During the 1970s and 1980s, legal precedent, governmental recommendations, and professional society guidelines drove the formation of hospital ethics committees (HECs). The Joint Commission on Accreditation of Health Care Organization’s requirements in the early 1990s solidified the role of HECs as the primary mechanism to address ethical issues in patient care. Because external factors drove the rapid growth of HECs on an institution-byinstitution basis, however, no initial consensus formed around the structure and function of these committees. There are now almost (...) 40 years of empirical studies on the composition, administration, and activities of HECs in the United States. We conducted a systematic review of the available empirical literature on HECs to describe their evolution. As HECs changed over time, they increased their total number of members and percentage of members from nursing and the community. Although physicians increasingly chaired these committees, their presence as a percentage of overall members declined. The percentage of administrative members remained steady, although committees became increasingly likely to have at least one administrative member. HECs were also increasingly likely to report to an administrative body or to the board of trustees or directors rather than to the medical staff. Finally, consultation volume increased steadily over time. There has not, however, been a national survey of the composition of ethics committees, their administration, or volume of consultation in more than 10 years, despite increasing calls for professional standards and quality improvement assessments among HECs. (shrink)

The debate about health insurance coverage and the related issue of unequal access to health care turn on fundamental questions of justice, but for an individual patient like DM, the abstract question about who is deserving of health insurance becomes a very concrete problem that has a profound impact on care and livelihood. DM's circumstances left him stuck in the hospital. A satisfactory discharge plan remained elusive; his insurance coverage severely limited the number and type of facilities that would accept (...) him; and his inadequate engagement in his own rehabilitation process limited discharge options even further. Despite extensive involvement with the psychiatry, social work, physical therapy, and occupational therapy teams, DM consistently made “bad” decisions. He repeatedly refused antibiotics and did not consistently work with rehab services to improve his strength and mobility. Although the clinicians wanted to provide him with the best care possible, he often seemed unwilling to do the things necessary to achieve this care—or perhaps his depression rendered him unable to do so. He also tended to take out his frustration on staff members caring for him. All of this was, in turn, very frustrating for the staff. It may be easy, however, to make too much of DM's role, to see his choices as more important than his circumstances. A major goal of the ethics consultants was to reframe DM's predicament for the staff members involved in his care. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 45-47, October 2012.

Growing evidence suggests that nurses and other clinicians often feel insufficiently equipped to manage ethical issues that arise in their practice (Truog et al. 2015; Woods 2005; Darmon et al. 201...

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Who are you? What is truly real? Is there such a thing as free will? If you have ever considered questions like these, that’s philosophy. The Philosophy Book for Beginners breaks down the core concepts of both Eastern and Western philosophy in clear language that explains the most important people and ideas. You’ll develop an understanding of the basic ideas and see your understanding of the world expand―no dense, academic texts required. -/- The major branches―Explore the central questions of metaphysics, (...) epistemology, logic, and axiology as you see how they changed over time. A wide range of thinkers―Discover the diverse perspectives of philosophers, from Socrates in the fifth century BCE to modern-day thinkers like Martha Nussbaum. Thought experiments―Each chapter focuses on a topic, like existentialism, stoicism, or radical faith, and ends with a related thought experiment for you to ponder. Gain a solid understanding of philosophy, with a book that makes it easy to grasp and relevant to the world today. (shrink)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and everyday life, Martha Nussbaum seeks (...) a theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

This volume brings together Nussbaum's published papers on the relationship between literature and philosophy, especially moral philosophy.

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back (...) pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

In this fascinating study, the author analyzes the conceptual roots of molecular biology and the social matrix in which it was developed.

