Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on (...) the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)

Ethics consultants and critical care clinicians reflect on Seattle’s early experience as the United States’ first epicenter of COVID-19. We discuss ethically salient issues confronted at UW Medicin...

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

Volume 20, Issue 3, March 2020, Page 6-8.

Clinical ethicists encounter the most emotionally eviscerating medical cases possible. They struggle to facilitate resolutions founded on good reasoning embedded in compassionate care. This book fills the considerable gap between current texts and the continuing educational needs of those actually facing complex ethics consultations in hospital settings. 28 richly detailed cases explore the ethical reasoning, professional issues, and the emotional aspects of these impossibly difficult consultations. The cases are grouped together by theme to aid teaching, discussion and professional growth. The (...) cases inform any reader who has a keen interest in the choices made in real-life medical dilemmas as well as the emotional cost to those who work to improve the situations. On a more advanced level, this book should be read by ethics committee members who participate in ethics consultations, individual ethics consultants, clinicians who seek education about complex clinical ethics cases, and bioethics students. (shrink)

Jean Dominique Bauby, former editor of Elle, suffereda stroke to his brain stem that left him with locked-in syndrome. Subsequently, through blinking his left eye, he writes his memoirof this experience, The Diving Bell and the Butterfly. Thispaper explores the meaning of embodiment, especially as one'sbody bears upon one's personal identity. It explores the variouschallenges and threats to selfhood that result from Bauby'sexperience and recounts how Bauby rises to the challenge throughhis memory and imagination.

The predominant ethical framework for addressing reproductive decisions in the maternal–fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment (...) to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients. (shrink)

Clinical ethicist and professor Mark Aulisio argues that good ethics consultation is not simply a manner of meaning well. He writes: [t]he path to ethics consultation is not paved only with good in...

The target article by Camisha Russell continues the important discussion about race, racism and bioethics that has appeared in AJOB for the past few years. Russell critically examines how un...

The American Journal of Bioethics, Volume 11, Issue 11, Page 26-27, November 2011.

The idea of patient advocacy as a function of clinical ethics consultation (CEC) has been debated in the bioethics literature. In particular, opinion is divided as to whether patient advocacy inherently is in conflict with the other duties of the ethics consultant, especially that of impartial mediator. The debate is complicated, however, because patient advocacy is not uniformly conceptualized. This article examines two literatures that are crucial to understanding patient advocacy in the context of bioethical deliberations: the CEC literature and (...) the literature on advocacy in the social work profession. A review of this literature identifies four distinct approaches to patient advocacy that are relevant to CEC: (1) the best interest approach, (2) the patient rights approach, (3) the representational approach, and (4) the empowerment approach. After providing a clearer understanding of the varied meanings of patient advocacy in the context of CEC, we assert that patient advocacy is not inherently inconsistent with the function of the ethics consultant and the CEC process. Finally, we provide a framework to help consultants determine if they should adopt an advocacy role. (shrink)

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.

A new research area linked to ethics, virtues, and morality is servant leadership. Scholars are currently seeking publication outlets as critics debate whether this new leadership theory is significantly distinct, viable, and valuable for organizational success. The aim of this study was to identify empirical studies that explored servant leadership theory by engaging a sample population in order to assess and synthesize the mechanisms, outcomes, and impacts of servant leadership. Thus, we sought to provide an evidence-informed answer to how does (...) servant leadership work, and how can we apply it? We conducted a systematic literature review (SLR), a methodology adopted from the medical sciences to synthesize research in a systematic, transparent, and reproducible manner. A disciplined screening process resulted in a final sample population of 39 appropriate studies. The synthesis of these empirical studies revealed: (a) there is no consensus on the definition of servant leadership; (b) servant leadership theory is being investigated across a variety of contexts, cultures, and themes; (c) researchers are using multiple measures to explore servant leadership; and (d) servant leadership is a viable leadership theory that helps organizations and improves the well-being of followers. This study contributes to the development of servant leadership theory and practice. In addition, this study contributes to the methodology for conducting SLRs in the field of management, highlighting an effective method for mapping out thematically, and viewing holistically, new research topics. We conclude by offering suggestions for future research. (shrink)

BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the (...) range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence. (shrink)

