ABSTRACT Refugees, as forced migrants, have suffered displacement under conditions not of their own choosing. In 2000 there were thought to be 22 million refugees of whom 6 million were HIV positive. While the New Zealand government has accepted a number of HIV positive refugees from sub‐Saharan Africa, this hospitality is under threat due to negative public and political opinion. Epidemic conditions raise the social stakes attached to sexual exchanges, contagion becomes a major figure in social relationships and social production, (...) and the fears of the contagious nature of those ‘just off the plane’ connect refugees to an equally deep‐seated fear of racial miscegenation. Jacques Derrida’s notion of unconditional hospitality is a dream of a democracy which would have a cosmopolitan form. This means that one cannot decide in advance which refugees one might choose to resettle. This paper will use Derrida’s notion of unconditional hospitality to emphasise the fragility of HIV positive refugees’ position, caught between becoming newly made New Zealand subjects while at the same time having that subjecthood threatened. For Derrida, both ethics and politics demand both an action and a need for a thoughtful response (a questioning without limit). (shrink)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1917 edition. Excerpt:... (6) Columns for Discount on Purchases and Discount on Notes on the same side of the Cash Book; (c) Columns for Discount on Sales and Cash Sales on the debit side of the Cash Book; (d) Departmental columns in the Sales Book and in the Purchase Book. (...) Controlling Accounts.--The addition of special columns in books of original entry makes possible the keeping of Controlling Accounts. The most common examples of such accounts are Accounts Receivable account and Accounts Payable account. These summary accounts, respectively, displace individual customers' and creditors' accounts in the Ledger. The customers' accounts are then segregated in another book called the Sales Ledger or Customers' Ledger, while the creditors' accounts are kept in the Purchase or Creditors' Ledger. The original Ledger, now much reduced in size, is called the General Ledger. The Trial Balance now refers to the accounts in the General Ledger. It is evident that the task of taking a Trial Balance is greatly simplified because so many fewer accounts are involved. A Schedule of Accounts Receivable is then prepared, consisting of the balances found in the Sales Ledger, and its total must agree with the balance of the Accounts Receivable account shown in the Trial Balance. A similar Schedule of Accounts Payable, made up of all the balances in the Purchase Ledger, is prepared, and it must agree with the balance of the Accounts Payable account of the General Ledger." The Balance Sheet.--In the more elementary part of the text, the student learned how to prepare a Statement of Assets and Liabilities for the purpose of disclosing the net capital of an enterprise. In the present chapter he was shown how to prepare a similar statement, the Balance Sheet. For all practical... (shrink)

Hospital chaplaincy, in its exposure to clients, colleagues, and care-takers from different faith backgrounds, can be understood in either generic or catholic terms. The first understanding, often merely implicit in denominationalist approaches, assumes that some “Absolute” can be prayerfully invoked through the medium of diverse rituals, confessions, and symbols. This position combines the advantage of unprejudiced acceptance of other creeds and traditions with the disadvantage of lacking resources for discriminating among the spiritualities that may be operative within those other (...) creeds and traditions. Catholicism, in linking true spirituality with the one true church as the mystical body of the Tri-une God, secures such a criterion but fails to satisfy the tolerance-of-acknowledgement in the secular sense, which is canonical in contemporary ecumenism. The Orthodox understanding of Catholicism is portrayed as imposing a non-judgemental humility and repentance which provides a solution to that spiritual-human dilemma of inter-faith cooperation in the hospital. (shrink)

Hospital ethics, familiar enough in practice but surprisingly neglected in the literature, deals with the ethical problems that arise distinctively or typically in hospitals. More precisely, it consists of the ethical principles that shouldgovern 1) the conduct of healthcare professionals and other staff in their capacities as members of the hospital as an institution, and 2) the conduct of the hospital itself as an institution. It is a species of institutional ethics, which focuses on the ethical problems (...) created or significantly shaped by the institutional setting in which they occur. (shrink)

