Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, (...) we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. (shrink)

Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members (...) of higher administration. These data will be of use to educators as well as to fellows who advocate for elements of training in preparation for their first position. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Kimberly et al. (2005) have examined an important issue surrounding end-of-life decision-making, that of honoring do-not-resuscitate (DNR) orders in the non-medical setting of public schools. Their...

We congratulate Fox and her colleagues (2007) for contributing to the published empirical literature on ethics consultation in United States hospitals. Their study demonstrates the continued wide v...

While consensus exists among many practitioners of ethics consultation about the need for and identification of core competencies and standards, there has been virtually no attempt to determine how these competencies and standards are best taught and assessed. We believe that clinical ethics consultation has reached a state of sufficient maturity that expert practitioners can evaluate those who are new to the field. We will outline several steps that can facilitate the creation of a certification process for clinical ethics consultants, (...) assuring the competency and quality of consultation for the patients, families, and healthcare professionals who utilize ECSs. (shrink)

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)

This essay considers medieval sewing in light of Austin's speechact theory. Analysing manuscripts, relics, indulgences, and even a bishop's mitre, the article argues that stitching was a way to enact, or intensify, the ritual purpose of objects, whether that was ceremonial, devotional, or authoritative. Whereas a speech act functions by its utterance, stitches act by forming visible and often ceremonious attachments between materials in order to aggrandise, embellish, assert and layer author ity, or swathe an object in textiles as if (...) it were a relic. _German_ Dieser Essay betrachtet mittelalterliches Nähen im Licht von Austins Sprechakttheorie. Indem er Manuskripte, Reliquien, Ablässe und sogar die Mitra eines Bischofs analysiert, argumentiert der Artikel, dass Nähen eine Weise war, den rituellen Gebrauch der Objekte einzusetzen oder zu intensivieren – ob es sich nun um zeremonielle, devotionale, oder autoritative Zwecke handelte. Während ein Sprechakt durch seine Äußerung agiert, handeln Nähstiche, indem sie sichtbare und oft feierliche Verbindungen zwischen Materialien schaffen, um Autorität zu steigern, zu verschönern, zu behaupten und zu schichten – oder um einen Gegenstand in Textilien zu hüllen, als handelte es sich um eine Reliquie. (shrink)

In this article, the authors introduce the concept of a “queer counter-mythology.” They do so by discussing a speculative song they wrote as an enactment of research-creation. Research-creation names an interdisciplinary scholarly praxis where artist-scholars create the artefacts they want to think-with, rather than analysing existing cultural productions. The song discussed in this article, “Cosmic Beavers,” proposes a queer counter-mythology that reimagines the historical, colonial archive by foregrounding the stories of giant, trans-dimensional beavers who shred Lewis and Clark and use (...) them to reinforce their Time-Dam. Drawing on this song, as well as queer theories of time and anti-colonial thinkers, the authors suggest that artistic interventions invoke speculative lures that, while not changing history, can complicate state-sanctioned archives and narratives of the past and future: they frame this intervention as a queer counter-mythology. (shrink)

The biopsychosocial model, which was deeply influential on psychiatry following its introduction by George L. Engel in 1977, has recently made a comeback. Derek Bolton and Grant Gillett have argued that Engel’s original formulation offered a promising general framework for thinking about health and disease, but that this promise requires new empirical and philosophical tools in order to be realized. In particular, Bolton and Gillett offer an original analysis of the ontological relations between Engel’s biological, social, and psychological levels of (...) analysis. I argue that Bolton and Gillett’s updated model, while providing an intriguing new metaphysical framework for medicine, cannot resolve some of the most vexing problems facing psychiatry, which have to do with how to prioritize different sorts of research. These problems are fundamentally ethical, rather than ontological. Without the right prudential motivation, in other words, the unification of psychiatry under a single conceptual framework seems doubtful, no matter how compelling the model. An updated biopsychosocial model should include explicit normative commitments about the aims of medicine that can give guidance about the sorts of causal connections to be prioritized as research and clinical targets. (shrink)

