Volume 20, Issue 6, June 2020, Page 75-77.

The authors present a case study involving truth telling responsibilities in the setting of nonepileptic seizures. Specifically, over the course of several suspected nonepileptic seizures, a patient’s seizures stopped after he received a saline flush meant to precede the administration of anti-seizure medication. The patient and his surrogate believed he had received the medication each time, and the team wondered whether they should disclose the truth. Some worried that disclosure would reinforce the suspected psychogenic behavior, exacerbating the patient’s condition. In (...) this way, the case study presents a twist on the traditional truth telling archetype. While most truth telling cases center on navigating cultural differences or worries about emotional harm, this case presented concerns about medical harm in the form of exacerbating the patient’s condition. The authors describe the complex patient-family-team dynamic that preceded this ethical dilemma, describe the case, analyze the ethical issue, and describe the outcome. (shrink)

Decisions about continuing or terminating a pregnancy touch on profound, individualized questions about bodily integrity, reproductive autonomy, deeply held values regarding one's capacity for parenthood, and, in the case of a high-risk pregnancy, the risks one is willing to take to have a baby. So far as possible, reproductive decisions are made between a patient, in some cases her partner, and her medical provider. However, this standard framework cannot be applied if the patient lacks decision-making capacity. In this essay, we (...) discuss one such case that came before our clinical ethics team. We describe the challenges of respecting a patient's reproductive preferences when the patient cannot share what those preferences are, and we argue that decisions regarding reproductive health care should not be treated with exceptionalism. Rather, they should proceed under the normal processes of surrogate decision-making, including the application of substituted judgment. This approach enables us to take the patient's values into account when considering the questions implicated in reproductive health care, just as we do for other kinds of health care decisions in which a patient's deeply held values are salient. (shrink)

Volume 20, Issue 3, March 2020, Page 39-41.

With the increasing professionalization of clinical ethics, some hospitals and health systems utilize both ethics committees and professional clinical ethicists to address their ethics needs. Drawing upon historical critiques of ethics committees and their own experiences, the authors argue that, in ethics programs with one or more professional clinical ethicists, ethics committees should be dissolved when they fail to meet minimum standards of effectiveness. The authors outline several criteria for assessing effectiveness, describe the benefits of a model that places primary (...) responsibility for ethics work with professional clinical ethicists—the PCE-primary model, and offer suggestions for alternative ethics program structures that empower healthcare professionals to contribute to ethics work in ways more tailored to their strengths and skills while minimizing the shortcomings of ethics committees. (shrink)

Effective documentation is considered a core competency for clinical ethics consultation. Ethics consultants within the Cleveland Clinic in Cleveland, Ohio, observed variation in the formatting of ethics chart notes across consultants and realized that this formatting was based on their own views of effectiveness. To minimize variation and optimize the readability and understandability of ethics chart notes for end users, a team undertook a quality improvement project to assess the formatting preferences of healthcare professionals who rely on ethics consultation notes. (...) The team developed three sample templates and conducted interviews with stakeholders to understand their preferences. A single standardized template was developed based on the preferences that emerged, which all consultants on the ethics consultation service then utilized. In the first five months of implementation, the percentage of end user respondents marking the highest Likert scale option on a post-consultation survey regarding whether the ethics consultation service provided helpful documentation increased from 60 percent to 72 percent compared to the same five-month period in the year prior. (shrink)

Propelling Clinical Ethics Forward: A Working Unconference was held from 28-29 April 2022 in Atlanta, Georgia. The event, the third installment in an ongoing series of Clinical Ethics Unconferences, brought together 77 individuals from 40 institutions to exchange innovative practices and collaborate to address issues facing the field of clinical ethics. In this article the authors highlight the five major themes that emerged from the 2022 Unconference, including: (1) tackling new and old problems in clinical ethics practice; (2) evolving models (...) of clinical ethics structure and delivery; (3) defining the scope of clinical ethics work; (4) addressing racism, ableism, and underrepresentation in clinical ethics work; and (5) collecting and utilizing data effectively. The authors also reflect on what was learned from the first three Unconferences and offer suggestions for future Unconferences. (shrink)