Recently, there has been a debate focusing on the question of whether groups can literally have beliefs. For the purposes of epistemology, however, the key question is whether groups can have knowledge. More specifi cally, the question is whether “group views” can have the key epistemic features of belief, viz., aiming at truth and being epistemically rational. I argue that, while groups may not have beliefs in the full sense of the word, group views can have these key epistemic features (...) of belief. However, I argue that on Margaret Gilbert's infl uential “plural subject” account of group belief, group views are unlikely to be epistemically rational. (shrink)

Personal narratives have become one of the most potent vehicles for advancing human rights claims across the world. Human Rights and Narrated Lives explores what happens when autobiographical narratives are produced, received, and circulated in the field of human rights. It asks how personal narratives emerge in local settings how international rights discourse enables and constrains individual and collective subjectivities in narration how personal narratives circulate and take on new meanings in new contexts and how and under what conditions they (...) feed into, affect, and are affected by the reorganization of politics in post-cold war, postcolonial, globalizing human rights contexts. (shrink)

This book is a collection of essays by a variety of specialists with a particular interest in palliative care. It contains seven chapters by six different authors. The first chapter Why is the study of ethics important? is by Patricia Webb, a lecturer in palliative care with a background in nursing. She tells us that studying ethics encourages logical reasoned thinking in the face of difficult decisions such as allocation of resources, access to services, best care, clinical research, and rights (...) to life. Webb reminds us that clinical guidelines may not be much help in the face of an ethical dilemma with no clear right or wrong answer. The chapter called Care versus cure by David Jeffrey, a consultant in palliative medicine and writer on medical ethics, reminds us that care is concerned as much with the subjective feelings of the patient as with the physical disease, and aims …. (shrink)

In this paper I take up a critical position in regard to the theme of debility around which this collection is framed. I argue that theorisations of ‘debility’ do little to progress theory and policy in regard to disability and share many of the problems inherent to the social model. I also suggest that the theorisation of debility is rooted in and reinforces ablebodied privilege. I begin with a critical analysis of the social model of disability and explore the dualisms (...) by which it either negates the body altogether or can only conceive the disabled body in negative terms. I then go on to explore how Puar's work on debility continues this negation of the disabled body. From this position I use the work of Inahara to excavate the foundations of ablebodied privilege. In Inahara's work gender is the analytic starting point, but for me white privilege is a much more effective mechanism through which to understand the impact and reproduction of ablebodied privilege— what McRuer refers to as ‘compulsory ablebodiedness'—which I argue underpins Puar's work. I conclude with some reflections upon how a critical analysis of ablebodied privilege might function and I reiterate its importance for a critical theory that goes beyond the mere repetition of binary structures of ablebodiedness and disability. (shrink)

The doctrine of double effect, together with other moral principles that appeal to the intentions of moral agents, has come under attack from many directions in recent years, as have a variety of rationales that have been given in favor of it. In this paper, our aim is to develop, defend, and provide a new theoretical rationale for a secular version of the doctrine. Following Quinn (1989), we distinguish between Harmful Direct Agency and Harmful Indirect Agency. We propose the following (...) version of the doctrine: that in cases in which harm must come to some in order to achieve a good (and is the least costly of possible harms necessary), the agent foresees the harm, and all other things are equal, a stronger case is needed to justify Harmful Direct Agency than to justify Harmful Indirect Agency. We distinguish between two Kantian rationales that might be given for the doctrine, a “dependent right” rationale, defended by Quinn, and an “independent right” rationale, which we defend. We argue that the doctrine and the “independent right” rationale for it are not vulnerable to counterexamples or counterproposals, and conclude by drawing implications for the larger debate over whether agents' intentions are in any way relevant to permissibility and obligation. (shrink)

Visual Agnosia is a comprehensive and up-to-date review of disorders of higher vision that relates these disorders to current conceptions of higher vision from cognitive science, illuminating both the neuropsychological disorders and the nature of normal visual object recognition.Brain damage can lead to selective problems with visual perception, including visual agnosia the inability to recognize objects even though elementary visual functions remain unimpaired. Such disorders are relatively rare, yet they provide a window onto how the normal brain might accomplish the (...) complex task of vision. Visual Agnosia reviews a century of case studies of higher-level visual deficits following brain damage, places them in the general context of current neuroscience, and draws relevant conclusions about the organization of normal visual processing. It is unique in drawing on research in cognitive psychology, computational vision, visual neurophysiology, and neuropsychology to interpret the agnosias and draw inferences from them about visual object recognition.Following a historical account of agnosia research, Visual Agnosia offers a taxonomy of a wide range of agnosia syndromes, describing and interpreting the syndromes in terms of the latest theoretical models of visual processing and ultimately bringing them to bear as evidence on a variety of questions in the study of higher vision.Martha J. Farah is Associate Professor of Psychology at Carnegie Mellon University. Visual Agnosia is included in the Issues in Biology of Language and Cognition series, edited by John Marshall. (shrink)