In this introductory essay, I describe feminist ethics as a kind of approach to morality that says we ought to pay attention to the facts on the ground and empirical information in order to know whether and how a moral problem is a gendered problem. One of the best accounts of feminist ethics is by Hilde Lindemann, who wrote that feminist ethics aims “to understand, criticize, and correct how gender operates within our moral and social beliefs and practices.” She doesn’t (...) define feminism as a theory about women, and neither do I. The term 'feminist' has more to do with the sources of this approach to ethics than the ultimate goals of such theorists; women were influential and early advocates of the view that sometimes a moral problem is a problem because it is gendered. (shrink)

Evidence-based practice in education involves basing decisions about what to do on evidence about the relative effectiveness of available interventions (e.g. programmes, products, practices). This article considers two influential critiques of evidence-based education (EBE) pertaining to its treatment of values. The ‘general critique’ condemns EBE for excluding values from decisions about what to do in education. The ‘specific critique’ condemns EBE for relying on a deterministic view of causality in education which disregards the complex, value-laden nature of educational contexts. I (...) argue that virtually all versions of EBE escape the general critique, including the dominant intervention-centred approach that relies on experimental research to discover ‘what works’, because the predictions EBE aims to support are only one premise in a broader normative argument. Further, intervention-centred EBE can avoid much of the specific values-based critique because it is consistent with a probabilistic, rather than deterministic, understanding of causality. However, I argue that only a context-centred approach to EBE that relies on evidence about the specific target setting from local sources in addition to evidence from theory and mixed methods research can fully address the specific critique by accommodating critics’ descriptive claims about the nature of educational contexts. (shrink)

Kok?Chor Tan argues for a conception of Liberal Cosmopolitanism that seeks to reconcile ideals of global justice and national partiality. I provide two objections to his luck egalitarian model of global justice: first, it fails to provide adequate space for legitimate cultural variation with respect to the understanding of and valuing of natural resources; and second, that its account of ideas of collective responsibility is restricted to a point at which it becomes unrecognizable and inefficacious. I conclude with some reflections (...) on the implications of my analysis for the more general question of whether or how national partiality and global justice can be reconciled. (shrink)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (...) (whether traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

Christians share a common concern for the earth. Evangelicals emphasize creation care; mainline Protestants embrace the green movement; the Catholic Church lists "10 deadly environmental sins;" and the Eastern Orthodox Patriarch has declared climate change an urgent issue of social and economic justice. This textbook examines seven contemporary environmental challenges through the lens of classical Christian virtues. Authors Kathryn Blanchard and Kevin O'Brien use these classical Christian virtues to seek a "golden mean" between extreme positions by pairing each virtue (...) with a pernicious environmental problem. Students are thus led past political pitfalls and encouraged to care for other creatures prudently, to develop new energy sources courageously, to choose our food temperately, to manage toxic pollution justly, to respond to climate change faithfully, to consider humanity's future hopefully, and to engage lovingly in advocacy for God's earth. Readers will emerge from this text with a deeper understanding of contemporary environmental problems and the fundamentals of Christian virtue ethics. (shrink)

The Catholic Tradition requires the faithful to form and follow their conscience. This is the case even with the recognition that consciences can be malformed and one can make errors in practical judgments. Water Shaping Stone examines various aspects of this tradition regarding conscience by using, among other sources, twentieth-century magisterial documents, theologians' works, and Scripture. Kathryn Lilla Cox argues that while the Magisterium retains teaching authority, and a responsibility to help form consciences through its teaching, focusing only on (...) the Magisterium leads to incomplete formation. A more holistic vision of conscience formation means considering the formation of the moral agent to be a multifaceted process that draws on, for example, teaching, prayer, rituals, Scripture, practices, and virtues, along with relationships with the Triune God and communities of accountability. This vision of conscience formation retains the magisterial teaching authority while acknowledging discipleship as the theological basis for making and assessing practical judgments of conscience. (shrink)