In an effort to create new synergies to fill gaps in evaluation of value, assessment of quality, and definition of roles in clinical ethics programs we convened a meeting entitled Innovations in Clinical Ethics: A Working Un-Conference (the Un-Conference) in August 2018. The Un-Conference was conceived to be a working event aimed at promoting cross pollination and idea generation for innovative practices in clinical ethics. The event was attended by 95 individuals from 62 institutions, representing a wide diversity of healthcare (...) systems, who believed in the concept and brought their enthusiasm and expertise to share with others. As a product of the Un-Conference, whitepaper groups developed summaries and broad overviews of areas that need to be further addressed within our field. The whitepapers are being published in this issue of The Journal of Clinical Ethics. The first three whitepapers highlight the broad themes of demonstrating value to the institution, quality assessment, and emerging roles for clinical ethics programs and ethicists. The final whitepaper offers guidance to clinical ethicists engaged in pediatric ethics work and, in conversation with the emerging roles article, thoughtfully reflects on the role of pediatric ethicists. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

Background: Nurses face ethical issues and experience moral distress in their everyday work. A nursing ethics champion program was developed at a hospital in the United States. Methods: As part of a quality improvement project, pre- and post-training surveys were developed to assess whether the program was feasible and sustainable, enhanced nurse confidence in recognizing and addressing ethical issues and moral distress, and increased nurse knowledge of institutional resources for addressing the same. Qualitative and quantitative analyses were performed. Results: Thirteen (...) nurses from both the critical care and medical/surgical settings participated in the program. The program proved feasible. Attrition after the educational sessions raised concerns about sustainability. Survey results suggest an association between participating in the program’s educational sessions and increased nurse confidence in recognizing and addressing ethical issues and moral distress, as well as identifying institutional resources that can assist nurses with the same. Discussion: Opportunities for future nursing ethics champion programs include increasing the interactivity and duration of educational sessions, making programs multidisciplinary, and creating materials for nurses to more easily share with colleagues. It would be valuable for future research to measure the impact of nursing ethics champion programs on nursing turnover. Implications: A nursing ethics champion program has the potential to help nurses feel better equipped to navigate ethical issues and moral distress in their everyday work. (shrink)

Despite an abundance of academic conferences, clinical ethicists lacked a forum to share innovative practices with peers and to generate solutions to common challenges. Organizers of the first Clinical Ethics Un-Conference developed a working event centered on active participation and problem solving through peer learning, with the goal of improving realworld practice. Registrants included 95 individuals from 64 institutions. Attendees were surveyed immediately after the Un-Conference, and again eight months later. After eight months, 85 percent (n = 33/39) of the (...) survey respondents reported that they found the event “highly impactful” or “some-what impactful” to their clinical practice, and 23 attendees reported that they had implemented ideas or projects inspired by the event. Three sets of best practice guidelines and four white papers were published from the event. As the field of clinical ethics continues to advance and evolve, this working event format offers an innovative, disruptive alternative to a traditional conference format and may serve as a model for future efforts aimed at improving real-world clinical ethics practice. (shrink)

The present paper is an attempt to give an account of the analytic-synthetic distinction both inside and outside of physical theory. It is hoped that the paper is sufficiently nontechnical to be followed by a reader whose background in science is not extensive; but it has been necessary to consider problems connected with physical science (particularly the definition of 'kinetic energy,' and the conceptual problems connected with geometry) in order to bring out features of the analytic-synthetic distinction that seem to (...) me to be the most important. (shrink)

What is the relationship between our perceptions and reality? What is the relationship between the mind and the body? These are questions with which philosophers have grappled for centuries, and they are topics of considerable contemporary debate as well. Hilary Putnam has approached the divisions between perception and reality and between mind and body with great creativity throughout his career. Now, in _The Threefold Cord: Mind, Body, and World,_ he expounds upon these issues, elucidating both the strengths and weaknesses (...) of current schools of thought. With his characteristic wit and acuity, Putnam offers refreshing solutions to some of philosophy's most vexing problems. Putnam first examines the problem of realism: is objective truth possible? He acknowledges the deep impasse between empirical and idealist approaches to this question, critiquing them both, however, by highlighting the false assumption they share, that we cannot perceive the world directly. Drawing on the work of J. L. Austin and William James, Putnam develops a subtle and creative alternative, which he calls "natural realism." The second part of the book explores the mind-body question: is the mind independent of our interactions with the physical world? Again, Putnam critically assesses two sharply antithetical contemporary approaches and finds them both lacking. _The Threefold Cord_ shows the entire mind-body debate to be miscast and draws on the later work of Wittgenstein, once more advancing original views on perception and thought and their relationship with both the body and the external world. Finally, Putnam takes up two related problems--the role of causality in human behavior and whether or not thoughts and sensations have an "existence" all their own. With Putnam's lucid prose and insightful examples, _The Threefold Cord_ loosens the Gordian knots into which philosophy has bound itself over the issue of epistemology. (shrink)