Javanese people have unique characteristics and traditions that make them appealing for research. One of the unique things of the Javanese tradition called bancaan is that it is aimed at appreciating children. Bancaan is a simple banquet of gratitude on the occasion of a child’s birthday by inviting their playmates to pray together for their good. This tradition is rich in the value of hospitality but began to disappear as influences of current development overtake. Given this reality, this study discovered (...) Christian values of hospitality in the bancaan tradition. This discovery is based on a survey by Lee Roy Martin and Michele Hersberger. This research is based on the paradigm of qualitative research. Data collection was conducted by examining the literature and studying the Bible. The problem was analysed using interactive analysis, revealing Christian hospitality values in the bancaan tradition. The values showed are as follows: bancaan is open to everyone in nature despite their backgrounds, bancaan is a form of interaction of hospitality in simplicity and bancaan is a form of regeneration of hospitality values to the child.Contribution: This manuscript provided an overview of one form of Javanese culture, which was then linked to the principles of hospitality from Jesus. This culture was a form of Javanese culture towards children’s appreciation. It is hoped that this manuscript contributes to the preservation of Javanese bancaan culture. (shrink)

Members of the Student Clinical Ethics Committee discussed the ethical issues arising in a case referred for consideration – a homeless man presenting to the emergency department of a busy London hospital with recent self-reported suicide attempts. Should he be admitted overnight in order to address a short-term shelter problem? The case study summarises the reflections of the Committee and focusses on the doctor’s duty of care and patient responsibility, benefits of admission and resource considerations.

Kant’s theory of international politics and his right of hospitality are commonly associated with expansive projects of securing human rights or cosmopolitan governance beyond state borders. This article shows how this view misunderstands Kant’s criticism of the law of nations tradition as handed down into the eighteenth century as well as the logic of his radical alternative, which was designed to explain the conditions of possibility of global peace as a solution to the Hobbesian problem of a war of (...) all against all in the state of nature. I resolve longstanding confusion over the meaning and justification of Kant’s right of “hospitality” by showing how it functions not as a freestanding positive claim demanding enforcement but as a way of ruling out specious justifications for war against those the traditional law of nations permitted one to label “enemies.” This poses important questions for contemporary theories of global justice. (shrink)

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of (...) Life-Sustaining Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send (...) a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to deal with (...) every day, ethical decision-making has become an inevitable challenge. The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. The process of data analysis resulted in the emergence of 3 main categories “respecting client’s values”, “performing tasks within the professional manner”, “personal characteristic”, and the emergence of eight sub-categories signifying participants’ experiences with regard to EDM. According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client’s values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties. (shrink)

Upon entering clinical medicine in the 1940s, antibiotic therapy seemed to complete a transformation of hospitals that originated in the late nineteenth century. Former death sinks had become harbingers of therapeutic progress. Yet this triumph was short-lived. The arrival of pathologies caused by resistant bacteria, and of nosocomial infections whose spread was helped by antibiotic therapies, seemed to be intimately related to modern anti-infective therapy. The place where such problems culminated were hospitals, which increasingly appeared as dangerous environments where attempts (...) to combat infectious diseases had instead created hothouses of disease evolution. This paper will focus on one aspect of that history. It caused clinical medicine and hospital hygiene in particular to pay attention to a dimension of infectious disease it had previously paid little attention to thus far: The evolution of infectious disease—previously a matter of mostly theoretical interest—came to be useful in explaining many phenomena observed. This did not turn hospital hygienists into geneticists, though it did give them an awareness that the evolution of infectious disease in a broad sense was something that did matter to them. The paper advances its argument by looking at three phases: The growing awareness of the hospital as a dangerous environment in the 1950s, comprehensive attempts at improving antibiotic therapy and hospital hygiene that followed from the 1960s and lastly the framing of such challenges as risk factors from the 1970s. In conclusion, I will argue that hospital hygiene, being inspired in particular by epidemiology and risk factor analysis, discussed its own specific version of disease emergence and therefore contributed to the 1980s debates around such topics. Being loosely connected to more specialized studies, it consisted of a re-interpretation of infectious disease centred around the temporality of such phenomena as they were encountered in day-to-day dealings of clinical wards. (shrink)

