The healthcare ethics consultant holds a widely described role in the modern American hospital. S/he may practice within a clinical discipline and be trained in bioethics, or be a trained phi...

Counseling parents on the cusp of delivering an extremely preterm infant is performed thousands of times every year in North America, Europe, Japan and in centers situated in other countries around...

ArgumentsPhysicians who counsel expectant parents about the needs for resuscitation and intensive care for an extremely preterm infant must be able to address many clinical facts and be prepared to face several ethical considerations. Such counseling is generally more than an acquisition of informed consent. It must be guided by ethical principles, values held dear by parents, relational priorities and directed toward an informed and shared decision-making process. Parents may come with a need for clinical facts, a desire that they (...) be heard as they express their values, and to help physicians realize that many are determined to follow a certain path well before such counseling occurs. They may well not be moved by counseling of the physician but still desire to be heard, respected, and allowed to contribute to their newborn’s care plans.ConclusionsRealizing this, the physician can be accepting and develop a trusting relationship with the parents that will be of value throughout the hospitalization regardless of outcome. (shrink)

Fetal medicine is an emerging field that raises unique ethical concerns. Our children’s hospital started a Fetal Health Center 10 years ago. In this specialized setting, a multidisciplinary t...

Pope Francis beautifully describes how the perinatal journey starts in mystery. Doctors may forget this. We focus on the science that may partially explain how conception and implantation occur, how the placenta functions, and the gradual development of embryo and fetus. But science cannot address that meta-physical—or spiritual—reality. The question of “why?” is never too far away from the minds of expectant parents. Why now? Why me? Why did my baby develop these terrible problems? Why is my life being challenged (...) in this way? Maternal-fetal “cross-talk” is a reality that cannot be denied. It occurs both when the fetus is quiet and when the fetus is active. It may be facilitated by fetal imaging—an ultrasound of... (shrink)

The Spring 1999 issue of CambridgeQuarterly adds to the growing body of academic inquiry into the goals of neonatal intensive care practices. Muraskas and colleagues thoughtfully presented the possibility of nontreatment for neonates born at or under 24 weeks gestation. Jain, Thomasma, and Ragas explained that quality of future life must not be ignored in clinical deliberation. And Hefferman and Heilig described once again the dilemmas nurses face when caring for potentially devastated neonates kept alive by technology. These authors take (...) brave steps by publicly questioning the trend of intensive medical support for most every American-born product of conception. But many questions addressing the goals of neonatal intensive care remain, and few authors have actually tried to distill these goals. (shrink)

(2009). Mellow Monday and furious Friday: The approach-related link between anger and time representation. Cognition & Emotion: Vol. 23, No. 6, pp. 1166-1180.

In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians (...) about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children’s hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are ethics committee meetings, Nursing Ethics Forum, ethics Brown Bag workshops, PICU ethics rounds, Grand Rounds, NICU Comprehensive Care Rounds, Palliative Care Team case conferences, multidisciplinary consults in Fetal Health Center, and ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of “core competencies” than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple “moral spaces” in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today. (shrink)

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

_Talking Books_ sets out to show how some of the leading children's authors of the day respond to these and other similar questions. The authors featured are _ Neil Ardley, Ian Beck, Helen Cresswell, Gillian Cross, Terry Deary, Berlie Doherty, Alan Durant, Brian Moses, Philip Pullman, Celia Rees, Norman Silver, Jacqueline Wilson, and Benjamin Zephaniah_. They discuss with great enthusiasm: *their childhood reading habits *how they came to be published *how they write on a daily basis *how a particular (...) book came together *a type of writing that they are especially known for. Through in-depth interviews, they each reveal their approach to their craft. Much is know and spoken of the product that is the children's book, but it is rare that writers are given the opportunity to talk at length about the process of writing for children. _Talking Books_ redresses the balance by presenting a wide selection of authors reflecting upon the joys and challenges of the craft, creativity and process of writing for children. (shrink)

Brian Roper refreshes our understanding of democracy using a Marxist theoretical framework. He traces the history of democracy from ancient Athens to the emergence of liberal representative and socialist participatory democracy in Europe and North America, through to the global spread of democracy during the past century.

