An outstanding group of leaders left evidence that a richer and more sustainable democracy could be achieved with American independence and democratic principles integrated into a new republican form of government. They were moved by principles that are the very spirit of democracy. These principles are needed to enhance democracy and improve well-being. Using the constructivist tradition of grounded theory and Aristotle’s conception of abstraction, the article proposes a theory of the first principles of democracy based on substantive data: the (...) Declaration of Independence, the Articles of Confederation, The Federalist Papers, and the United States Constitution. Knowledge, fairness, human dignity, hope, unity, and security are the first principles of democracy and are regarded as the bedrock of democracy and a government framework for the people. This theory contributed to a formal model of democratic social change. It also contributes a conceptual framework that supports Solum’s semantic originalism, a theory of constitutional interpretation. The principles of democracy can revitalize democracy and provide new possibilities by protecting education as an innate human right, abolishing capital punishment, criminalizing private prisons on the stock market, and reevaluating the proportionality of prison sentences. (shrink)

Existing social disparities in the United States are inconsistent with Lincoln’s promise of democracy; therefore, there is a need for a critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change. The result was the construction of two frameworks: the demoralization process that triggers social change, and a formal grounded theory that (...) could explain democratic social change endeavors across different domains and levels of analysis. This democratic social change grounded theory answers the research question: How do the principles of the American founding documents provide an understanding of the process of American democratic social change? (shrink)

The polarities of democracy framework is used to achieve human emancipation by simultaneously managing multiple paradoxes by employing Johnson’s polarity management as the conceptual framework. Although Johnson’s framework may be appropriate for managing other tension-dependent pairs, it is less suitable for managing multiple democratic values when the goal is human emancipation and sustainable democratic social change. Managing multiple polarities is exacerbated by the problem-shifting and problem-creation effect inherent in a tension-driven framework. The aim was to develop a constructivist grounded theory (...) to answer the research question: How can the first principles of democracy be used to reduce dynamic tension and achieve human emancipation? This gap has been filled by a parsimonious conceptual framework based on three democratic principles: human dignity, fairness, and knowledge. The principles of democracy conceptual framework can synthesize the tension between democratic values in order to manage, plan, and evaluate democratic social change initiatives. (shrink)

Background: The United States symbolizes democracy in the new world and contributes to global prosperity. Nevertheless, incrementalism is a historically dominant national approach to public policy implementation that delays democracy and undermines human dignity. Human flourishing and national development are endangered by slow-moving democratic changes. This necessitates a social justice framework that traces the exploitation of incrementalism and the consequences of opportunity gaps. Objectives: This study aims to construct a grounded theory to address and answer the following research question: Are (...) anti-democratic concepts part of a process or strategy that hinders democratic change, and what reinforces it, if anything? Methods: Two categories emerged from a grounded theory of democratic social change. This combination of anti-democratic tenets and democratic principles led to abductive reasoning to fill the research gap. Results: The key finding was the existence of a systematic approach that led to democracy while simultaneously disempowering the same group through legal and extralegal means. Two processes hinder democracy: incrementalism and an anti-democratic demoralizing process. A constructivist social justice grounded theory was developed to analyze and evaluate public policy for barriers and facilitators of democracy. A thorough analysis and evaluation of the impact and consequences of public policy is recommended to better understand how such policies impede democracy and influence American perceptions of justice. (shrink)

Great Britain subjugated colonists using various power strategies, including dehumanization, misinformation, fear, and other divisive strategies. The Founders described these oppressive strategies as “a long train of abuses and usurpations.” Throughout the Declaration of Independence and the U.S. Constitution, the Founding Fathers imbued the people with hope in a government for the people: one unlike that of the monarchy, which sought to protect itself at the expense of colonists. As a result, the Founders created a government more likely to lead (...) with fairness, demonstrate respect for human dignity, unite Americans as one people, empower citizens through hope, and lead the nation toward security. This socio-ethical framework was an abductive discovery nested within a grounded theory study where it had been concluded that the first principles of democracy were woven within the American founding documents. Using Charmaz’s constructivist grounded theory, the first principles of democracy—knowledge, fairness, human dignity, hope, unity, and security—were used to answer an emerging research question: Are there two democratic frameworks in the founding documents, and how do they differ? The first principles of democracy promote a culture of ethics, resilience, and freedom. Their empowering disposition makes them suitable as a normative framework for a democratic government for the people. (shrink)