There is conflicting experimental evidence about whether the “stakes” or importance of being wrong affect judgments about whether a subject knows a proposition. To date, judgments about stakes effects on knowledge have been investigated using binary paradigms: responses to “low” stakes cases are compared with responses to “high stakes” cases. However, stakes or importance are not binary properties—they are scalar: whether a situation is “high” or “low” stakes is a matter of degree. So far, no experimental work has investigated the (...) scalar nature of stakes effects on knowledge: do stakes effects increase as the stakes get higher? Do stakes effects only appear once a certain threshold of stakes has been crossed? Does the effect plateau at a certain point? To address these questions, we conducted experiments that probe for the scalarity of stakes effects using several experimental approaches. We found evidence of scalar stakes effects using an “evidence seeking” experimental design, but no evidence of scalar effects using a traditional “evidence-fixed” experimental design. In addition, using the evidence-seeking design, we uncovered a large, but previously unnoticed framing effect on whether participants are skeptical about whether someone can know something, no matter how much evidence they have. The rate of skeptical responses and the rate at which participants were willing to attribute “lazy knowledge”—that someone can know something without having to check—were themselves subject to a stakes effect: participants were more skeptical when the stakes were higher, and more prone to attribute lazy knowledge when the stakes were lower. We argue that the novel skeptical stakes effect provides resources to respond to criticisms of the evidence-seeking approach that argue that it does not target knowledge. (shrink)

The nature of moral action versus moral judgment has been extensively debated in numerous disciplines. We introduce Virtual Reality (VR) moral paradigms examining the action individuals take in a high emotionally arousing, direct action-focused, moral scenario. In two studies involving qualitatively different populations, we found a greater endorsement of utilitarian responses–killing one in order to save many others–when action was required in moral virtual dilemmas compared to their judgment counterparts. Heart rate in virtual moral dilemmas was significantly increased when compared (...) to both judgment counterparts and control virtual tasks. Our research suggests that moral action may be viewed as an independent construct to moral judgment, with VR methods delivering new prospects for investigating and assessing moral behaviour. (shrink)

From whence spring the sparks of creativity? It is to this very question that the field of depth psychology--especially that of C.G. Jung and his intellectual descendants--has much to contribute. Just as the Muses were the offspring of Mnemosyne, the goddess of memory, our memories are the ancestors of our creativity that finds its multifaceted expression in the written word, image, theater, dance, and music. The Unconscious Roots of Creativity seeks to push the investigation into that domain of memory that (...) is beyond our conscious reach. With articles from 16 contributors, the "red thread" running through each of the offerings in this volume is that, whatever its ultimate expression, the creative impulse has its roots deep in the psyche. Edited By Kathryn Madden, Leonard Cruz and Steven Buser with articles by Linda Carter, Anna Maria Costantino, Carol Thayer Cox, Leonard Cruz, Lisa Raye Garlock, James Hollis, Naomi Ruth Lowinsky, Ian Livingston, Kathryn Madden, Jordan S. Potash, Susan Rowland, Murray Stein, Ann Ulanov, Tjeu van den Berk, Robin van Loben Sels, and Heidi S. Volf. (shrink)

"Change is not merely necessary to life--it is life." That's Alvin Toffler, characteristically stating the profound in a profoundly direct way. And yes, even when we see change coming--as we're about to graduate from school, take a new job, get married--it's still not so easy to accept. And when we don't see it coming--oof, we have an even harder time. Here to help us embrace change and defuse its unsettling power is Change Happens, a full-color illustrated gift book to consult, (...) to share, to give, and to keep on a night table. Curated by Kathryn and Ross Petras, the ultimate connoisseurs of quotes whose books and calendars have over 4.5 million copies in print, these words of wisdom inspire us to be open to change and remind us that nothing positive in life ever happens without it. Arranged alphabetically by subject--including Adapting, Curveballs, Faith, Letting Go, Regrets, Second Chances, Vulnerability--it's a book to turn to in moments of need, when offering advice to a friend or loved one, when urging a child to find the courage to take a step, when marking an important occasion. (shrink)

