Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool. ECQAT enables raters to assess the (...) quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation, established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT,.. (shrink)

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients and managers ; semi-structured interviews with managers, clinicians, and ethics committee chairpersons. Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on (...) patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with (...) intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

There is a thriving debate over what aspects of our capacity to produce and understand language are special. My concern here is a key part of this wider debate: Is speech special? In particular, my focus is on speech perception, and whether it is special. This isn’t just one but a number of different questions. Too frequently, these very different questions are not clearly distinguished and kept apart. I discuss a framework for distinguishing various versions of the question, Is speech (...) perceptually special? Focusing on a particular class of questions, I make a proposal about the sense in which speech is perceptually special. According to this account, the capacity to perceive speech is an acquired perceptual skill, and involves learning to hear language-specific types of biologically-significant sounds. This account illuminates the significance of interlocution in understanding what makes the perception of speech distinctive. (shrink)

Although there is now some recognition that sexual abuse, particularly that which occurs in religious settings, has spiritual implications for women who have been abused, the spiritual implications of sexual abuse which occurs beyond the confines of specific religious practices and beliefs tend not to be acknowledged. Taking a stance that all people, irrespective of their involvement in a formal religion, are inherently spiritual, this paper identifies the key concepts associated with spirituality as meaning, identity, connectedness, transformation and transcendence. Examples (...) as to how each of these may be issues following the experience of sexual abuse are provided. This approach challenges prevailing notions that sexual abuse only has spiritual implications for women who identify with a particular religious tradition. Instead it is argued that an experience of sexual abuse can be critical for the spiritual life of any woman who is subjected to abuse. (shrink)

The #metoo movement has forced many fans to consider what they should do when they learn that a beloved artist has acted immorally. One natural thought is that fans ought to give up the artworks of immoral artists. In Why It's OK to Enjoy the Work of Immoral Artists, Mary Beth Willard argues for a more nuanced view. Enjoying art is part of a well-lived life, so we need good reasons to give it up. And it turns out good (...) reasons are hard to find. Willard show that it's reasonable to believe that most boycotts of artists won't succeed, so most of the time there's no ethical reason to join in. Someone who manages to separate the art from the artist isn't making an ethical mistake by buying and enjoying their art. She then considers the ethical dimensions of canceling artists and so-called "cancel culture," arguing that canceling is ethically risky because it encourages moral grandstanding. Willard concludes by arguing that the popular debate has overlooked the power of art to change our lives for the good. It's of course OK to decide to give up the artwork of immoral artists, but--as Willard shows in this provocative little volume--it's OK to continue to enjoy their art, as well. Key Features Offers accessible discussions of complicated philosophical topics like aesthetic value, collective action problems, and epistemic justice Provides a unique perspective and underexplored argument on the popular issue of cancellation Explores the role of aesthetic value in our lives, including its relation to our ethical decisions and our well being. (shrink)

Given the persistent conception of rhetoric as effective persuasion by any means for individual success, it is desirable to describe an alternative standard for evaluating argumentation from a rhetorical perspective. I submit formal propriety as a key norm. Conceiving of form as a process of expectation and fulfillment offers a method of reconstructing argumentation that is both descriptive and normative. I illustrate the method by critiquing a sample of argumentation, and conclude by addressing the strengths and limitations of this analytical (...) approach. (shrink)

The biomedical industry relies on the skills of animal technologists to put laboratory animal welfare into practice. This is the first study to explore how this is achieved in relation to their participation in implementing refinement and reduction, two of the three key guiding ethical principles––the “3Rs”––of what is deemed to be humane animal experimentation. The interpretative approach contributes to emerging work within the social sciences and humanities exploring care and ethics in practice. Based on qualitative analysis of participant observation (...) within animal research facilities in UK universities, in-depth interviews with ATs, facility managers, and other stakeholders, and analysis of regulatory guidelines, we draw a contrast between the minimum required of ATs by law and how their care work not only meets but often exceeds these requirements. We outline how ATs constitute a key source of innovation and insight into the refinement of animal care and the reduction of animal use, hitherto not formally acknowledged. Exploring AT care work as an example of ethics in practice makes an original contribution to broader debates within health care and animal welfare about how technology, regulation, and behavior can foster and sustain a “culture of care”. (shrink)