The Coalition of Immokalee Workers (CIW) has successfully combated modern-day slavery by transforming the ways that over a dozen major brands, including Taco Bell, Subway, and Wal-Mart, manage their supply chains. The CIW’s efforts over more than 20 years have effectively stopped enslavement practices, including abuses such as wage theft and peonage indebtedness. We conducted a field ethnography, interviews, and archival analyses to understand this success. We find that the CIW employs a decentered, egalitarian, and ensemble approach to their multiplicities (...) of alliances by collectively “animating” themselves and their partners through ensemble leadership. This combination of alliances, along with worker-driven monitoring, brings life to the CIW motto “We are all leaders.” Translating this motto into daily practice is how the CIW virtually eradicates enslavement practices in corporate supply chains. (shrink)

Mabel Cooper and Gloria Ferris lived in St Lawrence's Hospital one of the large learning disability institutions which were built round the edges of London. In this paper, Mabel and Gloria share their memories of three nurses at St Lawrence's, supported by Jane Abraham and in this process reveal a number of ethical issues that remain relevant today.

_Migration and the Education of Young People 0_–_19_ investigates migration from a number of perspectives to consider the changing dynamics of society within different countries. Examining the data associated with global migration by focusing on case studies from a wide range of countries, it provides detailed and balanced coverage of this politically sensitive topic to explore the educational needs of migrant young people, the impact of large-scale migration to and from countries and the policy challenges that individual countries face when (...) ensuring adequate provision for migrant young people within their education systems. Chapters cover: The reasons why people might move Social and emotional learning in Britain: a tool to guard against cultural pollution? Migration into a global city: the economic and educational success of London Latvian people on the move and the impact on education People’s movement – Greece Return migration in Lithuania: incoming challenges for children’s education The United States, Latin America, immigration and education Tanzanian street children: victims, ordinary lives or extraordinary survivors? This book explores the changing social dynamics through an extensive range of case studies and will be an essential resource for students taking undergraduate and postgraduate courses in education, sociology and international relations. (shrink)

A new look at Thucydides’ account of the debate at Sparta motivating the Spartan declaration of war may provide a footnote to valuable past discussion. Chief concerns about the debate have always been the uniqueness of the four-speech set-up; the oddity of an Athenian embassy in attendance at a Peloponnesian League meeting; and the unlikelihood that any detailed report of speeches made to the Peloponnesian League or Spartan assembly came to Athens. Thucydides' judgement concerning the cause of the Peloponnesian War (...) is far more likely to have been based on his knowledge of past and present relations between Athens and Sparta and members of the Peloponnesian League than on any information about an actual debate. But for τ δoντα he needed a confrontation which would not only dramatize both opposition I and characters of Sparta and Athens but also put them in historical context, that is, in their Persian War roles as recorded by Herodotus. Only in this way is it possible to explain peculiarities of this confrontation which appear to duplicate characteristics of the Herodotean debate involving Athens and Sparta before the battle of Plataea. Thuc. 1.67–88 is like Hdt. 8.140–4 in comprising four speeches of which the first 1 is answered by the third and the second is answered by the fourth. In each case Cl and C2 are spoken by representatives of a single people: with the Athenians in Herodotus’ debate answering two different peoples, and with two different Spartans in Thucydides answering two different peoples. (shrink)

Por un lado, el libro aborda la problemática educativa que enfrentan estudiantes mexicanos indocumentados en las universidades de los Estados Unidos. Por el otro lado, se aborda la atención específica (escolar, académica y administrativa) que la Universidad de Guadalajara (México), ofrece a los estudiantes migrantes retornados de los Estados Unidos.