Few scholars have explored the founding documents to identify the deliberate social change strategy that led to America's independence and a new form of government that was of, by, and for the people. This study aimed to apply a post-hoc polytheoretical framework of power to the findings of a democratic social change study to understand the dynamics of power between Great Britain and the American colonists. The original study employed the constructivist grounded theory tradition to explore democracy in the Declaration (...) of Independence, the Articles of Confederation, The Federalist Papers, and the United States Constitution. This produced two frameworks of power strategies, one empowering and the other demoralizing: principles of democracy and anti-democratic tenets. To gain a holistic perspective of the interplay of power, a polytheoretical framework of power consisting of theories of power proposed by Marx and Engels, Bourdieu, and Foucault was employed to discuss the findings. The findings suggested that democratic social change interacts with structural forces, culture, and power strategy selection. This could provide an alternative lens through which to explore whether people of color in America were used instrumentally to sustain democracy. (shrink)

Multidisciplinary healthcare committees meet regularly to discuss patients’ candidacy for emerging functional neurosurgical procedures, such as Deep Brain Stimulation . Through debate and discussion around the surgical candidacy of particular patients, functional neurosurgery programs begin to mold practice and policy supported both by scientific evidence and clear value choices. These neurosurgical decisions have special considerations not found in non-neurologic committees. The professional time used to resolve these conflicts provides opportunities for the emergence of careful, ethical practices simultaneous with the expansion (...) of therapy applications. (shrink)

As neural implants transition from engineering design and testing into human subjects research, careful consideration must be paid to the ethical elements in developing research protocols. Although these ethical aspects may be framed by the design choices of the engineering, a number of challenging choices arise. In spite of many ethical considerations for neural implant technologies being shared with generic research ethics questions, there are subsets needing special attention. Even in considerations requiring increased attention, substantial overlap can be found with (...) research ethics questions for general medical implants and for psychiatric pharmaceuticals. The special attention to specific ethical questions in neural implants exists because of the value placed on preserving cognition and control as well as our continued memory of significant past research abuses in neurosurgery. This paper focuses on three issues of particular saliency to neural implant testing: inclusion/exclusion of subjects with psychiatric conditions, consent withdrawal of research subjects, and enhancement as a goal. (shrink)

Objectives: To summarise the types of case brought to the Clinical Ethics Committee of the National Hospital of Norway from 1996 to 2002 and to describe and discuss to what extent issues of information/communication have been involved in the ethical problems. Design: Systematic review of case reports. Findings: Of the 31 case discussions, (20 prospective, 11 retrospective), 19 cases concerned treatment of children. Twenty cases concerned ethical problems related to withholding/withdrawing of treatment. In 25 cases aspects of information/communication were involved (...) in the ethical problem, either explicitly (n = 3) or implicitly (n = 22). Conclusion: Problems related to information/communication may underlie a classic ethical problem. Identification of these “hidden” problems may be important for the analysis, and hence, the solution to the ethical dilemma. (shrink)