Phosphatidylinositol 3‐phosphate (PtdIns3P) is generated on the cytosolic leaflet of cellular membranes, primarily by phosphorylation of phosphatidylinositol by class II and class III phosphatidylinositol 3‐kinases. The bulk of this lipid is found on the limiting and intraluminal membranes of endosomes, but it can also be detected in domains of phagosomes, autophagosome precursors, cytokinetic bridges, the plasma membrane and the nucleus. PtdIns3P controls cellular functions through recruitment of specific protein effectors, many of which contain FYVE or PX domains. Cellular processes known (...) to be controlled by PtdIns3P and its effectors include endosomal fusion, sorting and motility, autophagy, cytokinesis, regulated exocytosis and signal transduction. Here we discuss how Ptdins3P is generated on specific cellular membranes, how its localizations and functions can be studied, and how its effectors serve to control cellular functions.Editor's suggested further reading in BioEssays:Phosphatidylinositol 4,5‐bisphosphate: Targeted production and signalingAbstractHow does SHIP1/2 balance PtdIns(3,4)P2 and does it signal independently of its phosphatase activity?AbstractPhosphatidylinositol‐3,4,5‐trisphosphate: Tool of choice for class I PI 3‐kinasesAbstractPhosphatidylinositol‐4‐phosphate: The Golgi and beyondAbstract. (shrink)

The work reported in this monograph was begun in the winter of 1967 in a graduate seminar at Berkeley. Many of the basic data were gathered by members of the seminar and the theoretical framework presented here was initially developed in the context of the seminar discussions. Much has been discovered since1969, the date of original publication, regarding the psychophysical and neurophysical determinants of universal, cross-linguistic constraints on the shape of basic color lexicons, and something, albeit less, can now also (...) be said with some confidence regarding the constraining effects of these language-independent processes of color perception and conceptualization on the direction of evolution of basic color term lexicons. (shrink)

Objectives—To assess perceptions of the informed consent process in patients undergoing urgent abdominal surgery.Design—A prospective observational study was carried out using structured questionnaire-based interviews. Patients who had undergone urgent abdominal surgery were interviewed in the postoperative period to ascertain their perceptions of the informed consent process. Replies were compared to responses obtained from a control group undergoing elective surgery, to identify factors common to the surgical process and those specific to urgent surgery. Patients' perceptions of received information were also compared (...) to the information perceived to have been provided by the consent obtainers. Setting—Gastrointestinal surgical service of a university teaching hospital.Patients—Seventy-four consecutive patients undergoing urgent abdominal surgery and 80 control patients undergoing elective surgery. Main measurements—Principal outcome measures were patients' perceptions of factors interfering with the ability to give informed consent, assessment of the quality of informed consent and the degree of discussion of the expected outcomes. Results—Forty-nine of the seventy-four (66%) patients undergoing urgent surgery perceived that pain did not affect their ability to give informed consent. Twenty-seven reported an adverse effect of analgesia on the ability to give informed consent. Only 22% of patients undergoing urgent surgery perceived that there had been any discussion of potential side effects and complications of surgery. Conclusion–The majority of patients in this series with acute intra-abdominal surgical conditions perceive that they retain the ability to give informed consent for surgery. There is a need for improved discussion of therapeutic options and likely outcomes. (shrink)

This paper starts by investigating Ackermann's interpretation of finite set theory in the natural numbers. We give a formal version of this interpretation from Peano arithmetic (PA) to Zermelo-Fraenkel set theory with the infinity axiom negated (ZF−inf) and provide an inverse interpretation going the other way. In particular, we emphasize the precise axiomatization of our set theory that is required and point out the necessity of the axiom of transitive containment or (equivalently) the axiom scheme of ∈-induction. This clarifies the (...) nature of the equivalence of PA and ZF−inf and corrects some errors in the literature. We also survey the restrictions of the Ackermann interpretation and its inverse to subsystems of PA and ZF−inf, where full induction, replacement, or separation is not assumed. The paper concludes with a discussion on the problems one faces when the totality of exponentiation fails, or when the existence of unordered pairs or power sets is not guaranteed. (shrink)