Ethics consultation is a commonly applied mechanism to address clinical ethical dilemmas. However, there is little information on the viewpoints of health care providers towards the relevance of ethics committees and appropriate application of ethics consultation in clinical practice. We sought to use qualitative methodology to evaluate free-text responses to a case-based survey to identify thematically the views of health care professionals towards the role of ethics committees in resolving clinical ethical dilemmas. Using an iterative and reflexive model we identified (...) themes that health care providers support a role for ethics committees and hospitals in resolving clinical ethical dilemmas, that the role should be one of mediation, rather than prescription, but that ultimately legal exposure was dispositive compared to ethical theory. The identified theme of legal fears suggests that the mediation role of ethics committees is viewed by health care professionals primarily as a practical means to avoid more worrisome medico-legal conflict. (shrink)

Introduction Understanding the views of the public is essential if generally acceptable policies are to be devised that balance research access to general practice patient records with protection of patients' privacy. However, few large studies have been conducted about public attitudes to research access to personal health information. Methods A mixed methods study was performed. Informed by focus groups and literature review, a questionnaire was designed which assessed attitudes to research access to personal health information and factors that influence these. (...) A postal survey was conducted of an electoral roll-based sample of the adult population of Ireland. Results Completed questionnaires were returned by 1575 (40.6%). Among the respondents, 67.5% were unwilling to allow GPs to decide when researchers could access identifiable personal health information. However, 89.5% said they would agree to ongoing consent arrangements, allowing the sharing by GPs of anonymous personal health information with researchers without the need for consent on a study-by-study basis. Increasing age (by each 10-year increment), being retired and primary level education only were significantly associated with an increased likelihood of agreeing that any personal health information could be shared on an ongoing basis: OR 1.39 (95% CI 1.18 to 1.63), 2.00 (95% CI 1.22 to 3.29) and 3.91 (95% CI 1.95 to 7.85), respectively. Conclusions Although survey data can be prone to response biases, this study suggests that prior consent agreements allowing the supply by GPs of anonymous personal health information to researchers may be widely supported, and that populations willing to opt in to such arrangements may be sufficiently representative to facilitate valid and robust consent-dependent observational research. (shrink)

ObjectiveOur objective was to evaluate whether those individuals with previous involvement with formal clinical ethics processes differ in their attitudes towards the resolution of prototypical clinical ethics cases than general health care professionals. We hypothesized that those individuals with previous participation in ethics consultation would have significantly different attitudes on the appropriate role of ethics committees in the assessment and resolution of clinical ethical dilemmas than those who have not.MethodsWe conducted a case-based survey of health care professionals at six US (...) hospitals. We administered the survey to health care professionals in a variety of clinical roles at each center and further sub-categorized these by respondents reporting or not reporting their membership on an ethics committee or participation as an ethics consultant/requestor of ethics consult services. Using the analysis of variance test, we present the variation in attitudes using a 5-point Likert scale with 95% confidence intervals and significance set at p ≤ 0.05.ResultsA total of 240 respondents completed the survey (response rate: 63.6%) from all six surveyed centers (128 respondents with involvement with ethics consultation, 112 respondents without). Health care professionals not previously involved with formal clinical ethics processes were less likely to view the ethics committee as having a role in resolving the presented clinical ethical dilemmas ( p = 0.01 for analysis of variance comparison).ConclusionIn this multi-center survey study, health care providers without previous involvement with formal clinical ethics processes were less likely than those with previous involvement to support a role for ethics committees aiding in ethical case resolution. (shrink)

Drawing from the work of Dewey, Wittgenstein, and Heidegger, this book aims to relate a series of philosophic insights to the practice of engaging in design research for change. These insights are explored and presented as a set of potential strategies for grounding transformative design research within an intellectual context which both embraces and celebrates experience, process, and uncertainty. Chapter by chapter, through theory, practical examples, and case studies an accessible narrative opens up around the coupled themes of existence and (...) experience, language and meaning, and knowing and truth. The outcome is a rich and detailed perspective on the ways in which philosophy may afford design research for change a means to both explain, as well as understand, not only what it is and what it does, but also what it could be. The book will be of interest to scholars working in design studies, design theory and design research. (shrink)

We sought to evaluate whether health care professionals’ viewpoints differed on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas based on practice location. We conducted a survey study from December 21, 2013 to March 15, 2014 of health care professionals at six hospitals. The survey consisted of eight clinical ethics cases followed by statements on whether there was a role for the ethics committee or hospital in their resolution, what that role might be and (...) case specific queries. Respondents used a 5-point Likert scale to express their degree of agreement with the premises posed. We used the ANOVA test to evaluate whether respondent views significantly varied based on practice location. 240 health care professionals completed the survey. Only three individual queries of 32 showed any significant response variations across practice locations. Overall, viewpoints did not vary across practice locations within question categories on whether the ethics committee or hospital had a role in case resolution, what that role might be and case specific queries. In this multicenter survey study, the viewpoints of health care professionals on the role of ethics committees or hospitals in the resolution of clinical ethics cases varied little based on practice location. (shrink)

