End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not ?futile.? Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, ?If this were not an attempted suicide, would a request to withdraw care be reasonable?? We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

Discussions surrounding patient engagement and empowerment often use the terms “patient” and “consumer” interchangeably. But do the two terms hold the same meaning, or is a “patient” a passive actor in the health care arena and a “consumer” an informed, rational decision-maker? Has there been a shift in our usage of the two terms that aligns with the increasing commercialization of health care in the U.S. or has the patient/consumer dynamic always been a part of the buying and selling of (...) health care in the American system? Recent discussions of the issue exist in the popular press and in social media forums such as TEDMED, but few direct analyses of the ethical, legal, and policy ramifications of this possible shift in terminology are available in the academic literature. This paper analyzes our usage of the terms and any recent changes in the dynamic and discusses the ethical, legal, and policy implications of this simple terminology for the physicianpatient relationship. (shrink)

We are grateful for the careful reading and insightful responses of the several peer commentaries to our proposed approach to requests to withhold or withdraw life support therapies among patients...

We are grateful for the careful reading and insightful responses of the several peer commentaries to our proposed approach to requests to withhold or withdraw life support therapies among patients...

Despite claims to the contrary, the science of ecology has a long history of building theories. Many ecological theories are mathematical, computational, or statistical, though, and rarely have attempts been made to organize or extrapolate these models into broader theories. The Theory of Ecology brings together some of the most respected and creative theoretical ecologists of this era to advance a comprehensive, conceptual articulation of ecological theories. The contributors cover a wide range of topics, from ecological niche theory to population (...) dynamic theory to island biogeography theory. Collectively, the chapters ably demonstrate how theory in ecology accounts for observations about the natural world and how models provide predictive understandings. It organizes these models into constitutive domains that highlight the strengths and weaknesses of ecological understanding. This book is a milestone in ecological theory and is certain to motivate future empirical and theoretical work in one of the most exciting and active domains of the life sciences. (shrink)

This paper summarizes three major approaches to the problem of business ethics. Comparisons and contrasts are drawn between the moralistic approach of Berhman, the social contract theory of Nash, and a comprehensive systems approach as articulated by Elbing. In the final section, some attempt is made to indicate how these models may be implemented into managerial policy decision making process by the use of group work and ascending communication. Some consideration of using organizational structure to implement ethical concerns is indicated.

The recent global economic collapse brings new calls for reform and change as well as a re-examination of the ethical foundations underpining it. Most professors as well as students remain profoundly unhappy with the Business Curricula. The curricula appear to swing between technological training and academic theory. There is little genuine focus on the central issue of the problem: the students’ and faculty’s assumptive world which drives the selection of the materials chosen for presentation as well as the decision-making process. (...) In the pragmatic quest to achieve status within academe, business schools appear to have forgotten that their subject matter is not one cognate domain but a mixture of several areas including mathematics, economics, anthropology, sociology, psychology, logic and planning. Course structures must be redesigned as consilient. That is, each course contains in it the links to other courses and is not expected to be complete in themselves; the new structures proposed are no longer under the direct control of one instructor but each course is under the control of a committee. This creates a linkage between courses that together from a linked chain of knowledge where the strength of the curriculum is tied to the consilient strength of the courses. The result is an organic and developmental model for teaching and learning with a strong ethical foundation as well as developed moral links to effective decision making. (shrink)

This paper will argue the importance of the creation of a moral compass, driven by empathy and a rigorously trained will in higher education leadership to develop a tighter relationship between higher education and wealth equity. We will explore the foundational documents that first discussed these issues within a global context. Further, We explore how these goals, enhanced by insights promulgated by the United Nations, can be achieved by teaching empathy, developing a moral compass and training the will.