Sandplay is a growing field of interest for Jungian and other psychotherapists. _Sandplay - Silent Workshop of the Psyche_ by Kay Bradway and Barbara McCoard, provides an introduction to sandplay as well as extensive new material for those already using this form of therapy. Based on the authors' wide-ranging clinical work, it includes: in-depth sandplay case histories material from a wide range of adults and children over 90 illustrations in black and white and colour detailed notes on interpretation of sand (...) trays an examination of symbols and concepts used in sandplay. Clearly written and soundly based in theory, this book provides historical background for understanding sandplay as well as helpful discussion of how it works in a clinical context. Kay Bradway and Barbara McCoard bring their indispensable personal experience to the subject to stress the healing potential of sandplay. They also reflect on the nature of a therapy where the psyche works largely in silence. (shrink)

Sociology and Animals : Beginnings -- Animals and Biology as Destiny -- Animals, Social Inequalities and Oppression -- Animals, Crime and Abuse -- Town and Country : Animals, Space and Place -- Consumption of the Animal -- Animals, Leisure and Culture -- Animal Experiments and Animal Rights -- Conclusion: Sociology for Other Animals.

This paper argues that current iterations of lesbian, gay, bisexual, transgender and intersex rights are limited by an overreliance on particular representations of sexuality, in which homosexuality is defined negatively through a binary of homosexual/heterosexual. The limits of these representations are explored in order to unpick the possibility of engaging in a form of sexuality politics that is grounded in difference rather than in sameness or opposition. The paper seeks to respond to Braidotti’s call for an “affirmative politics” that is (...) open to forms of creative, future-oriented action and that might serve to answer some of the more common criticisms of current LGBTI rights activism. (shrink)

Adult playfulness describes individual differences in framing everyday situations as personally interesting, and/or entertaining, and/or intellectually stimulating. We aimed at extending initial evidence on the interconnectedness between language use and adult playfulness by asking 264 participants to provide written descriptions of their understanding of playfulness and collected self-reports of their playfulness. We used the Linguistic Inquiry and Word Count methodology to quantitatively analyze the language use in these descriptions and tested the associations with individual differences in participants’ age, gender, and (...) playfulness. While higher expressions in all measures of playfulness did go along with writing more content when describing playfulness, facet-wise analyses revealed differential findings ; but the effects were small. We found that being a women and younger age were related to writing longer texts, and we discovered additional associations between certain LIWC categories and age and gender. Our study expands the knowledge about adult playfulness and its manifestations in natural language use. We embed our findings into previous research and discuss limitations and potential approaches for replication studies. (shrink)

The ethics of Aristotle , and virtue ethics in general, have enjoyed a resurgence of interest over the past few decades. Aristotelian themes, with such issues as the importance of friendship and emotions in a good life, the role of moral perception in wise choice, the nature of happiness and its constitution, moral education and habituation, are finding an important place in contemporary moral debates. Taken together, the essays in this volume provide a close analysis of central arguments in Aristotle's (...) Nicomachean Ethics and show the enduring interest of the questions Aristotle raises. (shrink)

In the explosion of recent books on Heidegger, Karl Löwith’s work, now available in an excellent English edition, distinguishes itself by careful historical scholarship and insightful immanent critique. Along with Hannah Arendt, Hans Jonas, and Herbert Marcuse, Löwith was one of Heidegger’s first students; all were later forced into exile by the National Socialist movement their teacher publicly supported for a time. Löwith’s work on the philosophy of history and the nineteenth century is already well known in English; now we (...) can appreciate his evaluation of Heidegger. Invoking Nietzsche’s dictum, “One repays a teacher poorly if one always remains only a pupil”, Löwith here achieves a balanced critique of Heidegger’s thought and its political implications. He avoids both defensive apologies and ad hominem attacks: “Between the two extremes of fascination and repulsion, we are attempting to pursue a critical middle path”. As Richard Wolin explains in the introduction, “Throughout Löwith’s narrative it is not Heidegger’s greatness as a thinker that is in dispute, but the uses to which that greatness allowed itself to be put”. (shrink)