Upon entering clinical medicine in the 1940s, antibiotic therapy seemed to complete a transformation of hospitals that originated in the late nineteenth century. Former death sinks had become harbingers of therapeutic progress. Yet this triumph was short-lived. The arrival of pathologies caused by resistant bacteria, and of nosocomial infections whose spread was helped by antibiotic therapies, seemed to be intimately related to modern anti-infective therapy. The place where such problems culminated were hospitals, which increasingly appeared as dangerous environments where attempts (...) to combat infectious diseases had instead created hothouses of disease evolution. This paper will focus on one aspect of that history. It caused clinical medicine and hospital hygiene in particular to pay attention to a dimension of infectious disease it had previously paid little attention to thus far: The evolution of infectious disease—previously a matter of mostly theoretical interest—came to be useful in explaining many phenomena observed. This did not turn hospital hygienists into geneticists, though it did give them an awareness that the evolution of infectious disease in a broad sense was something that did matter to them. The paper advances its argument by looking at three phases: The growing awareness of the hospital as a dangerous environment in the 1950s, comprehensive attempts at improving antibiotic therapy and hospital hygiene that followed from the 1960s and lastly the framing of such challenges as risk factors from the 1970s. In conclusion, I will argue that hospital hygiene, being inspired in particular by epidemiology and risk factor analysis, discussed its own specific version of disease emergence and therefore contributed to the 1980s debates around such topics. Being loosely connected to more specialized studies, it consisted of a re-interpretation of infectious disease centred around the temporality of such phenomena as they were encountered in day-to-day dealings of clinical wards. (shrink)

BackgroundContemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.ObjectiveTo investigate physicians’ experience in ethical decision-making and their attitude towards ethics consultation.MethodsIn a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians’ attitudes towards ethics consultation; physicians’ opinions on qualities and skills of an ethics consultant, and socio-demographic characteristics. Data analysis included descriptive (...) statistics, χ2 and t-test.ResultsResponse rate was 88.9% (n = 112). Men and women were equally represented (48.2%–51.8%). The sample consisted of experienced physicians: 42.9% had 11–20 years experience, and 33% had 21–30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over ¾ of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).ConclusionsThe study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services. (shrink)

Normal 0 0 1 128 734 6 1 901 11.1539 0 0 0 A thrown stone raises the question of the position of authority and does so only by remarking us as responsible for our limits and their transgression, but it also raises the problem of boundaries. Are they natural, or are they inscribed in us? In Ancient Athens, boundary-stones were inscribed with a word that raises the problem of definition by implicating a coincidence of meanings. These stones (...) were never supposed to mark a boundary as an adamantine barrier proscribing transgression from one side to the other. And yet they did not for all that cease to be and mark a boundary. Although the identity between the stone and the word for boundary does not provide any answers as to how boundaries should be maintained or dissolved, it does raise the problem of the relation that the boundary engenders and the bond that it poses between two sides as a question of hospitality. (shrink)

This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such high-tech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent patients, (...) rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics. The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development. Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions. (shrink)

The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as (...) well as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients’ care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel. (shrink)

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. (...) Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician‐patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. (shrink)

As the war in Syria and the destruction of the Calais camp in France in 2016 bitterly demonstrate, declarations of human rights and asylum devolve into empty promises without a common sense of solidarity and an implicit understanding that we share responsibility for the world and one another. Today’s refugee crisis demonstrates that many of the problems that Hannah Arendt identified during the first half of the twentieth century are still with us. National security and the state of exception increasingly (...) place refugees and migrants at the borders of international law. This article argues that Immanuel Kant’s Perpetual Peace and Arendt’s postwar reflections on the stateless as modern pariahs continue to frame current debates on hospitality, human rights, and responsibility. Without a recognition of our common humanity and shared world, sovereign states will continue to find exceptions to the legal status of refugees and migrants, thus enabling their exclusion from political life and the very laws that should protect them. Falling outside human rights law and the rights of refugees leads to the uncertainty of the pariah. (shrink)

The COVID-19 pandemic created new conditions for the functioning of all organizations. Suddenly, there was a problem with the lack of appropriate leadership styles models in health care organizations, which are particularly vulnerable to disruptions in a pandemic. Hospitals, in particular, have become exposed to organizational and managerial problems. The article aims to propose an appropriate leadership style model that will guarantee a high level of hospital efficiency, taking into account a pandemic situation in the example of private (...) hospitals in Indonesia. Organizational identification is promoted as a mediating variable due to the high level of this variable in explaining hospital performance in Indonesia based on preliminary studies. During research used a structural equation model using 394 samples at the unit leadership level in private hospitals in Indonesia. The results of this study explain that there is an impact between innovative leadership and strategic leadership styles on hospital performance. Private hospitals in Indonesia need to improve themselves to use the most appropriate leadership style model based on the needs of the hospital itself. (shrink)

