Much evidence suggests that semantic characteristics of a message (e.g., the extent to which the message evokes thoughts of spatial or motor properties) and social characteristics of a speaking situation (e.g., whether there is a listener who can see the speaker) both influence how much speakers gesture. However, the Gesture as Simulated Action (GSA) framework (Hostetter & Alibali, ) predicts that these effects should not be independent but should interact such that the effect of visibility is lessened when a (...) message evokes strong thoughts of action. This study tested this claim by comparing the gesture rates produced by speakers as they described 24 nouns that vary in how strongly they evoke thoughts of action. Further, half of the words were described with visibility between speaker and listener blocked. The results demonstrated a significant interaction as predicted by the GSA framework. (shrink)

Speakers often use gesture to demonstrate how to perform actions—for example, they might show how to open the top of a jar by making a twisting motion above the jar. Yet it is unclear whether listeners learn as much from seeing such gestures as they learn from seeing actions that physically change the position of objects (i.e., actually opening the jar). Here, we examined participants' implicit and explicit understanding about a series of movements that demonstrated how to move a set (...) of objects. The movements were either shown with actions that physically relocated each object or with gestures that represented the relocation without touching the objects. Further, the end location that was indicated for each object covaried with whether the object was grasped with one or two hands. We found that memory for the end location of each object was better after seeing the physical relocation of the objects, that is, after seeing action, than after seeing gesture, regardless of whether speech was absent (Experiment 1) or present (Experiment 2). However, gesture and action built similar implicit understanding of how a particular handgrasp corresponded with a particular end location. Although gestures miss the benefit of showing the end state of objects that have been acted upon, the data show that gestures are as good as action in building knowledge of how to perform an action. (shrink)

According to the SIMS model, mimicry and simulation contribute to perceivers' understanding of smiles. We argue that similar mechanisms are involved in comprehending the hand gestures that people produce when speaking. Viewing gestures may elicit overt mimicry, or may evoke corresponding simulations in the minds of addressees. These real or simulated actions contribute to addressees' comprehension of speakers' gestures.

BackgroundUpper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke.AimSynthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke.MethodsPubMed, SCOPUS, and PEDro databases were systematically searched (...) for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols.ResultsTwenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI –0.18 to 0.46, I255%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI –0.34 to 1.18, I273%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline.ConclusionThis review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions. (shrink)

... a vulnerable and fragmented work force.10 Based largely on oral history interviews, this ... THE TRUST The Trust was founded in 1970 by the Wisconsin Education Association ... of the National Staff Organization, an independent union represent- ing employees of teachers ' unions . ... \n.