Inspired by Mariana Ortega's invitation to reflect on diverse iterations of intersectionality, this article focuses on María Lugones's engagements with two Black feminist concepts, namely, interlocking oppressions and intersectionality. It explores these concepts alongside Lugones's use of her own terms such as intermeshed, curdling, multiplicity, and fusion, in several paradigm shifting essays, specifically, “Purity, Impurity, and Separation”, “Tactical Strategies of the Street Walker”, “On Complex Communication”, “Heterosexism and the Colonial/Modern Gender System”, “Toward a Decolonial Feminism”, “Methodological Notes Toward a Decolonial (...) Feminism”, and “Radical Multiculturalism and Women of Color Feminisms”. It also underscores Ortega's important contributions bringing these Black and Latina feminist concepts together in philosophically productive ways—in a spirit of collaboration and coalition rather than zero-sum competition. (shrink)

Indeterminate Bodies organizes a number of theoretical and empirical studies around the concept and actuality of indeterminacy, as it relates to body and society. Located within the struggle to apprehend different categories of ‘body’ in the volatile flows of late-capital, indeterminacy is considered through such multiple incarnations as economy, contingency, inheritance, question, force, uncertainty, materiality and affective resistance to determination. While indeterminacy is often positioned as the ‘trouble’ or friction in subject/object knowledge-formation (framed as ontological or empirical challenge), it also (...) engenders affects such that some subjects are both in and out of recognition. Questions of indeterminacy overlap with work on imperceptibility, giving rise to interlocked questions about the modes of representation, categorization, inclusion, exclusion and sensibility in the production of bodies. We address the hesitancies, difficulties and necessities of working with and through indeterminacy in order open up new descriptions, visions and modes of political work. (shrink)

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

The scientific, ethical, and policy issues raised by research involving the engraftment of human neural stem cells into the brains of nonhuman primates are explored by an interdisciplinary working group in this Policy Forum. The authors consider the possibility that this research might alter the cognitive capacities of recipient great apes and monkeys, with potential significance for their moral status.

Ethical sensitivity was introduced to caring science to describe the first component of decision making in professional practice; that is, recognizing and interpreting the ethical dimension of a care situation. It has since been conceptualized in various ways by scholars of professional disciplines. While all have agreed that ethical sensitivity is vital to practice, there has been no consensus regarding its definition, its characteristics, the conditions needed for it to occur, or the outcomes to professionals and society. The purpose of (...) this article is to explore the meaning of the concept of ethical sensitivity based on a review of the professional literature of selected disciplines. Qualitative content analysis of the many descriptors found within the literature was conducted to enhance understanding of the concept and identify its essential characteristics. Ethical sensitivity is considered to be an emerging concept with potential utility in research and practice. (shrink)

If the Anthropocene represents a new epoch of thought, it also represents a new form of materiality and historicity for the human as strata and stratigrapher of the geologic record. This collision of human and inhuman histories in the strata is a new formation of subjectivity within a geologic horizon that redefines temporal, material, and spatial orders of the human. I argue that the Anthropocene contains within it a form of Anthropogenesis – a new origin story and ontics for man (...) – that radically rewrites material modes of differentiation and concepts of life, from predominantly biopolitical notions of life toward an understanding of life’s geophysical origination. Here, I use the term Anthropogenesis to suggest that two things explicitly happen in the nomination of the Anthropocene: 1) the production of a mythic Anthropos as geologic world-maker/destroyer of worlds, and 2) a material, evolutionary narrative that re-imagines human origins and endings within a geologic rather than an exclusively biological context. In contrast to the homogeneous geomorphizing of the Anthropocene, I suggest that socializing the strata needs a more nuanced notion of ‘geologic life’ that challenges the construction of the Anthropocene as an undifferentiated social stratification. (shrink)

The Anthropocene marks a moment of wild destratification of the planet that requires analysis of the relations between geologic forces and social practices. Deleuze and Guattari’s concept of strata is examined in order to develop a geophilosophy for the Anthropocene. Establishing a model of strata that conjoins earth and social flows together into planes of interrelated production highlights how the fossil substratum subtends contemporary forms of social relations. Stratifications, it is argued, are planes of social reproduction that both constrain and (...) are expressive of possible modes of expression. If power, according to Foucault, is a relation between forces, geosocial strata conceptualizes how stratifications organize and capture forces into political geology. Concentrating on diagramming moments of crossing strata, it is suggested that Anthropocene geopolitics needs to be located at the intersection of geosocial formations and processes of fossilization, rather than through a new assemblage of planetary scale. (shrink)