In this essay I discuss the issue of Kantian hospitality and how Katrin Flikschuh’s arguments in “Kant’s Nomads: Encountering Strangers” offer us a framework for dealing with certain problems that seem to arise out of the Kantian account, namely, problems of dealing with cultures unlike modern liberal states, such as nomadic and indigenous communities. I look at some criticisms of Kant’s position on hospitality and cosmopolitan right and on how Flikschuh’s discussion helps to resolve these criticisms. I focus especially on (...) her discussion of respectful interaction and openness in the course of encountering cultural others, encounters that inherently and positively contain a large element of unexpectedness. (shrink)

Hospital ethics committees (HECs) have historically been instituted top-down, often ignoring the needs of the professionals and patients who might use their services. Seventy-four physicians and 123 nurses participated in a hospital-wide needs assessment designed to [1] identify their perceptions of the functions of the HEC, [2] determine which services and educational programs were most desired, and [3] explore which forums were most preferred for discussion of ethical problems. Results indicated that utilization of the HEC focused around five (...) areas of concern: withdrawing/withholding treatment, rationing and control of health care, children's rights, role of the patient and family in decisionmaking, and disagreements about treatment. Physicians and nurses differed widely in their attitudes. Perceptions about the appropriate functions of the HEC strongly influenced decisions regarding which HEC services to use. Needs assessment can play an important role in developing HEC goals and designing programs that meet the needs of professionals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics Committees in HospitalsPat Milmoe McCarrick (bio)(Literature about hospital ethics committees has grown enormously since Scope Note 3 first appeared. This update provides new information about resources and documents now available while continuing to include important earlier sources.)Hospital ethics committees increasingly have taken hold in the United States since 1983, when the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (...) encouraged their creation in its report, Deciding to Forego Life-Sustaining Treatment (III, 1983, p. 5).The President's Commission report (pp. 160-64) suggested the following roles for ethics committees: 1) review of treatment decisions made on behalf of incompetent, terminally ill patients; 2) review of medical decisions having ethical implications with the option, in cases of disagreement, to refer cases to a court with proper jurisdiction; 3) provision of social, psychological, spiritual, or other counseling for patients, family members, physicians, or other hospital staff; 4) establishing guidelines regarding treatment or other medical decisions; and 5) sponsoring or conducting educational programs to inform all concerned, including the public, about ethical problems in medicine.No exact count of these committees is available. According to estimates cited by Donald F. Phillips, managing editor of Hospital Ethics, about two-thirds to three-fourths of hospitals with more than 200 beds have ethics committees, as do about one-third of hospitals under 200 beds. He thinks that about half of the 6,000 hospitals in the United States now have working ethics committees.Several journal articles and a court decision in the late 1970s influenced their formation. A 1975 journal article by pediatrician Karen Teel (VII A) urged the use of hospital ethics committees to provide for dialogue in individual care situations as an appropriate sharing of responsibility. Another early article suggested that beyond parents and treating physicians, a "disinterested," mixed lay and medical committee could consider cases about defective newborns to improve the ethical decisionmaking process (VII A, Robertson and Fost, 1976). Three 1977 discussions in the Hastings Center Report highlighted this new concept (VII A, Levine; Shannon; Veatch).Produced at the National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057. It is supported by funds provided under grant number LM04492 from the National Library of Medicine, National Institutes of Health. Literature available through June 1992 is represented in this Scope Note. [End Page 285]The court decision was the March 31, 1976 ruling by the New Jersey Supreme Court in the Karen Quinlan case. The parents of a young woman in a persistent vegetative state had requested that she be taken off a respirator. The court designated a "prognosis" role for the hospital ethics committee and stipulated that the committee must concur that the patient will never return to a "cognitive, sapient state" before the life-support system can be withdrawn (In the Matter of Karen Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976)). Shortly after the Quinlan decision, Massachusetts General Hospital's Clinical Care Committee created an ad hoc subcommittee (a psychiatrist, a legal counsel, an ICU nurse, an oncologist/internist, a surgeon, and a lay person who had recovered from serious cancer disease) which looked at 15 cases. Based on the subcommittee's success, establishment of a permanent committee to review treatment of the terminally ill was recommended by the critical care committee (VII A, Clinical Care Committee 1976).In its 1984 Baby Doe rules, the federal government recommended establishment of infant care review committees, which promoted the growth of hospital ethics committees (VII C, Povar 1991). In July 1987 Maryland became the first state to require by law that hospitals establish patient care advisory committees to offer advice about choices available in the care of life-threatening illnesses; this requirement was extended to nursing homes in 1990 [codified as amended at Md. Health-Gen. Code Ann. Sections 19-370 to -374 (1990)] (VII C, Hollinger 1991).Recently the role for these committees has been noted in the Accreditation Manual for Hospitals, 1992 Supplement (p. 10, Patient Rights, Section RI. 1.1.6.1) of the Joint Commission... (shrink)