Academics from diverse disciplines are recognizing not only the procedural ethical issues involved in research, but also the complexity of everyday “micro” ethical issues that arise. While ethical guidelines are being developed for research in aboriginal populations and low-and-middle-income countries, multi-partnered research initiatives examining arts-based interventions to promote social change pose a unique set of ethical dilemmas not yet fully explored. Our research team, comprising health, education, and social scientists, critical theorists, artists and community-activists launched a five-year research partnership on (...) arts-for-social change. Funded by the Social Science and Humanities Research Council in Canada and based in six universities, including over 40 community-based collaborators, and informed by five main field projects, we set out to synthesize existing knowledge and lessons we learned. We summarized these learnings into 12 key points for reflection, grouped into three categories: community-university partnership concerns, dilemmas related to the arts, and team issues. In addition to addressing previous concerns outlined in the literature, we identified power dynamics hindering meaningful participation of community partners and university-based teams that need to be addressed within a reflective critical framework of ethical practice. We present how our team has been addressing these issues, as examples of how such concerns could be approached in community-university partnerships in arts for social change. (shrink)

Tax administrators are empowered by the state to secure compliance with tax obligations. Enforcing compliance on the ground is complex, and street-level administrators often engage in the “art of the possible,” leading to dilemmas in the field. This paper examines tax administrators’ practices with regard to Jamaican property tax defaulters with outstanding tax liabilities in excess of 3 years. Drawing on interviews with tax administrators and other key agents, we find that tax administrators reposition themselves from objective enforcers to empathizing (...) officials engaging in schemes of action, doing what they can do rather than what they should do. This is a practical-sense approach to securing compliance. We identify two forms of empathy, assimilated and cynical, and conclude that administrators’ empathetic identification with defaulters does not necessarily arise solely from concern for social cohesion, or inter-subjective compassion, but also sometimes from self-interest. (shrink)

The current rise of neurodevelopmental disorders poses a critical need to detect risk early in order to rapidly intervene. One of the tools pediatricians use to track development is the standard growth chart. The growth charts are somewhat limited in predicting possible neurodevelopmental issues. They rely on linear models and assumptions of normality for physical growth data – obscuring key statistical information about possible neurodevelopmental risk in growth data that actually has accelerated, non-linear rates-of-change and variability encompassing skewed distributions. Here, (...) we use new analytics to profile growth data from 36 newborn babies that were tracked longitudinally for 5 months. By switching to incremental (velocity-based) growth charts and combining these dynamic changes with underlying fluctuations in motor performance – as the transition from spontaneous random noise to a systematic signal – we demonstrate a method to detect very early stunting in the development of voluntary neuromotor control and to flag risk of neurodevelopmental derail. (shrink)

Originally published as the Continuum Companion to Continental Philosophy, this book offers the definitive guide to contemporary Continental thought. It covers all the most pressing and important themes and categories in the field - areas that have continued to attract interest historically as well as topics that have emerged more recently as active areas of research. Twelve specially commissioned essays from an international team of experts reveal where important work continues to be done in the field and, valuably, how the (...) various topics intersect. Featuring a series of indispensable research tools, including an A to Z of key terms and concepts, a chronology, and a guide to practical research in the field, this is the essential reference tool for anyone working in and studying Continental Philosophy. (shrink)

According to accounts of the Passion, Christ cries out from the cross, “My God, my God, why have you forsaken me?” The cry, I argue, manifests that Christ lacks a belief that God is with him. Given the standard view of faith—belief that p is required for faith that p—it would follow that Christ lost his faith that God is with him just before he died. In this paper, I challenge the standard view by looking at the cognitive requirement of (...) faith. Although faith that p requires some positive cognitive orientation toward p, that orientation need not be belief. I show that reliance is an alternative stance that fulfills the cognitive requirement of faith. Reliance aims at providing sensible guidance for action that is in accord with one’s values/ends. Thinking of the cognitive component of Christ’s faith in terms of reliance makes sense of the doubt manifested in his cry. (shrink)

In recent years, it has become clear that food security is intimately related to complex environmental, social, political, and economic issues. Even though several studies document the impact of climate on food production and agriculture, a growing segment of research examines how climate change impacts food systems and associated livelihoods. Furthermore, while women play a crucial role in providing food security for their families, little research exists that examines the nexus among gender relations, climate change, and household food security. This (...) study investigates these relationships by asking: how is the production and reproduction of knowledge about food security and climate change shaped by gender and lived experience, and how does this knowledge influence attitudes and strategies for maintaining food security in a changing climate? Drawing on the results of research in two communities in central Mexico, I argue that women’s perceptions of and strategies for maintaining food security are derived from their socio-political, environmental, and economic contexts. This study contributes to both the growing literature on the gender dynamics of climate change, as well as debates about the role of bioengineered seeds in helping farmers to adapt to a changing climate. (shrink)

Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to consent (...) to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified. (shrink)

Gender-affirming hormone therapy is increasingly available to support healthy development of transgender youth, but ethical concerns have been raised regarding fertility-related implications. In this article, I present data from an exploratory qualitative study of the decision-making experiences of trans youth, parents of trans youth, and healthcare providers serving trans youth related to fertility and family creation. I discuss how cisnormative and bionormative biases can impact care and contribute to ethically problematic narratives of regret. Finally, I offer recommendations to support ethically (...) sound, gender-affirmative fertility and family creation counseling with transgender youth. (shrink)

A series of high-profile ethical lapses by senior military professionals has generated calls from levels as high as the commander in chief for a renewed emphasis on military ethics. Leaders engaged in professional military education (PME) across the joint force have worked to ensure their programs support this call. This paper explores and assesses the ethics education programs at the service senior leader colleges (war colleges). There are three fundamental questions facing those charged with teaching ethics to senior military officers. (...) What are the desired outcomes of ethics education? How should the curriculum be structured to achieve those outcomes? And, finally, what is the correct faculty composition to develop and employ that curriculum? Using the answers to those questions to produce a rough framework for a model war college ethics education program, this paper then compares the current war college programs to this model form in order to determine areas of strength and weakness. This analysis reveals that the existing ethics education programs at the war colleges compare favorably to the model program structure. However, leaders at these institutions could further strengthen their programs by creating and empowering an "ethics team" that includes trained ethicists and military practitioners and by conducting more robust faculty development programs for nonethicists."--Provided by publisher. (shrink)

That women tend to see harassment where men see harmless fun or normal gendered interaction is one of the more robust findings in sexual harassment research. Using in-depth interviews with employed men and women, this article argues that these differences may be partially explained by the performative requirements of masculinity. The ambiguous practice of “girl watching” is centered, and the production of its meaning analyzed. The data suggest that men's refusal to see their behavior as harassing may be partially explained (...) through the objectification and attenuated empathy that the production of masculine identities may require. Thus, some forms of harassment and their interpretations may more accurately be seen as acts of ignoring than states of ignorance. Implications for anti-sexual harassment policies and training are explored. (shrink)

Ethical perception involves seeing what is ethically salient about the particular details of the world. This kind of seeing is like informed judgment. It can be shaped by what we know and what we come to learn about, and by the development of moral virtue. I argue here that we can learn to see food justice, and I describe some ways to do so using three narrative case studies. The mechanism for acquiring this kind of vision is a “food justice (...) narrative” that is particular and concrete. These kinds of stories are counter narratives to a popular and dominant “script” about food that disguises the identity of people who eat, and obscures how constraints on free choice are created by particular lived circumstances. Food justice narratives specify the social and political location of individual people who are trying to nourish themselves. Once this contextual surround is included we are in a position to ask why this person, in this set of circumstances, is impeded in their access to nutritious food. This is not a question we are likely to consider if we leave out the identity of food consumers. Food justice narratives are forward looking as well because they bring into clearer focus what actions and kinds of social activism are appropriate responses to constraints on free choice. (shrink)

For trans youth, the experience of gender differs from expectations based on sex assigned at birth (Frohard-Dourlent, Dobson, Clark, Duoll, & Saewyc, 2016). To support gender health—the ability to...

For graduate students to succeed as professionals, they must develop a set of general “survival skills”. These include writing research articles, making oral presentations, obtaining employment and funding, supervising, and teaching. Traditionally, graduate programs have offered little training in many of these skills. Our educational model provides individuals with formal instruction in each area, including their ethical dimensions. Infusion of research ethics throughout a professional skills curriculum helps to emphasize that responsible conduct is integral to succeeding as a researcher. It (...) also leads to the consideration of ethical dimensions of professional life not covered in traditional ethics courses. (shrink)

Clp ATPase chaperone proteins are found in procaryotes and eucaryotes. Recently, ClpC of Bacillus subtilis was found to be part of a regulatory switch(1). ClpC, in combination with the MecA and ComS proteins, regulates the activity of a transcription factor, ComK, which is necessary for the development of genetic competence (the ability to bind and take up exogenous DNA). The complex of ClpC:MecA:ComK renders ComK inactive. Interaction between ComS and the ternary complex releases active ComK. This regulatory switch controls ComK (...) activity in response to cell density signals that affect production of ComS. Regulated interaction between Clp ATPases and target proteins might prove to be widespread. (shrink)