Customer behavior, market dynamics, and technological advances have made it challenging for marketing theorists to provide comprehensive explanations and actionable insights. Although there are numerous substantive marketing frameworks, no formal marketing theory exists. This study aims to develop the first formal grounded theory in marketing by incorporating artificial intelligence and Forde's conceptual framework as a guiding lens. Charmaz's constructivist grounded theory tradition and Forde's conceptual framework and data analysis strategy were employed for this purpose. The data analysis strategy used with (...) grounded theory’s constant compare-and-contrast method comprises holistic and systems thinking, dramaturgical and situational analysis, perspective-taking, and deconstruction. To evaluate Glaser’s assertion that all is data, artificial intelligence was incorporated into the research as the data source for retrieving the theoretical samples to address the primary research question: How can Forde's conceptual framework and artificial intelligence be leveraged to develop a formal marketing theory grounded in evidence? Of significance was the emergence of democratic marketing behaviors and the normalization of anti-democratic marketing approaches leveraged to manipulate buyers or gain access to segments of customers. Buyers and sellers can simultaneously benefit from and be prejudiced by marketing exchange dynamics. This finding lends credibility to the newly emerged framework of strategic actions where empowerment and disempowerment are leveraged to achieve specific goals. Considering this finding, it is suggested that businesses view marketing as a symbiotic relationship between two power centers, buyers and sellers, who respectively strive to maintain human dignity and sustainability. Researchers are encouraged to apply the framework across substantive areas, international markets, public relations, political campaigns, and others. (shrink)

Grounded theory methodology is perceived as challenging due to its systematic and rigorous process. However, this is because most people do not realize that the strategies used in the grounded theory data analysis process are used by laypeople and professionals regularly, if not daily. This article aims to help others interested in grounded theory with a background in qualitative data analysis feel comfortable engaging in the methodology and constructing multiple theories in the same study. It shares my latest experience incorporating (...) various data analysis strategies with the constructivist approach: holistic and systems thinking, situational analysis, dramaturgical analysis, perspective taking, and abstraction. The examples remove the mystery from abstraction and abductive reasoning. (shrink)

Archaeological excavations carried out at Pentridge Prison discovered the ruins and foundations of three panopticon exercise yards. This paper details the scope and observations of the excavation program and discusses the influence of Jeremy Bentham’s panopticon model on penal reform and prison design in Australia in the middle of the 19th Century.

Systematic pluralism does not purport to be a new philosophy. Rather, it is a position on positions, a discovery of something previously unrecognized in the nature of philosophical thought. Further, “since the special arts and sciences are particular embodiments of philosophic principles, a pluralism at the level of philosophy implies a similar pluralism at the level of the special arts and sciences.” Therefore, the claims of systematic pluralism are not limited to philosophy but the position has something fundamental to report (...) about all departments of human thought, resulting in the characteristic movement between levels of generality, from widest philosophical import to narrowest disciplinary application, which appears over and over again in the writings of systematic pluralists and which is well exemplified by the essays in this issue of The Monist, the first of any publication dedicated entirely to the examination of discoveries which are now over half a century old. (shrink)

Shocking, brilliant, and eccentric, the French author, translator, and artist Pierre Klossowski (1905-2001) exerted a profound effect on French intellectual culture throughout the twentieth century. The older brother of the painter Balthus, secretary to the novelist Andre Gide, friend to Geroges Bataille and Maurice Blanchot, and heralded as one of the most important voices in the French "return to Nietzsche" by Michel Foucault and Gilles Deleuze, Klossowski pursued his singular vision of mortal embodiment through a variety of scholarly manifestations. In (...) Such a Deathly Desire, Klossowski's original interpretation of Nietzsche's eternal return is developed around the enigmatic figure of the "demon," then deepened with provocative readings of Gide's correspondence; Barbey d'Aurevilly's novel A Married Proest; and the intertwining of language and death in the work of Bataille, Blanchot, and Brice Parain. The book concludes with the powerful essay "Nietzsche, Polytheism, and Parody," in which Klossowski articulates the consequences of the eternal return and the meaning of Nietzsche's genealogy of the fabulation of the world. Intersecting with and confounding a range of disciplines - including psychoanalysis, literary criticism, gender studies, and philosophy - Klossowski's critical writings on language, literature, and the aesthetics of embodiment remain powerful and original contributions to contemporary concerns in the theoretical humanities. (shrink)