Commercialism first became a major problem for medicine in the decade of the 1970s, when huge quantities of new money began to flow into the healthcare system, as a result of Medicaid and Medicare, and the rapid expansion of private, employer-based insurance. Of course, physicians benefited, but most of this new money went to insurance plans and medical care delivery institutions, like hospitals, nursing homes, diagnostic services, and ambulatory care facilities of many kinds. Many of these were newly established (...) for-profit businesses. A vast number of satellite enterprises sprang up to serve the growing needs of the new businesses by providing services like marketing and advertising, brokering, consulting, information technology, financial services, case and disease management, billing and collecting, and so forth. (shrink)

The aim of this article is to add to the research surrounding nurses' work in hospitals. Throughout history, nurses have faced adverse working conditions, an aspect of their work that remains remarkably unchanged today. Prevailing historical ideologies and sociopolitical conditions influences the context of nurses' work in contemporary hospitals. This research revealed how ruling patriarchal power and nurses' altruistic ways normalize the conditions in hospitals as nurses' work. Moving discourses further add to the work of nurses in hospitals. For example, (...) cost containment strategies, overcapacity and short staffing have resulted in practices to accommodate these problems. While contemporary hospitals may look different, clearly, inside, little has changed since the early days; hospital issues have clearly become an ordinary part of nurses' work. This article discusses how the conditions in hospitals have become an ordinary part of nurses' work. The research in this article emphasizes how prevailing ideologies and institutional discourses make invisible and taken‐for‐granted, how this normalizing of nurses' work contributes to sustaining the hospital's power. (shrink)

In this study I intend to prove that there is a close connection between ethical purposes of Environmental Philosophy as World Philosophy and the idea of sacred nature as part of the “world” in a phenomenological sense, which includes sacred space as defined in the philosophy of religion. The main points that intersect here are: the idea of sacred space; the perception of virtue in a sacred world; the beauty of creation: nature, life, human sensibility. The theoretical background of this (...) study contains points of view that express phenomenological, hermeneutic, theological, and aesthetic conceptions belonging to authors and exegetes such as Mircea Eliade, William E. Paden, David Cave, Ion Ianoși, Douglas Allen, Arnold Berleant, and Vincent Blok. I believe that the neglect of the environment-as-a-condition-of-life (the consequences of which can already be seen in ecological imbalances) is caused by, among other factors, the desacralization of human attitudes towards nature and the world of life. Few people still have a feeling of sacred nature or the aesthetic emotion of perceiving beauty in natural forms. The relationship with the environment and nature is reduced to its exploitation as a source of economic profit or as a way for spending free time, a source of personal comfort devoid of any spiritual significance. Surely we cannot go back to archaic religions or medieval Christianity, but we can reintegrate into our moral values something of those cultures’ admiration and respect for the beauty/sublimity of nature and the world as expressions of divine creation, as something sacred. Philosophical debates related to this retrieval and their dissemination could be part of solving the ecological problems of the contemporary world. (shrink)

BackgroundThe theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure (...) that this practice is in line with the overarching goals of this approach and support the development of standards.MethodsWe analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why—and under what circumstances—some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ2 difference tests and Welch’s t-test.ResultsA total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation.ConclusionFrom the client’s point of view, there does not seem to be only one “right” way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations. (shrink)

The physician’s duty of confidentiality is based on the observance of the patient’s privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients’ data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. (...) The present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital. The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices. (shrink)

Student nurses are confronted by many ethical challenges in clinical practice. The aim of the study was to explore Malawian students’ experiences of ethical problems during their clinical placement. A phenomenological hermeneutic design comprising interviews and qualitative content analysis was used. Ten students were interviewed. Three main themes emerged: 1) Conflict between patient rights and the guardians’ presence in the hospital; 2) Conflict between violation of professional values and patient rights caused by unethical behaviour; and 3) Conflict between moral (...) awareness and the ideal course of action. The students had difficulties ensuring patient rights and acting in accordance with western norms and values which are not always appropriate in the Malawian context. The students require role models who demonstrate professional attitudes towards patients’ rights and values. There is a need to create pedagogical strategies in which a caring attitude and ethical reflection can be learned and cultivated in clinical practice. (shrink)