In this book, Michael Arbib, a researcher in artificial intelligence and brain theory, joins forces with Mary Hesse, a philosopher of science, to present an integrated account of how humans 'construct' reality through interaction with the social and physical world around them. The book is a major expansion of the Gifford Lectures delivered by the authors at the University of Edinburgh in the autumn of 1983. The authors reconcile a theory of the individual's construction of reality as a network (...) of schemas 'in the head' with an account of the social construction of language, science, ideology and religion to provide an integrated schema-theoretic view of human knowledge. The authors still find scope for lively debate, particularly in their discussion of free will and of the reality of God. The book integrates an accessible exposition of background information with a cumulative marshalling of evidence to address fundamental questions concerning human action in the world and the nature of ultimate reality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:St. John Henry Newman's Theory of Doctrinal Development and the Synodal Process:A Survey and Concrete ApplicationWilliam B. GoldinGood afternoon, Your Excellencies, Most Reverend bishops, and my brother priests. Firstly, please permit me to say that, while it is certainly an honor to have been invited to speak to you, for which I would like to express my gratitude to my own bishop and our host for this reunion, His (...) Excellency, Bishop Kevin W. Vann, it is also not a little bit daunting. To speak to such an erudite group of clerics, all of whom have a connection to our common alma mater and to the various celebrated universities in the Eternal City, brings back fond memories of my three years at the Casa Santa Maria. During that time, while I would occasionally have the opportunity to preach at Sunday Masses at the Casa, I was always keenly aware that I was not nearly as qualified to do so as many of my listeners. As such, I beg your pardon if I should fail to explain adequately any aspect of this lecture, and I would be grateful for any questions and/or corrections, theological or otherwise, that you may have afterwards.Let us begin with a prayer:In the Name of the Father, and of the Son, and of the Holy Spirit. Amen. [End Page 21]Come, Holy Spirit, fill the hearts of thy faithful, and enkindle in them the fire of thy love. Send forth thy Spirit and they shall be created, and thou shalt renew the face of the earth.Let us pray.O God, who didst inspire thy faithful by the light of thy Holy Spirit, grant that, in the same Spirit we may be truly wise and ever more rejoice in His holy consolation.Through Christ our Lord.Amen.Vergine Immacolata... Aiutateci.Introduction: The Synod on Synodality and Speculation on Doctrinal ChangeIn the late autumn of 2021, Bishop Vann appointed me and my colleague, Mrs. Katie Dawson, our diocesan director of parish faith formation, as the coordinators for the Synod on Synodality in the Diocese of Orange. In this role, we were tasked with bringing to fruition the diocesan phase of the synodal consultation of the faithful here in Orange County. Since last autumn, we have labored to carry out the bishop's synodal plan for this diocese, and I must say that I have been pleasantly surprised with the manner in which the consultation took place, and in its results, notwithstanding my initial reservations both as to the scope of this particular synod and as to the potential risks inherent in such a universal survey. As we all know from diocesan and parochial life, "listening sessions" have a tendency to become "shouting sessions"; and as a thoroughgoing introvert myself, such sessions do not exactly bring joy to my heart. Thankfully, though, my fears were not realized, and the actual experience of our synodal process was almost altogether pleasant.Perhaps surprisingly, one of the fruits of our consultation, which we heard from the majority of the faithful, is their clear desire for doctrinal clarity in their faith journeys. The majority of the People of God in Orange County whom we surveyed do not want to see any doctrinal changes emerge from this synod that could be critiqued for being in serious discontinuity with the [End Page 22] solemnly defined magisterial teaching of the past. Regularly, they expressed to us that, if our "journeying together" is to be authentic and credible, then the continuity of our doctrinal teaching is a matter of no small importance. Indeed, the ability of many to take the Church's faith seriously depends on whether the doctrinal content of that faith seems solid and unshakeable. If the content of our faith can shift substantially in ways that mirror modern shifts in secular thinking, then people can easily critique our faith as being blown about by the winds of change, with no certitude whatsoever. If something taught by the Catholic Church can be true today and false tomorrow, then why is the Catholic Church's message worth listening to at all? What we heard from the overwhelming majority of... (shrink)

“Ontario and its Universities” embodies the views, on several central issues in higher education in Ontario, of members of a seminar which met regularly in the autumn of 1973 and early winter of 1974. The seminar was initiated by a group of professors from the University of Toronto and York University. They invited a number of their academic colleagues and several interested and informed persons from the wider public to discuss with them the responsibilities and essential requirements of the (...) contemporary university in Ontario. (shrink)