An experiment was conducted to investigate the relative contributions of syntactic form and content to conditional reasoning. The content domain chosen was that of causation. Conditional statements that described causal relationships (if (cause>, then (effect>) were embedded in simple arguments whose entailments are governed by the rules -oftruth-functional logic (i.e., modus ponens, modus tollens, denying the antecedent, and affirming the consequent). The causal statements differed in terms ofthe number of alternative causes and disabling conditions that characterized the causal relationship. (A (...) disabling condition is an event that prevents an effect from occurring even though a relevant cause is present.) Subjects were required to judge whether or not each argument’s conclusion could be accepted. Judgments were found to vary systematically with the number of alternative causes and disabling conditions. Conclusions of arguments based on conditionals with few alternative causes or disabling conditionswerefoun~d:tobe-rnore accept~ able than cdnclusions based on those with many. (shrink)

Prior researchers have studied individual components of a theoretical decision-making model. This paper presents the results of a more complete study of the model components and presents limited support of theory. The study examines the relative importance of regulatory, organizational, and personal constructs on an individual''s ethical sensitivity. Auditors from the major international accounting firms, located in two southeastern cities, are surveyed. Structural equation modeling is used to allow for the simultaneous evaluation of the three constructs of interest. The results (...) indicate that the regulatory and organizational constructs are negatively correlated with the personal experience construct. The three constructs are not significant causal factors on ethical sensitivity. This result may be due to the manner in which ethical sensitivity is typically measured or may indicate that the complexity of the ethical decision-making process is not fully captured in the theoretical models. Thus, the models suggested in the prior literature and the results presented in prior studies of the individual components may need to be reconsidered. (shrink)

An important contribution of Alan Patten’s Equal Recognition is the conception of neutrality that grounds his defence of minority cultural rights. Built in to his conception of neutrality of treatment is a notion of ‘fairness’ whose effect is to provide an upfront, across the board limitation on the demands cultural minorities may legitimately make on the rest of society. There must be limits on the duty to accommodate, but it obscures more than it illuminates to build this into the content (...) of the right to equal recognition itself. We see more clearly what is at stake in these conflicts by articulating the value of self-determination independently and taking account of necessary limits to its satisfaction as part of a second-stage analysis of what duties may be claimed and against whom. Familiar principles of discrimination law exemplify this alternative model. This presents the interest in self-determination more robustly, while acknowledging that the claims of duty arising out of it are defeasible. The result is a more flexible and nuanced exploration of the complex moral issues involved when fundamental interests clash. (shrink)

Research from ethology and evolutionary biology indicates the following about the evolution of reasoning capacity. First, solving problems of social competition and cooperation have direct impact on survival rates and reproductive success. Second, the social structure that evolved from this pressure is the dominance hierarchy. Third, primates that live in large groups with complex dominance hierarchies also show greater neocortical development, and concomitantly greater cognitive capacity. These facts suggest that the necessity of reasoning effectively about dominance hierarchies left an indelible (...) mark on primate reasoning architectures, including that of humans. In order to survive in a dominance hierarchy, an individual must be capable of (a) making rank discriminations, (b) recognizing what is forbidden and what is permitted based one's rank, and (c) deciding whether to engage in or refriin from activities that will allow one to move up in rank. The first problem is closely tied to the capacity for transitive reasoning, while the second and third are intimately related to the capacity for deontic reasoning. I argue that the human capacity for these types of reasoning have evolutionary roots that reach deeper into our ancestral past than the emergence of the hominid line, and the operation of these evolutionarily primitive reasoning systems can be seen in the development of human reasoning and domain-specific effects in adult reasoning. (shrink)

Dominance hierarchies are ubiquitous in the societies of human and non-human animals. Evidence from comparative, developmental, and cognitive psychological investigations is presented that show how social dominance hierarchies shaped the evolution of the human mind, and hence, human social institutions. It is argued that the pressures that arise from living in hierarchical social groups laid a foundation of fundamental concepts and cognitive strategies that are crucial to surviving in social dominance hierarchies. These include recognizing and reasoning transitively about dominance relations, (...) fast-track learning of social norms (permissions, prohibitions, and obligations), detecting violations of social norms (cheating), monitoring reciprocal obligations, and reading the intentions of others. (shrink)