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions (...) of 35 nurses and midwives from three public hospitals located in the Western, Northern and North‐western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self‐improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity. (shrink)

A 78 year old married woman with progressive Alzheimer's disease was admitted to a local hospital with pneumonia and other medical problems. She recognized no one and had been incontinent for about a year. Despite aggressive treatment, the pneumonia failed to resolve and it seemed increasingly likely that this admission was to be for terminal care. The patient's husband (who had been taking care of her in their home) began requesting that the doctors be less aggressive in her treatment (...) and, as the days wore on, he became more and more insistent that they scale back their aggressive care. The physicians were reluctant to do so, due to the small but real chance that the patient could survive to discharge. But her husband was her only remaining family, so he was the logical proxy decisionmaker. Multiple conferences ensued, and finally a conference with a social worker revealed that the husband had recently proposed marriage to the couple's housekeeper and she had accepted. (shrink)

ABSTRACT In Mexico informed consent is a legal requirement that ensures that patients who are invited to participate in clinical trials are provided with all the information needed to decide whether to participate, or not, in a research protocol. To improve our understanding of the problems physicians in developing countries encounter, when obtaining informed consent (IC), we examined their opinion on the importance of IC in clinical research, the quantity and quality of the information provided to the participant, and the (...) conditions in which the IC is obtained. Investigators considered that IC was useful to the patients, providing information that helped the patient to make a decision about his/her participation. Nevertheless, they felt that for some aspects of the research, like drug development in general, the use of placebos, and the randomization process, many of the patients were not capable of fully understanding the information provided, referring to the complexity of the information and illiteracy as the main reasons. Many investigators were not acquainted with some of the guidelines established in the Mexican General Law of Health,1 36% of them admitting to not having completed their IC letters. Most investigators gave only minutes to the patient to make a decision and 20% of ICs were obtained while the patient was hospitalized. Except for one investigator, all of them considered that specific training in medical ethics would be useful for the daily clinical work. (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

The Hannover qualifying programme ‘ethics consultation in hospitals’, conducted by a four-institution cooperation partnership, is an interdisciplinary, scientifically based programme for healthcare professionals interested in ethics consultation services and is widely acknowledged by hospital managements and healthcare professionals. It is unique concerning its content, scope and teaching format. With its basic and advanced modules it has provided training and education for 367 healthcare professionals with 570 participations since 2003 (until February 2010). One characteristic feature is its attractiveness for health (...) professionals from different backgrounds. Internationally, the Hannover programme is one of the few schedules with both academics and non-academics as target groups and a high participation rate of physicians. The concept of the Hannover programme is in great demand, and its schedule is continuously optimised through evaluation. The goals of enabling healthcare professionals from different professional backgrounds to define and reflect ethical problems, to facilitate and support the process of decision-making and to work out structures for their own institutions seem to have been achieved. However, in order to obtain effective and sustainable results, participation in the programme should be supplemented regularly by in-house training sessions or individual expert consultations. Future challenges include new thematic courses and providing a network for former participants, especially when they come from non-academic hospitals. The network is a reasonable platform to discuss participants' experiences, successes and pitfalls. A further task will be research on how the programme's concept can support the sustainability of ethics structures in the various institutions. (shrink)

What is strange? Or better, who is strange? When do we encounter the strange? We encounter strangers when we are not at home: when we are in a foreign land or a foreign part of our own land. From Freud to Lacan to Kristeva to Heidegger, the feeling of strangeness--das Unheimlichkeit--has marked our encounter with the other, even the other within our self. Most philosophical attempts to understand the role of the Stranger, human or transcendent, have been limited to standard (...) epistemological problems of other minds, metaphysical substances, body/soul dualism and related issues of consciousness and cognition. This volume endeavors to take the question of hosting the stranger to the deeper level of embodied imagination and the senses. This volume plays host to a number of encounters with the strange. It asks such questions as: How does the embodied imagination relate to the Stranger in terms of hospitality or hostility? How do we distinguish between projections of fear or fascination, leading to either violence or welcome? How do humans "sense" the dimension of the strange and alien in different religions, arts, and cultures? How do the five physical senses relate to the spiritual senses, especially the famous "sixth" sense, as portals to an encounter with the Other? Is there a carnal perception of alterity, which would operate at an affective, prereflective, preconscious level? What exactly do "embodied imaginaries" of hospitality and hostility entail, and how do they operate in language, psychology, and social interrelations? And what, finally, are the topical implications of these questions for an ethics and practice of tolerance and peace? (shrink)