Locke composed the Epistola de Tolerantia, in all probability, during the late Autumn of 1685 when he was a prudent exile in Holland, suspected of complicity in Shaftesbury’s plots against Charles II. Before going to Holland, at the age of 51, he had published nothing except some occasional verse; but he had made many notes and drafts on a variety of subjects like political sovereignty, religion, morality, natural law, epistemology—subjects on which he was later to become one of the (...) foremost spokesmen for English philosophy. Toleration was such a subject and a particularly sensitive one, in the circumstances of Locke’s exile and because of the heated controversies it engendered in the Europe of the seventeenth century. His stay in Holland provided the necessary leisure and the conversation of his friends, notably Philip van Limborch, the necessary stimulus. The Epistola de Tolerantia, addressed to Limborch, was published at Gouda in 1689—anonymously, as might be expected, for Locke was an excessively discreet man in such regards. The authorship, however, was soon an open secret; there is a letter of testy remonstrance in which Locke asks Limborch whether he had revealed the secret and Limborch’s reply to the effect that the authorship was widely-known in England and that, when asked point-blank, he could not but tell the truth and confirm it. This exchange took place after Locke had returned to England. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:69 WILLIAM ROBERTSON AND DAVID HUME: THREE LETTERS The relationship between David Hume and his fellow Scottish historian William Robertson has always seemed one-sided. Despite the existence of fifteen letters to Robertson in the standard volumes of Hume's correspondence,1 Hume scholars have long had reason to regret the lack of a single extant letter from Robertson to Hume. None are to be found, for example, where one would most (...) expect them to be — in the Royal Society of Edinburgh, alongside the letters to Hume from various other Moderate clergymen and literati in Robertson's circle, such as Hugh Blair and Adam Ferguson. Fortunately, however, two of Robertson's letters to Hume (numbered II and III below) have now turned up where one would not expect them to be — among Robertson's own correspondence in the Robertson2 Macdonald Papers, National Library of Scotland. They are not mere drafts, such as one is accustomed to find among an author's private papers; rather, they are autograph signed letters that appear to have actually been posted. How and when they found their way back to Robertson's personal papers, and what became of the rest of Robertson's letters to Hume, are questions open to speculation. For the moment we are grateful for the letters we now have, neither of which is known to have been published before in whole or in part. Nor has Hume been identified before as the recipient of either of these letters, though internal evidence makes it clear that he was. Both letters date from the late 1760s, when Hume was living in London and Robertson was at the peak of his multi-faceted career in Edinburgh as university principal, parish minister, ecclesiastical leader, and man of letters. The first of them, dated 27 March 1767, was sent to Hume in his capacity as under- 70 secretary of state in the Northern Department (an office he held from February 1767 to January 1768). It is plainly a reply to a letter of 19 March, in which Hume had discussed three topics to which Robertson was 5 responding: Robertson's efforts to secure a military chaplaincy for a certain Scottish minister (evidently named Brodie); Conway's role in the famous dispute between Hume and Rousseau; and the public response to Adam Ferguson's newly published Essay on the History of Civil Society. In addition Robertson addresses a matter that Hume had apparently broached with him at some earlier time: the attempt to find a suitable Scottish church to which Hume might obtain a crown presentation for his nephews' tutor, the Rev. Christopher Tait. The letter concludes on a note of admiration that is characteristic not only of Robertson but of most of Hume's other "Protestant Pastors" in Scotland. The second letter to Hume, dated 31 January 1769, is chiefly concerned with the forthcoming publication of Robertson's History of Charles V and the French translation of it by J.-B.-A. Suard — subjects that had been treated in two letters from Hume to 7 Robertson of autumn 1768. It also contains a strong recommendation for a bright young Scottish writer (in both the legal and literary senses of that term) who would one day become Robertson's most vitriolic critic: Gilbert Stuart. On the personal side, there is encouragement for the now unemployed Hume to return to Edinburgh, as he was then threatening to do, after his "great glut of society" at Paris and London, and there are allusions in the closing paragraph to Hume's part in introducing his friend to polite society when Robertson had visited London to arrange the publication of Charles V in the spring of 1768. 71 To these two letters from Robertson we have prefixed a third from earlier in the same decade, one Q not actually addressed to Hume but largely about him. Robertson wrote it to their common friend Gilbert Elliot (later Sir Gilbert Elliot) on 8 March 1762, two days before the Town Council elected Robertson principal of Edinburgh University. The first paragraph deals with the principalship and relates to Hume only indirectly, as we point out in a footnote. The second paragraph, however, contains interesting... (shrink)

A major resource expanding the study of early Chinese philosophy, religion, literature, and politics, this book features the first complete English-language translation of the_ Luxuriant Gems of the "Spring and Autumn"_ (_Chunqiu fanlu_),_ _one of the key texts of early Confucianism. The work is often ascribed to the Han scholar and court official Dong Zhongshu, but, as this study reveals, the text is in fact a compendium of writings by a variety of authors working within an interpretive tradition that (...) spanned several generations, depicting a utopian vision of a flourishing humanity that they believed to be Confucius's legacy to the world. The Spring and Autumn (_Chunqiu_) is a chronicle kept by the dukes of the state of Lu from 722 to 481 B.C.E. _The Luxuriant Gems_ follows the interpretations of the _Gongyang Commentary_, whose transmitters belonged to a tradition that sought to explicate the special language of the _Spring and Autumn_. The Gongyang masters believed that the_ Spring and Autumn_ had been written by Confucius himself, employing subtle and esoteric phrasing to indicate approval or disapproval of important events and personages. The _Luxuriant Gems_ augments Confucian ethical and philosophical teachings with chapters on cosmology, statecraft, and other topics drawn from contemporary non-Confucian traditions, reflecting the brilliance of intellectual life in the Han dynasty during the formative decades of the Chinese imperial state. To elucidate the text, Sarah A. Queen and John S. Major divide their translation into eight thematic sections with extensive introductions that address dating, authorship, authenticity, and the relationship between the original text and the evolving _Gongyang_ approach. (shrink)