Harvey Siegel's (1985) attempts to revive the traditional epistemological formulation of the rationality of science. Contending that "a general commitment to evidence" is constitutive of method and rationality in science, Siegel advances its compatibility with specific, historically attuned formulations of principles of evidential support as a virtue of his aprioristic candidate for science's rationality. In point of fact, this account is compatible with virtually any formulation of evidential support, which runs afoul of Siegel's claim that scientific beliefs must be evaluated (...) with respect to their rationality. The unwelcome consequence of Siegel's view is that most any belief, scientific or pseudoscientific, can be defended as rational. Indeed, if we want to furnish a warrant for rational choice, we must turn to the very historically informed principles of evidential support that are dismissed by Siegel as providing a misleading portrait of science's rationality. (shrink)

The new inter-disciplinary eclecticism championed by many philosophers of science has generated a heterogeneous family of science studies projects. Philosophers who favor an inter-disciplinary approach face many problems if they are to successfully forge a hybrid science studies that does not violate their integrity as philosophers in particular, they must isolate an intellectual space in which traditional agendas, such as the concern for the clarification of concepts, can hold court. In this paper, I outline what I regard as a new (...) brand of HPS, one that is deeply rooted in the history of the exact science. The virtue of this New HPS, I will submit, is that it furnishes philosophers of science with a fresh perspective from which to carry on philosophy's classic normative mission. (shrink)

Social Epistemology, as formulated by Steve Fuller, is based on the suggestion that rational knowledge policy must be held accountable to ‘brute facts’ about the nature of our human cognitive pursuits, whatever these may be. One difficulty for Fuller concerns the conception of the social which underwrites social epistemology. I argue that social epistemology conflates the social with human psychological properties that are available for public scrutiny and, accordingly, that social epistemology is best viewed as a brand of psychologism. Though (...) Fuller's proposal signifies an important step in the ongoing attempt by scholars to eradicate the last traces of Descartes' epistemological device of a disembodiedres cogitans, I conclude that his conception of the social is too weak to serve as the basis for a socially-embedded discipline in anything but name only. (shrink)

Euglenids comprise a group of single‐celled eukaryotes with diverse modes of nutrition, including phagotrophy and photosynthesis. The level of morphological diversity present in this group provides an excellent system for demonstrating evolutionary transformations in morphological characters. This diversity also provides compelling evidence for major events in eukaryote evolution, such as the punctuated effects of secondary endosymbiosis and mutations in underlying developmental mechanisms. In this essay, we synthesize evidence for the origin, adaptive significance and diversification of the euglenid cytoskeleton, especially pellicle (...) ultrastructure, pellicle surface patterns, pellicle strip number and the feeding apparatus. We also highlight holes in our knowledge that must be filled before we are able to confidently describe euglenid cell biology and infer the earliest stages in euglenid evolution. Nonetheless, by possessing combinations of characters resulting from adaptive change and morphostasis, euglenids have retained key pieces of evidence necessary for reconstructing the early evolution and diversification of eukaryotic life. BioEssays 29:987–1000, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Marine interstitial environments are teeming with an extraordinary diversity of coexisting microeukaryotic lineages collectively called “meiofauna.” Interstitial habitats are broadly distributed across the planet, and the complex physical features of these environments have persisted, much like they exist today, throughout the history of eukaryotes, if not longer. Although our general understanding of the biological diversity in these environments is relatively poor, compelling examples of developmental heterochrony (e.g., pedomorphosis) and convergent evolution appear to be widespread among meiofauna. Therefore, an improved understanding (...) of meiofaunal biodiversity is expected to provide some of the deepest insights into the following themes in evolutionary biology: (i) the origins of novel body plans, (ii) macroevolutionary patterns of miniaturization, and (iii) the intersection of evolution and community assembly – e.g., “community convergence” involving distantly related lineages that span the tree of eukaryotes. (shrink)

Two principal questions are addressed: In De Finibus 3.54 what position does Cicero imagine the talus to fall and lie? How does this talus simile shed light on the problematic relationship between the Stoics’ doctrine of ‘preferred indifferents’ and their definition of the Good as virtue?