This pioneering study is one of the first English-language books to address Jewish theology from a postmodern perspective, probing the question of how it has the potential to survive the postmodern onslaught that some see as heralding the collapse of religion. Basing her arguments on both philosophical and theological scholarship, the author shows how postmodernism might actually be a resource for rejuvenating religion. Her response to the conception of theology and postmodernism as competing systems of thought is based on a (...) close critical study of Rav Shagar (Shimon Gershon Rosenberg) and Tamar Ross. She analyzes their writings through the lens of the most radical continental postmodern philosophers and cultural critics in order to offer a compelling theology compatible with their world-view. Whether the reader considers postmodernism to be inherently problematic or merely inconsequential, this study demonstrates why reconsidering these preconceptions is one of the most pressing issues in contemporary Jewish thought. (shrink)

In this paper we present an equivalence between the category of commutative regular rings and the category of Boolean-valued fields, i.e., Boolean-valued sets for which the field axioms are true. The author used this equivalence in [12] to develop a Galois theory for commutative regular rings. Here we apply the equivalence to give an alternative construction of an algebraic closure for any commutative regular ring.Boolean-valued sets were developed in 1965 by Scott and Solovay [10] to simplify independence proofs in set (...) theory. They later were applied by Takeuti [13] to obtain results on Hilbert and Banach spaces. Ellentuck [3] and Weispfenning [14] considered Boolean-valued rings which consisted of rings and associated Boolean-valued relations. To the author's knowledge, the present work is the first to employ the Boolean-valued sets of Scott and Solovay to obtain results in algebra.The idea that commutative regular rings can be studied by examining the properties of related fields is not new. For several years algebraists and logicians have investigated commutative regular rings by representing a commutative regular ring as a subdirect product of fields or as the ring of global sections of a sheaf of fields over a Boolean space. These representations depend, as does the work presented here, on the fact that the set of central idempotents of any ring with identity forms a Boolean algebra. The advantage of the Boolean-valued set approach is that the axioms of classical logic and set theory are true in the Boolean universe. Therefore, if the axioms for a field are true for a Boolean-valued set, then other properties of the set can be deduced immediately from field theory. (shrink)

In this essay, I explore this idea of a collective consciousness. I propose that individuals can share in a collective consciousness by forming a collective subject. I begin the essay by considering and rejecting three possible pictures of collective subjectivity: the group mind, the emergent mind, and the socially embedded mind. I argue that each of these accounts fails to provide one of the following requirements for collective subjectivity: (1) plurality, (2) awareness, and (3) collectivity. I then look to Edmund (...) Husserl’s idea of ‘social subjectivities’ for a possible account, but I agree with Alfred Schutz that Husserl fails to explain how such subjectivities are constituted by the conscious acts of individuals. In an effort to provide such an explanation, I turn to a discussion of our basic capacities for social intentionality: empathy, intersubjectivity, and co-subjectivity. In the final section of the essay, I argue that individuals can form a collective subject by taking a first-person plural perspective and ‘simulating’ the consciousness of the collective that they form. This account has the required features of plurality, awareness, and collectivity. (shrink)

The author means to show how focusing on the sense of hearing can sharpen our understanding of Kierkegaard’s argument – in the first portion of Either/Or – that Don Giovanni ranks supreme among works of art. After explaining how he takes Kierkegaard’s case to rest on the issue of the ear being the “most spiritually qualified sense,” he shows how attending to the importance of hearing within the original Don Juan myth, as well as within Mozart and Da Ponte’s treatment (...) of it, can help us understand the myth’s dependence on and repudiation of Christianity: unlike sight, hearing places us in close spiritual intimacy with its source, even as it also opens up specific possibilities of theatricality and deceit. He concludes by arguing why hearing should be regarded as the paradigmatic sense in relation to which Kierkegaard understands the task of philosophy itself, in contrast to earlier philosophical emphases on visible intelligibility. (shrink)