A major resource expanding the study of early Chinese philosophy, religion, literature, and politics, this book features the first complete English-language translation of the_ Luxuriant Gems of the "Spring and Autumn"_,_ _one of the key texts of early Confucianism. The work is often ascribed to the Han scholar and court official Dong Zhongshu, but, as this study reveals, the text is in fact a compendium of writings by a variety of authors working within an interpretive tradition that spanned several (...) generations, depicting a utopian vision of a flourishing humanity that they believed to be Confucius's legacy to the world. The Spring and Autumn is a chronicle kept by the dukes of the state of Lu from 722 to 481 B.C.E. _The Luxuriant Gems_ follows the interpretations of the _Gongyang Commentary_, whose transmitters belonged to a tradition that sought to explicate the special language of the _Spring and Autumn_. The Gongyang masters believed that the_ Spring and Autumn_ had been written by Confucius himself, employing subtle and esoteric phrasing to indicate approval or disapproval of important events and personages. The _Luxuriant Gems_ augments Confucian ethical and philosophical teachings with chapters on cosmology, statecraft, and other topics drawn from contemporary non-Confucian traditions, reflecting the brilliance of intellectual life in the Han dynasty during the formative decades of the Chinese imperial state. To elucidate the text, Sarah A. Queen and John S. Major divide their translation into eight thematic sections with extensive introductions that address dating, authorship, authenticity, and the relationship between the original text and the evolving _Gongyang_ approach. (shrink)

At present one of the important tasks of the scholarly world is to reevaluate objectively the teachings of Confucius. The discussions of Confucius during the 1960s made a certain amount of progress, but a number of problems remain that were not truly debated in accord with the policy of "let a hundred schools contend." At the time, the self-appointed authority on theory, Guan Feng, disseminated a series of arbitrary theories that had a very unhealthy influence. The later movement to criticize (...) Confucius which was controlled by the "gang of four" included some themes that expanded upon the theories of Guan Feng and which still act as mental blocks to the reopened debate on Confucius. Thus it is essential that we engage in a thorough review of Guan Feng's criticism of the thought of Confucius and liquidate the remaining effects of ultraleftist thought. The present article suggests a few views of my own in an attempt to undertake a preliminary critique of Guan Feng's theory of what he called the three types of "humaneness" [ren] of the Spring and Autumn era [722-481 B.C.]. (shrink)