Comparison of similarities between women and animals does not necessarily show that animals are oppressed, much less that they are oppressed by patriarchy. Moreover, by seeking to establish symbolic connections, ecofeminists run the risk of essentializing women as emotional and bodily and closer to nature than men. Feminists have little to gain by concentrating exclusively on how the concepts of woman and animal overlap. Likewise, there is little to be gained for animal liberation by comparing women and animals in theory (...) and practice. Feminists have obligations to liberate animals to the degree that they have obligations to liberate any oppressed population, but not because there are either theoretical, practical, or symbolic connections between women and animals. (shrink)

Comparison of similarities between women and animals does not necessarily show that animals are oppressed, much less that they are oppressed by patriarchy. Moreover, by seeking to establish symbolic connections, ecofeminists run the risk of essentializing women as emotional and bodily and closer to nature than men. Feminists have little to gain by concentrating exclusively on how the concepts of woman and animal overlap. Likewise, there is little to be gained for animal liberation by comparing women and animals in theory (...) and practice. Feminists have obligations to liberate animals to the degree that they have obligations to liberate any oppressed population, but not because there are either theoretical, practical, or symbolic connections between women and animals. (shrink)

Drawing on 45 interviews, this article addresses how heterosexual men and women respond to and discuss opposite and same-sex nude images in distinctive ways. Viewing both female and male nudes provides an opportunity to observe the sexual and gender identity work men and women perform when confronted with this cultural object. Both men and women have access to shared, readily available cultural scripts for interpreting and responding to female nude images. Neither men nor women are culturally adept at the interpretation (...) and use of nude male images, particularly the man in the soft porn frame. Men respond to this male nude with overt rejection and stated disinterest. Women are more likely to reject the seductive advance or welcome it with attached feelings of guilt. (shrink)

This article examines, by way of a case study, a community where groundwater has been highly contaminated with nitrate and how that situation brings together matters of public policy, environmental justice, and emerging technology. The Mountain View community lies in an unincorporated area of Bernalillo County, New Mexico; the neighborhood is 77% Hispanic and is a pocket of poverty whose residents are considered at risk for environmental injustice. Groundwater nitrate contamination was discovered in the 1960s, but residents were merely encouraged (...) to dig deeper wells, until 1984 when most residents were put on nearby municipal water after a child was poisoned and hospitalized with methemoglobinemia, known as blue baby syndrome. In situ biodenitrification is an emerging technology that has been shown to completely remediate groundwater nitrate contamination after the injection of a food source for naturally occurring denitrifying bacteria; this technology is being considered for use in Mountain View. (shrink)

Fox-Genovese, Kaminer, and Riley all write the history of feminism as a history of conflict between feminists who desire to deny difference in favor of equality and those who desire to celebrate difference. And they all ask what this contradiction lying at the heart of feminist theory implies for the practice of feminist politics. These works reveal the need for feminists who engage this debate to be self’-Conscious in their formulations.

This 2007 volume is intended to help readers understand the relationship between international law and international relations. As a testament to this dynamic area of inquiry, new research on IL/IR is now being published in a growing list of traditional law reviews and disciplinary journals. The excerpted articles in this volume, all of which were first published in International Organization, represent some of the most important research since serious social science scholarship began in this area more than twenty five years (...) ago. They are important milestones toward making IL/IR a central concern of scholarly research in international affairs. The contributions cover some of the main topics of international affairs to provide readers with a range of theoretical perspectives, concepts, and heuristics that can be used to analyze the relationship between international law and international relations. (shrink)

Much of the focus of programs designed to promote responsible conduct in research has traditionally been on the high crimes of fabrication, falsification, and plagiarism. We believe that equally deserving of our attention are the misdemeanors that also can occur. Viewed as individual events, these “little murders” are far less serious. Yet, we believe that in the aggregate they can do great harm, not the least because they can set the stage for far greater crimes.

Fox-Genovese, Kaminer, and Riley all write the history of feminism as a history of conflict between feminists who desire to deny difference in favor of equality and those who desire to celebrate difference. And they all ask what this contradiction lying at the heart of feminist theory implies for the practice of feminist politics. These works reveal the need for feminists who engage this debate to be self-conscious in their formulations.