This article argues the philosophical concerns and foundational challenges raised by a for-profit model of education. The for-profit model is governed by a business paradigm, without reference to the context in which it is found. The authors explore primary ethical questions and challenges presented by this model. As such, they present potential solutions to the growing problem in higher education as a corporate entity. The authors introduce a potential model for analysis of the issues and suggest an interventional technique with (...) concrete directions for change. Universities are on the threshold of a transformation which can no longer be isolated from wider society. This environment awakened the critical task of blending corporate success with educational integrity. (shrink)

Like process theism, Christian theology affirms the immanence of God in the world and of the world in God. Unlike process theism, it also affirms the ontological priority of God over the world. As a result, Christian theologians will object to describing God’s relation to the world by analogy with the mind’s relation to the body or in terms of whole-part relations. In Christian history, the God-world relation has been more often described in terms of “participation.” The world is said (...) to participate in God, keeping in mind that this language is highly metaphorical. The idea of participation is a development of themes enunciated by Plato and Aristotle, but adapted by Christian theologians to trinitarian ends. The created world participates in God by reflecting the trinitarian life of identity and difference. This establishes an organic and internal relation between God and the world. (shrink)

There remains a paucity of research investigating the efficacy of executive coaching. Ambiguity surrounds its definition, its methodology and outcomes. Despite this, the executive coaching remains a viable business proposition. Practitioners bring services to the business community offering services that transcend traditional performance management consultations establishing independent “performance-driven” relationships with executives. This paper examines the process of coaching suggesting that a better understanding of process will enhance practice efficacy and accelerates empirical investigations. In addition, ethical, confidential and legal issues require (...) attention when planning to utilize an executive coach. All this implicates the need to better understand coaching – and how it typically operates. Case studies are provided in the examination of coaching consultations in Fortune 100 settings. (shrink)

This book is a collection of reflections and empirical studies which examine the many facets of the meanings of work. The authors are significant scholars in fields of study ranging from ethics to sociology. The book is a text which aims at balancing the academic with the practical and so the chapters often reflect the tensions implicit in such a venture. The reader will find in these pages historical, philosophical, educational, religious, entrepreneurial and many other points of view which combine (...) to emerge as a text which is both encyclopedic in information yet engaging and lively in style. The reader will be able to understand how the meanings of work have changed over the centuries varying according to historical place and point of view. At the same time, the diligent reader will observe the centrality that work has in the lives of people both practically and in terms of life quests. Work has previously been defined as an activity that produces something of value for other people. This definition does not even begin to include the information about work that is presented in this book. The reader will feel a invigorating sense of worth from this book. (shrink)

This book is an important contribution to the Values literature on the meanings of work. These essays explore the philosophical, ethical, religious, and social foundations that underscore so much of the current thinking and concern about work satisfaction and the place of work in the search of meaning. Various points of view are presented and these include among others historical perspectives, empirical studies and cross-cultural explorations. The result is a compelling and critical volume which challenges many basic cultural and empirical (...) assumptions and raises many questions about values and value-based decisions. (shrink)

The private self, however, cannot stand alone. "We cannot think of the self except in contrast to that which is other than the self". Royce finds the source of physical nature in this need of the self for a not-self. The whole difference between inner and outer is social in origin, for only social confirmation can sustain our belief that a fact is an outer fact rather than an inner fact which no one else can observe.

The rule of law in our society is responsible for preserving personal freedoms in spite of a regulated economy. Thinking about law, Historically, Has moved from personal or authoritarian law to natural law to a theory of consent or contract. Contract depersonalizes human relations, In being regulated by impersonal agencies, Opening the way for government regulation. But this regulation is only of those areas of life which are impersonal and leaves people free with regard to the ends of life. One (...) danger to freedom in a controlled economy is the growth of administrative law. (staff). (shrink)

The primary purpose of the system of linear notation is to make the logic of the syllogism more convenient to use by eliminating many of the operations required by its traditional forms. Except for its employment of the distinction between symmetric and nonsymmetric relations and the distinction between transitive and nontransitive relations, linear notation introduces no new principles into syllogistic logic. It is new only as a system of notation. As a system of notation it radically simplifies the application of (...) the principles of syllogistic logic to the analysis of arguments.The use of linear notation enables us to state subject-predicate propositions in such a way that their formal relations with each other are revealed directly without the necessity of performing any of the separate operations required by the traditional methods of syllogistic logic. Very complex arguments, involving any number of related premises, can be stated in such form that all possible conclusions that are obtainable by any combination of syllogistic operations may be read directly from the premises. (shrink)