Between 15 and 60% of patients are considered ?difficult? by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed ?difficult.? But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the ?difficult? patient as reacting to the perception of ill treatment, then there is an (...) ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Reading Kierkegaard I: Fear and Trembling by Paul MartensDerek HostetterReading Kierkegaard I: Fear and Trembling Paul Martens EUGENE, OR: CASCADE BOOKS, 2017. 130 pp. $18.00The very first line of Reading Kierkegaard I: Fear and Trembling warns that "reading Søren Kierkegaard is a task that requires a relatively high level of intellectual investment" (ix). Yet the difficult task Paul Martens sets for himself, in keeping with the goal of (...) the Cascade Companions series, is to provide a short introduction to Kierkegaard's thought for a nonspecialist readership. In this first volume, the primary text in focus is Fear and Trembling (FT), with a second volume to focus on Works of Love. More specifically, the threefold purpose of this volume is "(1) to illuminate the internal logic of the text in a manner that renders the text more accessible; (2) to highlight the links between FT and Kierkegaard's broader context in a way that helps one make sense of some of its more opaque sections; and (3) to attend to the theological themes that permeate and drive the text" (xi). [End Page 205]Martens helpfully follows the structure provided by FT, explicating each "chapter" in turn and highlighting the ways it relates to the others as well as to the argument as a whole. This approach is particularly helpful for the long and difficult Problem III "chapter" in FT, which Martens frames as an attempt by Kierkegaard's pseudonymous author Johannes de Silentio to perform the text's argument by demonstrating "that the whole investigation—any investigation, even an unlimited poetic investigation of characters and concepts—only leads to one conspicuous conclusion: Abraham is unintelligible" (54).Attention to the links between FT and Kierkegaard's broader context is also helpful for unifying the seemingly disparate arguments in FT. In Martens's reading of this context, FT is to be understood against the broad backdrop of Kierkegaard's criticisms of nineteenth-century Danish Christendom and the particular backdrop of the Hegelianism that de Silentio finds within it. The overall task of FT is then "to raise the price of faith" (71).Martens clearly attends to the text's theological themes with his repeated juxtaposition between "faith" as de Silentio sees it in the story of Abraham and "the ethical" as de Silentio sees it in nineteenth-century Denmark. Many theological themes are also highlighted and then brought into the reader's context in the discussion questions that follow each chapter.In addition to the discussion questions, Martens provides an appendix, which includes a timeline of Kierkegaard's first authorship, a glossary of important terms that may be unfamiliar, and a list of suggested readings for further study. The glossary will be a particularly helpful tool for those less familiar with Kierkegaard. However, there are also several terms missing that are both significant enough and unclear enough to warrant inclusion. One thinks here of a figure like Socrates and concepts like the knight of faith and the knight of infinite resignation.Similarly, another feature of the book that is both a strength and a weakness is its commitment to the text of FT rather than the scholarship surrounding the text. This is a strength because it keeps the book short and accessible for nonspecialists. It is also a weakness, however, because the reader interested in further study is not clearly pointed toward competing interpretations, despite the fact that some lines are ripe for a brief footnote providing such a reference—"Not all agree with me on this" (76).Overall, the discussion questions and appendix, its short length and overall readability, and its commitment to the text make Reading Kierkegaard I: Fear and Trembling a significant pedagogical contribution to ethics and Kierkegaard studies as an entry point for nonspecialists. [End Page 206]Derek HostetterUniversity of DaytonCopyright © 2018 Society of Christian Ethics... (shrink)

Many clinical ethics services issue recommendations about ethical controversies that arise in patient care. Their role is configured to be arbiters of moral permissibility, rendering verdicts on which option of those available constitute the morally superior course of action. They produce moral judgements on questions, such as: Should dialysis be started or foregone? Should life-sustaining care be withdrawn or continued? Is it permissible for the clinician to refuse a course of treatment desired by a particular patient or family? But decisions (...) in such cases presume a type of expertise that ethics consultants do not plausibly possess: i.e., the insight to know whose values – which ethical priorities – should trump in situations that are morally ambiguous and normatively contested. This is especially worrisome against the backdrop of the values-pluralism that exists in diverse, heterogeneous societies. This kind of authoritative response to moral uncertainty teeters on hubris, and can have a profoundly negative impact on the lives touched by these decisions. This chapter will argue that the moral arrogance that stems from a conviction of expertise is one of the gravest dangers of contemporary clinical ethics consultation. (shrink)

Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering (...) sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”. (shrink)

Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the “difficult” patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics meetings and (...) conversations and idea-sharing among practitioners on HEC social media. While there are a handful of papers gesturing toward a bioethical critique of behavior contracts of various types, the use of behavior contracts in the context of interpersonal conflict has not been vetted by bioethicists to determine their ethical legitimacy or efficacy. In this paper, we highlight a set of ethical concerns that we believe must be addressed before continuing or widespread implementation of behavior contracts to manage the “difficult” patient or family. (shrink)

Responding to Max Weber’s modern diagnosis of nature, science, and medicine as disenchanted, this article aims to reenvision nature and medicine with a sense of enchantment drawing from the Christian themes of creation, Christology, suffering, and redemption. By reenvisioning nature as enchanted with these theological themes, the vocation of medicine might be revitalized in terms of suffering presence, healing care, and works of mercy toward the neighbor in need.