Our world is not simply religious or simply secular but complexly both. A wide range of issues for universities arise from this, such as the need to have such issues widely discussed and also to develop the field of theology and religious studies. Five key responsibilities are: towards future generations; for the formation of people in wisdom as well as through information, knowledge, practices and skills; for uniting teaching and research; for contributing to religious and secular society; and for the (...) fostering of collegiality and good governance. If these are to be fulfilled well the best of religious and secular wisdom is needed. The final sections of the paper outline a Christian wisdom theology with reference to the responsibilities of universities, concluding with a case study of the relevance of Scriptural Reasoning (the mutual study of their scriptures by a group of Jewish, Christian and Muslim text scholars, philosophers and theologians) to the responsibilities of universities towards the flourishing of our religious and secular world. (shrink)

PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers.DESIGN and METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of the (...) Quality of Informed Consent Questionnaire .RESULTS: The mean age of the sample of 143 participants was 71 years . Analysis of covariance was used to compare QuIC scores between the intervention group and control group . In the 1-week model, no statistically significant intervention effect was found . However, the intervention status by patient status interaction was statistically significant . In the 1-month model, no statistically significant intervention effect was found . Again, however, the intervention status by patient status interaction was statistically significant . At both time periods, intervention group patients scored higher on the QuIC than did intervention group caregivers, and control group patients scored lower on the QuIC than did control group caregivers.IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients. (shrink)

Ford has developed the relationship between theology and each of these other spheres, but this is the first volume to bring together a complete and well-rounded account of theology's interaction with all its conversation partners. An innovative book about the shape of theology in reaction to its relationship with the Church, with theologians, with other religions, and with the university Written by David Ford, recognized internationally as one of the most creative of contemporary theologians Considers how theology shapes (...) other areas of life via its conversations in the public sphere and with non-faith communities Views theology as both a way of thinking and a way of living, and considers how this lived character cannot be entirely grasped through reason alone The first volume to bring together a complete and well-rounded account of theology’s interaction with all its conversation partners. (shrink)

Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & othersThe decision of Dame Butler-Sloss in the case of Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & Others1 has already achieved notoriety. The disturbing facts have received widespread media coverage and fuelled further legal and political debate surrounding the “reproductive revolution”.2 This short paper assesses the context and potential implications of the recent decision and, in particular, the nature and meaning of parenthood and the family.THE CASETwo (...) couples, referred to Mr and Mrs A and Mr and Mrs B, were attending the assisted conception unit at Leeds General Infirmary to receive infertility treatment. Both couples understood that they were participating in a technique called intracytoplasmic sperm injection , a technique which would use the eggs of the wife and the sperm of the husband in each case. Mrs A had consented to her eggs being mixed with her husband’s sperm to create an embryo which would then be implanted in her, hopefully resulting in pregnancy. Mr A had consented to his wife’s treatment. Mr and Mrs B gave their consent to similar IVF procedures, although Mr B had expressly refused to consent to his sperm being used in treating others.Following a mix up at the unit, which Butler-Sloss referred to as “a ‘mistake’ … despite its inadequacy as a description of what occurred”, Mr B’s sperm was injected into Mrs A’s eggs. She became pregnant and later gave birth to healthy twins. The mistake became apparent only on Mrs A’s delivery of twins of mixed race; Mr and Mrs A are both white, Mr and Mrs B both black. DNA testing subsequently established that Mr B was the biological father of the children. He has had no subsequent contact with them and …. (shrink)

For Calvin, the understanding of God's accommodation to the limits and needs of the human condition was a central feature of the interpretation of Scripture and of the entire range of his theological work.

This work aims to describe how developments in thinking on evolutionary biology require re-assessment of initial rejection of the relevance and applicability of neo-Darwinian evolution to the Gaia hypothesis.