Dominance hierarchies are ubiquitous in the societies of human and non-human animals. Evidence from comparative, developmental, and cognitive psychological investigations is presented that show how social dominance hierarchies shaped the evolution of the human mind, and hence, human social institutions. It is argued that the pressures that arise from living in hierarchical social groups laid a foundation of fundamental concepts and cognitive strategies that are crucial to surviving in social dominance hierarchies. These include recognizing and reasoning transitively about dominance relations, (...) fast-track learning of social norms (permissions, prohibitions, and obligations), detecting violations of social norms (cheating), monitoring reciprocal obligations, and reading the intentions of others. (shrink)

Job burnout, organizational commitment, and work environment continue to be important areas of research to be studied in the realm of company employment and employee retention. Job burnout is the state of physical and emotional exhaustion and perceiving one’s profession as dull or overwhelming. Meanwhile, organizational commitment refers to the company’s attitude towards the organization and their employees, encompassing loyalty, moral responsibility, and their willingness to work. And lastly, work environment provides opportunities for employees to establish connections, develop skills, and (...) maximize their full potential in performing tasks. For the current study, researchers utilized descriptive-correlational research design to investigate the influence of Work Environment towards the job burnout and organizational commitment of BPO agents in selected companies in Bulacan, Philippines. Hence, Danish Psychosocial Work Environment Questionnaire (DPQ), Maslach Burnout Inventory - General Survey (MBI-GS), and the Three-Dimensional Model of Organizational Commitment Scale (ACS, NCS, CCS) were employed to properly assess the study's objectives. Multiple Linear Regression Analysis was performed to analyze the collected data. Based on the analysis, findings show that work environment has no significant influence on the job burnout and organizational commitment of BPO Agents. Furthermore, the results of this study were thoroughly evaluated, leading to an in-depth discussion. Based on the findings, recommendations were made to benefit the stakeholders of the study and contributeto the existing body of knowledge. (shrink)

When reasoning about deontic rules (what one may, should, or should not do in a given set of circumstances), reasoners adopt a violation‐detection strategy, a strategy they do not adopt when reasoning about indicative rules (descriptions of purported state of affairs). I argue that this indicative‐deontic distinction constitutes a primitive in the cognitive architecture. To support this claim, I show that this distinction emerges early in development, is observed regardless of the cultural background of the reasoner, and can be selectively (...) disrupted at the neurological level. I also argue that this distinction emerged as a result of selective pressure favouring the evolution of reasoning strategies that determine survival within dominance hierarchies. (shrink)

Understanding the causes of maize landrace loss in farmers’ field is essential to design effective conservation strategies. These strategies are necessary to ensure that genetic resources are available in the future. Previous studies have shown that this loss is caused by multiple factors. In this longitudinal study, we used a collection of 93 maize landrace accessions from Morelos, Mexico, and stored at the International Maize and Wheat Improvement Center (CIMMYT) Maize Germplasm Bank, to trace back to the original 66 donor (...) families after 50 years and explore the causes for why they abandoned or conserved their seed lots. We used an actor-centered approach, based on interviews and focus group discussions. We adopt a Multi-Level Perspective framework to examine loss as a process, accommodating multiple causes and the interactions among them. We found that the importance of maize landrace cultivation had diminished over the last 50 years in the study area. By 2017, 13 families had conserved a total of 14 seed lots directly descended from the 1967 collection. Focus group participants identified 60 accessions that could still be found in the surrounding municipalities. Our findings showed that multiple interconnected changes in maize cultivation technologies, as well as in maize markets, other crop markets, agricultural and land policies, cultural preferences, urbanization and climate change, have created an unfavorable environment for the conservation of maize landraces. Many of these processes were location- and landrace-specific, and often led to landrace abandonment during the shift from one farmer generation to the next. (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were members (...) of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

The main contention of this paper is that the underlying aim behind efforts to integrate ethics into the business school curriculum is in order to motivate and enable future business leaders to manage ethically and respond effectively to the challenges of sustainable development. Conceptualising ethics education in terms of eliciting behavioural change enables access into the insights provided by social psychological research into factors affecting behaviour, such as self-efficacy, subjective norms, knowledge, awareness, attitudes and role models. MSc students studying entrepreneurship (...) applied their entrepreneurial skills to help social enterprises achieve their objectives as part of their assessed coursework. With reference to a content analysis of their reflections, it is argued that such placements address these key factors identified as predicting behavioural change in a way that more traditional pedagogies cannot. (shrink)