atteignant l’extrémité. Mais le dénudement touche aussi au dénuement : aujourd’hui, la pensée doit répondre d’une détresse du monde et d’un souci de l’histoire qui défient toutes nos philosophies, nos religions, nos représentations. (...) Comment penser, comment recommencer à penser dans la nudité : à partir de rien de donné, en vue de rien de capitalisable? Pas de “salut”, pas de “fin”, mais à chaque instant, au contraire, une ouverture singulière du sens d’être sans fin. Cela définit d’abord la pensée – le dénudement – comme une conduite, une tenue et une allure : un ethos autant qu’une techné. ». (shrink)