AbstractDuring the Covid-19 pandemic, ethicists and researchers proposed human challenge studies as a way to speed development of a vaccine that could prevent disease and end the global public health crisis. The risks to healthy volunteers of being deliberately infected with a deadly and novel pathogen were not low, but the benefits could have been immense. This essay is a history of the three major efforts to set up a challenge model and run challenge studies in 2020 and 2021. The (...) pharmaceutical company Johnson and Johnson, the National Institutes of Health in the United States, and a private-public partnership of industry, university, and government partners in Britain all undertook preparations. The United Kingdom’s consortium began their Human Challenge Programme in March of 2021.Beyond documenting each effort, the essay puts these scientific and ethical debates in dialogue with the social, epidemiological, and institutional conditions of the pandemic as well as the commercial, intellectual, and political systems in which medical research and Covid-19 challenge studies operated. It shows how different institutions understood risk, benefit, and social value depending on their specific contexts. Ultimately the example of Covid-19 challenge studies highlights the constructedness of such assessments and reveals the utility of deconstructing them retrospectively so as to better understand the interplay of medical research and research ethics with larger social systems and historical contexts. (shrink)

Presentación del Dossier: Feminismos y posthumanismo.

Can we reconcile the idea that we are free and responsible agents with the idea that what we do is determined according to natural laws? For centuries, philosophers have tried in different ways to show that we can. Hilary Bok takes a fresh approach here, as she seeks to show that the two ideas are compatible by drawing on the distinction between practical and theoretical reasoning.Bok argues that when we engage in practical reasoning--the kind that involves asking "what should (...) I do?" and sifting through alternatives to find the most justifiable course of action--we have reason to hold ourselves responsible for what we do. But when we engage in theoretical reasoning--searching for causal explanations of events--we have no reason to apply concepts like freedom and responsibility. Bok contends that libertarians' arguments against "compatibilist" justifications of moral responsibility fail because they describe human actions only from the standpoint of theoretical reasoning. To establish this claim, she examines which conceptions of freedom of the will and moral responsibility are relevant to practical reasoning and shows that these conceptions are not vulnerable to many objections that libertarians have directed against compatibilists. Bok concludes that the truth or falsity of the claim that we are free and responsible agents in the sense those conceptions spell out is ultimately independent of deterministic accounts of the causes of human actions.Clearly written and powerfully argued, Freedom and Responsibility is a major addition to current debate about some of philosophy's oldest and deepest questions. (shrink)

The final published book by Nobel Prize-winning author and philosopher Henri Bergson (1859-1941), La pensée et le mouvant (translated here as The Creative Mind), is a masterly autobiography of his philosophical method. Through essays and lectures written between 1903 and 1923, Bergson retraces how and why he became a philosopher, and crafts a fascinating critique of philosophy itself. Until it leaves its false paths, he demonstrates, philosophy will remain only a wordy dialectic that surmounts false problems. With masterful skill and (...) intensity, Bergson shows that metaphysics and science must be rooted in experience for philosophy to become a genuine search for truth. And in the quest for unanswered questions, the spiritual dimension of human life and the importance of intuition must be emphasized. A source of inspiration for physicists as well as philosophers, Bergson's introduction to metaphysics reveals a philosophy that is always on the move, blending man's spiritual drive with his mastery of the material world. (shrink)

Can we reconcile the idea that we are free and responsible agents with the idea that what we do is determined according to natural laws? For centuries, philosophers have tried in different ways to show that we can. This text seeks to show that the two ideas are compatible by drawing on the distinction between practical and theoretical reasoning.

As George Boole saw it, the laws of logic are the laws of thought, and by this he meant, not that human thought is actually governed by the laws of logic, but, rather, that it should be. Boole’s view that the laws of logic have normative implications for how we ought to think is anything but an outlier. The idea that violating the laws of logic involves epistemic impropriety has seemed to many to be just obvious. It has seemed especially (...) obvious to those who see propositional justification as more fundamental than doxastic justification. Whatever other principles are required for defining propositional justification, the laws of logic seem indispensable. The idea that violation of the laws of logic involves some sort of epistemic impropriety—whatever the peculiarities of our psychology may be—has served as a fixed point around which defenders of the fundamentality of propositional justification are united, whatever their other differences. This paper challenges that common thread in defenses of the fundamentality of propositional justification. It is argued that the laws of logic have no bearing whatever on epistemic justification. Once we see why this should be so, the way is paved for seeing why it is that doxastic justification is more fundamental than propositional justification. (shrink)

In this book Putnam turns to pragmatism - and confronts the teachings of James, Peirce, Dewey, and Wittgenstein - not solely out of an interest in theoretical ...