The immigrant problem, one of the most striking socio-pathological events of our day, is more often raised in the context of political issues. While these debates are driven by local and political interests, what is hidden behind political calculations is the tragic position of the migrant. The migrant, who comes to the agenda with political debates, takes on an extremely negative image in terms of social relations. The problem with the sameness of "We" is that the "Other" or (...) the immigrant, as the expression of an element that is incompatible with the local culture, is pushed from the field of "I" into otherness, and is evaluated as an element of conflict that does not force the transformation of publicity on the social level. Although the interest-based determining power of politics has negative effects on the formation of sufficient human common sense regarding the problem, there is an intense debate in the philosophical literature on the basis of Immanuel Kant, Hannah Arendt, Emmanuel Lévinas. Most of the studies put forward in the context of associating the ideas put forward by the thinkers in question with immigration have kept the research deep but limited in scope. In our study, the subject was not deemed necessary in depth, it was sufficient to discuss the basic thinkers, views and the basic dynamics of the relevant views on the subject, and care was taken to outline the relevant literature. Levinas, who stands out as one of the dynamics of the basic literature on immigration and the emphasis on "Otherness", pointed to Western thought that did not prioritize ethical relations as the cause of the political crises of his time. Levinas tries to handle the problem of Otherness, which emerges as a political, ethical and legal problem of the tension that the "I"-centered way of thinking, which brings about sameness, will experience against the "Other", in a different way from the tradition of thought that prioritizes ontology. In the thought of Levinas, who considers the “Other” as an alternative field of sameness, the transcendence dimension of Otherness has the function of removing the Self from narcissism through the discovery or tension of the alterity in the "Other" rather than the sameness of the position of the "I" against the "Others". There is a belief that the "Other", embodied in transcendent Otherness, will lead to an act of unconditional hospitality in the "I". It can be seen that Arendt also discusses the problems that Levinas puts on the agenda. In the context of "Otherness", Arendt's criticisms of the concept of right, which manifests itself with a political ontological understanding rather than an ethical relationship as expressed in Levinas, are in question. Thus, while it becomes possible to question the legal structure that does not include the “Other” in the political sphere, the importance of the "Other" for political discourse is also revealed. At this point, conditional hospitality comes to the fore in the context of foreigner's right, which we encounter in Kant. However, Derrida, who would state that Levinas's unconditional hospitality had practical problems, also found Kant's conditional hospitality problematic. The immigrant, as the “Other” of our time, which is hoped to gain an ethical-political basis of thought in the context of the idea of hospitality, aims to re-discuss the idea of hospitality developed in the existing literature, while also being a call to produce thoughts on the philosophical understanding of the immigrant and the importance of creating a philosophy of immigration. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive (...) qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

It is a common practice for family members to bring food to hospitalized loved ones. However, in some cases, this food contravenes a patient's dietary plan. Such situations can create significant tension and distrust between health care professionals and families and may lead the former to doubt a family's willingness or ability to support patient recovery. This case‐study essay offers an ethical analysis of these situations. We draw on Hilde Lindemann's work to argue that providing food to family members is (...) an important way that families discharge their moral functions of caring for their members and holding them in their identities. When family members are hospitalized, other means of performing these functions are limited. Acknowledging the ethical importance of feeding family members alongside the medical need for dietary restrictions, we offer strategies for creative problem‐solving that center diet as a subject for shared decision‐making and regular, ongoing communication among health care professionals, patients, and families. (shrink)

Caring for hospitalized patients with COVID-19 raises ethical dilemmas in which clinicians must weigh the unknown value of an intervention against the unknown risk of viral transmission. Current guidelines for delivering high-value care in the time of the COVID-19 pandemic do not directly address ethical dilemmas that arise from the unique concerns of individual patients. We propose an “ethical pause” in which clinicians address ethical dilemmas by taking time to ask three questions that invoke the major bioethical principles of beneficence, (...) nonmaleficence, and distributive justice: will this intervention help my patient? Could this intervention harm my patient? Could this intervention harm or help others? Using two exemplar cases, we demonstrate how the process of deliberately asking and answering structured ethical questions is a mindful problem-solving strategy that facilitates delivery of high-value care. (shrink)

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of (...) MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)

The philosophy of family‐centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision‐making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents (...) must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. (shrink)