As groups around the country begin to craft standards for clinical ethics consultations, one focus of that work is the proper procedure for conducting ethics consults. From a recent empirical look into the workings of ethics consult services (ECSs), one worrisome finding is that some ECSs rely on a committee vote when making a recommendation. This article examines the practice of voting and its moral standing as a procedural strategy for arriving at a clinical ethics recommendation. I focus here on (...) the type of clinical ethics conflicts that are most likely to lead an ECS to vote, namely, conflicts involving ethical uncertainty—or, in the Greek, aporia. I argue that in cases of aporia, voting on an ethics conflict is not a morally justifiable procedure. Then on the same grounds that I use to show that voting is ethically problematic, I raise broader concerns about the common practice of making recommendations by other procedures. In contrast to the standard approach of adjudicating between moral claims, I argue that ECSs can best resolve aporetic conflict through the process of clinical ethics mediation. (shrink)

Internationally, there is an on-going dialogue about how to professionalize ethics consultation services . Despite these efforts, one aspect of ECS-competence that has received scant attention is the liability of failing to adequately capture all of the relevant moral considerations in an ethics conflict. This failure carries a high price for the least powerful stakeholders in the dispute. When an ECS does not possess a sophisticated dexterity at translating what stakeholders say in a conflict into ethical concepts or principles, it (...) runs the risk of naming one side's claims as morally legitimate and decrying the other's as merely self-serving. The result of this failure is that one side in a dispute is granted significantly more moral weight and authority than the other. The remedy to this problem is that ECSs learn how to expand the diagnostic moral lens they employ in clinical ethics conflicts. (shrink)

Proficient listening has been viewed as a critical skill in HEC (healthcare ethics consultation) from the inception of the practice, and it is included in the field’s set of core competencies that practitioners need to master to become a certified healthcare ethics consultant (HEC-C). Despite its centrality to the work of HEC, practitioners and trainees receive little or no formal training in the craft of listening, and there are few available resources that ethics consultants and trainees can access to enhance (...) their listening skills. This dearth of training in the skill of listening belies the enormous challenge of listening proficiently. Although many clinical ethics researchers refer to the need for “active listening” in HEC, the term is employed without description or instruction. In this article, I argue that a more helpful depiction of the requisite skill is conveyed by the term “diagnostic listening.” After describing the strategy of diagnostic listening, I introduce a novel technique for honing the listening skills needed for HEC: the ADEPT Model. The ADEPT Model is a tool that can begin to fill the training gap for this important skill. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 10-11, August 2012.

In their systematic review of the work of the ASBH Core Competencies Update Task Force, Anita Tarzian and ASBH Core Competencies Update Task Force (2013) write, “The ethics facilitation approach do...

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU by Charles C. CamosyAutumn Alcott RidenourReview of Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU CHARLES C. CAMOSY Grand Rapids, MI: Eerdmans, 2010. 208 pp. $18.00In Too Expensive to Treat? Charles Camosy makes an important contribution to bioethics and Christian ethics by making the case for the need to consider social factors when treating imperiled newborns. (...) Arguing for both the full moral status of newborns and Roman Catholic social teaching’s emphasis on the just allocation of resources, Camosy calls the medical community, bioethicists, and [End Page 209] Christian ethicists to account for current practices that disproportionately favor exorbitant costs for imperiled infants over other even more basic medical needs within the US health care system. Written before the adoption of the Affordable Care Act under the Obama administration, Camosy’s argument has only increased in significance given the national need to prioritize resources in view of the government’s expansion of health care coverage.Born within twenty-two to twenty-four weeks of gestation and weighing between 500 and 850 grams, some imperiled infants absorb hundreds of thousands of dollars in short-term care that may extend into millions of dollars given long-term costs (146, 171–93). Recognizing the tragic reality in which “we have virtually unlimited health care needs” coupled with “limited health care resources,” Camosy contends that current Medicaid funds that privilege the NICU (neonatal intensive care unit) should be reevaluated (1–3). In an effort to temper the “autonomous,” patient-driven principle with “justice,” Camosy poses a challenging philosophical, theological, and practical proposal for what he identifies as the “gray area” of the NICU.Maintaining a twofold commitment to human dignity that values the moral worth of the infant, on the one hand, and the common good that privileges a preferential option for the poor, on the other, Camosy develops his argument in four major steps. First, he validates the moral status of newborn infants and rejects social quality of life models that dismiss their intrinsic status as “persons.” Second, he dismisses arguments that emphasize personal dignity at the expense of considering the social quality of life, pointing out that such arguments disregard Catholic social teaching’s emphasis on the link between relational anthropology and human personhood (100). Third, he contends that “weak” social quality of life models that privilege the patient or individual over social considerations do not take seriously either Catholic social teaching’s emphasis on the common good or the potentially overwhelming economic and practical burdens they might place on families and society as a whole. Finally, Camosy presents a constructive proposal for limiting NICU resources that seeks to counter a culture of overtreatment that idolizes technology and is at the mercy of an unrestrained free market (162). Emphasizing the need for a just allocation of resources, he supports withholding and withdrawing life-sustaining treatment in some cases, thus foreseeing the possible death of some infants. Although he does not accept the direct killing of these infants, he does maintain that Catholic social teaching would allow for the withdrawal of life-sustaining treatment based on certain criteria.Camosy raises a host of important considerations relevant to decisions about imperiled infants. Yet a few questions remain. First, from a Christian point of view, does he not fall into a kind of soft utilitarianism, even though he himself desires to avoid the pitfalls of utilitarianism? Second, how might Camosy envision Christian practices that care for “exposed” infants left without life-sustaining treatment? Finally, what about the difficult emotions that accompany [End Page 210] the death of an infant or child? Do certain kinds of grief complicate our rationing choices that appear to pit the old against the young? While perhaps unanswerable, these questions merit further discussion.Autumn Alcott RidenourMerrimack CollegeCopyright © 2015 Society of Christian Ethics... (shrink)

Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)—and surely the least discussed—are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions (...) from interests and describes a set of strategies for managing contentious ethics consultations or working with “difficult” patients, families, or patient-careprovider interactions. (shrink)

Articulating the public's widespread unease about animal biotechnology has not been easy, and the first attempts have not been able to provide an effective tool for navigating the moral permissibility of this research. Because these moral intuitions have been difficult to cash out, they have been belittled as representing nothing more than fear or confusion. But there are sound philosophical reasons supporting the public's opposition to animal biotechnology and these arguments justify a default position of resistance I call the Presumption (...) of Restraint . The Presumption of Restraint constitutes a justificatory process that sets out the criteria for permitting or rejecting individual biotechnology projects. This Presumption of Restraint can be overridden by compelling arguments that speak to a project's moral and scientific merit. This strategy creates a middle-of-the-road stance that can embrace particular projects, while rejecting others. The Presumption of Restraint can also serve as a model for assessing moral permissibility in other areas of technological innovation. (shrink)

While Simone de Beauvoir's inaugural reflection in The Coming of Age depicting the aging experience as one of social marginalization and lament seemingly endures, a surprising source for offering hope to aging persons may be found in the theology of Karl Barth in congruence with W. H. Vanstone. This essay reconsiders the meaning of aging within a Christological interpretation that not only values the various life stages along with intergenerational relationships but also offers meaning for the embodiment of active and (...) passive agency during the aging stage of life. (shrink)

There were several worrisome results in the long-awaited studies on clinical ethics consultation by Fox et al, but one of the most sobering was the self-assessments made by ECSs (Ethics Consult Ser...

The Quality Attestation Presidential Task Force's recent proposal for “quality attestation” (QA) of clinical ethics consultants was advanced on the premise that, “[g]iven the importance of clinical ethics consultation, the people doing it should be asked to show that they do it well.” To this end, the task force attempted to develop “a standardized system for proactively assessing the knowledge, skills, and practice of clinical ethicists.” But can this proposed method deliver? If the proposed QA process is flawed, it will (...) label clinical ethicists as qualified to do clinical ethics consultations (CECs) when they are not. The result will be the creation of a new, likely intractable, problem of CEC “false positives:” consultants who have passed QA without actually possessing the requisite knowledge and skills to perform CECs.To avoid the risk of false positives, the QAPTF needs to conduct a rigorous analysis of the skills that the QA process will be positioned to judge and those that are simply beyond the scope of its current metrics. Rather than “attesting” to overall CEC “quality,” QA needs to be precise about the skill inventory it can confirm yet honest about the skills it has no basis to assess. I will argue here that QA has strong prospects for accurately assessing consultants’ competence in ethical analysis but very weak prospects for determining competence in two other skills listed as essential by the QAPTF: value‐neutrality and conflict resolution. (shrink)

Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care from (...) longshot to fantasy using two pediatric cases. This progression may be differentiated into four distinct stages of care related to the potential of achieving the initial goals of care. Physicians are often ill prepared for the progression of treatments from a longshot hope to an unfeasible and, therefore, typically unjustified intervention. We present a structured approach to guide clinicians at referral institutions where these situations may be common. The transition of care from “longshot” to “fantasy” is an inherent part of quaternary care for the sickest of patients that has been underexplored. Physicians are often poorly equipped to approach that transition. We advocate this approach to the shift from longshot to fantasy with the belief that such a structured method will have multiple benefits, including: reduced suffering for the patient; decreased emotional burden on patient and family; decreased provider moral distress; increased likelihood of seeking high quality palliative care earlier; and provision of honest and straightforward information to patients and their families. (shrink)

One area of bioethics education with direct impact on the lives of patients, families, and providers is the training of clinical ethics consultants who practice in hospital‐based settings. There is a universal call for increased skills and knowledge among practicing consultants, broad recognition that many are woefully undertrained, and a clear consensus that CECs must avoid an “authoritarian approach” to consultation—an approach, that is, in which the consultant imposes his or her values, ethical priorities, or religious convictions on the stakeholders (...) in an ethics conflict. Yet little work has been done on how to teach CECs not to impose their values in an ethics consultation, or even on the dimensions of this problem. In this essay, I propose a tool for bioethical instruction that targets this question: how can CECs be taught a nonauthoritarian mode of ethical analysis and consultation that can avert the problem of values imposition? (shrink)

Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the (...) costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs. (shrink)

Sentence comprehension involves maintaining and continuously integrating linguistic information and, thus, makes demands on working memory. Past research has demonstrated that semantic WM, but not phonological WM, is critical for integrating word meanings across some distance and resolving semantic interference in sentence comprehension. Here, we examined the relation between phonological and semantic WM and the comprehension of center-embedded relative clause sentences, often argued to make heavy demands on WM. Additionally, we examined the relation between phonological and semantic WM and the (...) comprehension of transitive and dative active and passive sentences, which may also draw on WM resources depending on the number of propositions that must be maintained and the difficulty of processing passive clauses. In a large sample of individuals with aphasia, we assessed whether comprehension performance on more complex vs. simpler active-passive or embedded relative clause sentences would be predicted by semantic but not phonological WM when controlling for single word comprehension. For performance on the active-passive comprehension task, we found that semantic WM, but not phonological WM, predicted comprehension of dative sentences when controlling for comprehension of transitive sentences. We also found that phonological WM, but not semantic WM, predicted mean comprehension for reversible active-passive sentences when controlling for trials with lexical distractors. On the relative clause comprehension task, consistent with prior results, we found that semantic WM, but not phonological WM, predicted comprehension of object relative clause sentences and relative clause sentences with a passive construction. However, both phonological WM and semantic WM predicted mean comprehension across all relative clause types for reversible trials when controlling for trials with lexical distractors. While we found evidence of semantic WM’s role in comprehension, we also observed unpredicted relations between phonological WM and comprehension in some conditions. Post-hoc analyses provided preliminary evidence that phonological WM maintains a backup phonological representation of the sentence that may be accessed when sentence comprehension processing is less efficient. Future work should investigate possible roles that phonological WM may play across sentence types. (shrink)

Professional mediators have long possessed a skill set that is uniquely suited to facilitation of difficult conversations between and among individuals in emotionally charged situations. This skill set has increasingly been recognized as invaluable to the work of clinical ethics consultants as they navigate conflicts involving families, surrogates, and providers. Given widespread acknowledgment that communication difficulties lie at the root of many clinical ethics conflicts, mediation offers techniques to enhance communication between conflicting parties. This special section of The Journal of (...) Clinical Ethics focuses on core aspects of the mediation process designed for effective management of clinical conflict emanating from communication breakdowns, highly charged value conflicts, and instances of perceived disrespect. (shrink)

Volume 19, Issue 11, November 2019, Page 62-63.

(2013). De-Escalating Conflict: Mediation and the “Difficult” Patient. The American Journal of Bioethics: Vol. 13, No. 4, pp. 11-12. doi: 10.1080/15265161.2013.768855.