To date, no definition of life has been unequivocally accepted by the scientific community. In frustration, some authors advocate alternatives to standard definitions. These include using a list of characteristic features, focusing on life’s effects, or categorizing biospheres rather than life itself; treating life as a fuzzy category, a process or a cluster of contingent properties; or advocating a ‘wait-and-see’ approach until other examples of life are created or discovered. But these skeptical, operational, and pluralistic approaches have intensified the debate, (...) rather than settled it. Given the failure of even these approaches, we advocate a new strategy. In this paper, we reverse the usual line of reasoning and argue that the “life problem” arises from thinking incorrectly about the nature of life. Scientists most often conceptualize life as a class or kind, with earthly life as a single instance of it. Instead, we advocate thinking about Earth’s Life as an individual, in the way that species are now thought to be. In this view, Life is a monophyletic clade that originated with a last universal common ancestor, and includes all its descendants. We can continue to use the category ‘life’ pragmatically to refer to similarities between various phenomena and Life. But the relevant similarities are a matter of interest and preference, not a matter of fact. The search for other life in the Universe, then, is merely a search for entities that resemble parts of Life in whatever sense astrobiologists find most appealing. This does not mean that the search for evolved complexity elsewhere in the universe or its creation in the lab are futile endeavors, but that debates over whether they count as ‘life’ are. Ironically, finally abandoning the concept ‘life’ may make our searches for evolved complexity more fruitful. We explain why. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

In his late unfinished work on aesthetic theory, Adam Smith develops the concept of rythmus to explore such arts as music, dance and poetry. Smith argues that rythmus communicates emotion in a very specific way. For Smith, narrative arts, such as drama or the novel, predominately seek to recreate or represent in the minds of their readership or audience the emotions of the characters that are portrayed. But what we experience through rythmus, by contrast, is an original, and not a (...) sympathetic, feeling. Rythmus is the communicative medium of a paradoxical mode of collective feeling in which each person feels his or her own emotions, and yet all feel the same thing; in which social being is at once non-fungible and shared. (shrink)

That holobionts are units of selection squares poorly with the observation that microbes are often recruited from the environment, not passed down vertically from parent to offspring, as required for collective reproduction. The taxonomic makeup of a holobiont’s microbial community may vary over its lifetime and differ from that of conspecifics. In contrast, biochemical functions of the microbiota and contributions to host biology are more conserved, with taxonomically variable but functionally similar microbes recurring across generations and hosts. To save what (...) is of interest in holobiont thinking, we propose casting metabolic and developmental interaction patterns, rather than the taxa responsible for them, as units of selection. Such units need not directly reproduce or form parent-offspring lineages: their prior existence has created the conditions under which taxa with the genes necessary to carry out their steps have evolved in large numbers. These taxa or genes will reconstruct the original interaction patterns when favorable conditions occur. Interaction patterns will vary in ways that affect the likelihood of and circumstances under which such reconstruction occurs. Thus, they vary in fitness, and evolution by natural selection will occur at this level. It is on the persistence, reconstruction, and spread of such interaction patterns that students of holobiosis should concentrate, we suggest. This model also addresses other multi-species collectively beneficial interactions, such as biofilms or biogeochemical cycles maintaining all life. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

This article reports the results of an anonymous survey of researchers at a government research institution concerning their perceptions about ethical problems with journal peer review. Incompetent review was the most common ethical problem reported by the respondents, with 61.8% (SE = 3.3%) claiming to have experienced this at some point during peer review. Bias (50.5%, SE = 3.4%) was the next most common problem. About 22.7% (SE = 2.8%) of respondents said that a reviewer had required them to include (...) unnecessary references to his/her publication(s), 17.7% (SE = 2.6%) said that comments from reviewers had included personal attacks, and 9.6% (SE = 2.0%) stated that reviewers had delayed publication to publish a paper on the same topic. Two of the most serious violations of peer review ethics, breach of confidentiality (6.8%, SE = 1.7%) and using ideas, data, or methods without permission (5%, SE = 1.5%) were perceived less often than the other problems. We recommend that other investigators follow up on our exploratory research with additional studies on the ethics of peer review. (shrink)

This essay details the resurgence of wellness program as employed by large corporations with the aim of reducing healthcare costs. The essay narrows in on a discussion of how Big Data collection practices are being utilized in wellness programs and the potential negative impact on the worker in regards to privacy and employment discrimination. The essay offers an ethical framework to be adopted by wellness program vendors in order to conduct wellness programs that would achieve cost-saving goals without undue burdens (...) on the worker. The essay also offers some innovative approaches to wellness that may well better serve the goals of healthcare cost reduction. (shrink)

Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)