Significant global events in recent years have had a substantial impact on the nursing profession. The COVID-19 pandemic, climate change, and systemic racism are a few of the many complex issues that create a landscape of disruption and uncertainty in healthcare. With the aims of protecting both people and the planet, the United Nations’ Sustainable Development Goals offer a road map to combat these global concerns, yet require more widespread consideration as a way forward. Education on the Sustainable Development Goals (...) is recognised as a key aspect for healthcare professionals to take action towards achieving the targets of the goals. For student nurses, the undergraduate curriculum offers an opportunity to enculturate future nurses on the important role they play in the global agenda to transform our world. Brazilian pedagogue Paulo Freire's theoretical approach to education, critical pedagogy, espouses transformation with conscientization, dialogue and liberation, which may create a paradigm shift toward global action. This discussion paper seeks to provide an argument for embedding the Sustainable Development Goals into nursing curricula using the philosophies of Freire's critical pedagogy. It will argue that a critical approach to education is required to create the transformation needed for student nurses to be educated on the Sustainable Development Goals. (shrink)

This essay is written in two parts. The first is a commentary on the affective politics of philosophy as a discipline. The theme here is philosophy’s reverence problem, an affective bond to the teacher and the text, which is threatened or even injured by feminist philosophy. Feminist philosophy emerges as disruptive irreverence in the midst of the discipline, and injured reverence becomes a powerful prereflective motivation for resistance to feminist thought. The second part of the essay is an exploration of (...) the field of inquiry called feminist phenomenology. Is feminist phenomenology simply phenomenology from another point of view, that of the embodied female subject? Is it conducted, in other words, in a space beyond politics and power where the difference of this subject discloses values and meanings that have not yet been thematized in phenomenological inquiry, but which phenomenology is already competent to pursue? Or does feminist phenomenology disrupt or transform phenomenological practice as we traditionally understand it? In this paper, I claim that phenomenology must be critical in order to be feminist, that it must disrupt phenomenological practice rather than simply “applying” it to a new object, “woman.” In the work of Simone de Beauvoir we find a different phenomenological practice that feminists can count as a positive inheritance. The real difference of feminist phenomenology, however, only emerges in the practice itself. In order to capture something about this difference I take the phenomenon of shame as a case study, and compare three recent phenomenological accounts of shame. (shrink)

Involvement of industry in academic research is widespread and associated with favorable outcomes for industry. The objective of this study was to review empirical data on the attitudes of researchers toward industry involvement and financial ties in research. A review of the literature for quantitative data from surveys on the attitudes of researchers to financial ties in research, reported in English, resulted in the 17 studies included. Review of these studies revealed that investigators are concerned about the impact of financial (...) ties on choice of research topic, research conduct and publication, but this concern is less among investigators already involved with industry. Researchers approve of industry collaboration and financial ties when the ties are indirectly related to the research, disclosure is upfront, and results and ideas are freely publicized. However, their trust in disclosure as a way to manage conflicts may reveal a lack of awareness of the actual impact of financial incentives on themselves and other researchers. (shrink)

This book of sixteen original essays is the first to explore this range of new developments in the philosophy of mathematics, in a language accessible to ...

Health care is transitioning from genetics to genomics, in which single-gene testing for diagnosis is being replaced by multi-gene panels, genome-wide sequencing, and other multi-genic tests for disease diagnosis, prediction, prognosis, and treatment. This health care transition is spurring a new set of increased or novel liability risks for health care providers and test laboratories. This article describes this transition in both medical care and liability, and addresses 11 areas of potential increased or novel liability risk, offering recommendations to both (...) health care and legal actors to address and manage those liability risks. (shrink)

The questions of how human beings produce and comprehend language continue to engage a variety of researchers and scholars, and it is becoming increasingly clear that only interdisciplinary approaches will yield productive answers. This complex issue of discourse processing is the subject of this volume, and the contributors address it from the varying perspectives of cognitive psychology linguistics, and computer science. The chapters provide a fascinating overview of emerging theories in the new discipline of cognitive science. A useful introductory chapter (...) by the editors explains the relationships of chapters to one another and outlines the long-term implications of the work they report. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

Background and aim With the increasing interest in lifestyle, health and consequences of unhealthy lifestyles for the healthcare system, a new kind of solidarity is gaining importance: lifestyle solidarity. While it might not seem fair to let other people pay for the costs arising from an unhealthy lifestyle, it does not seem fair either to punish people for their lifestyle. However, it is not clear how solidarity is assessed by people, when considering disease risks or lifestyle risks. The aim of (...) this study was to investigate the degree of solidarity with lifestyle as well as with other factors that are related to health outcomes—for example, old age—and the relation between this degree of solidarity and various characteristics. Methods This cross-sectional study is part of the Dutch longitudinal SMILE study. Data on the degree of solidarity with different lifestyles and old age, and the relation between the degree of solidarity and various demographic and other variables were obtained in a questionnaire survey. Results Solidarity with smokers and overweight people was moderate, as was solidarity with older people. Respondents were ambivalent about athletes. Respondents who were younger, male and highly educated, and those with a healthy lifestyle, a small social network, high quality of life and an internal locus of control, showed low solidarity. Conclusions Solidarity with an unhealthy lifestyle and old age is moderate and the degree of solidarity varies among the different subgroups. (shrink)

In summary, the creation and maintenance of the Wistar Rats as standardized animals can be attributed to the breeding work of Helen Dean King, coupled with the management and husbandry methods of Milton Greenman and Louise Duhring, and with supporting documentation provided by Henry Donaldson. The widespread use of the Wistar Rats, however, is a function of the ingenuity of Milton Greenman who saw in them a way for a small institution to provide service to science. Greenman's rhetoric, as captured (...) in his Director's Reports, prepared annually from 1905 until his death in 1937, shows that he was unusually sensitive to his times and to the economics of science and of society. In the era when biology was being defined, he recognized in the rat the potential to be a living analog to the pure chemicals that legitimated experimental science. From management literature he extracted the ideals of uniformity of product, standards of quality, and efficiency of production, applying them to scientific practice to generate an animal model that thrives as standard equipment in laboratories throughout the world today.I will close with a quote from Frederick W. Taylor that is a cogent statement of the contribution to science and scientific progress made by standardized tools and their creators. Equating the surgeon and the workman, Taylor wrote: [He is given] the finest implements, each one of which has been the subject of special study and development ... [and] the very best knowledge of his predecessors; and, provided with standard implements and methods which represent the best knowledge of the world up to date, he is able to use his own originality and ingenuity to make real additions to the world's knowledge, instead of reinventing things which are old.Standardized tools, whether surgeons' implements or laboratory-bred rats, are one of the vehicles for carrying scientific knowledge forward from generation to generation. In this sense, Greenman's Wistar Rats have done their job, in his words, of “providing service to science.”. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Based on interviews with 40 first-time mothers, the authors develop an argument that supplements the critique of medicalized childbirth by focusing on the social context in which women give birth. Particularly important about that context is women's privatized responsibility for babies' well-being, and a dearth of social supports for mothering, including the sharing of that responsibility by fathers. Contextualizing childbirth in this way makes clearer not only why many women are favorable toward medical intervention but also the decisions women make (...) during hospital births. The women we interviewed displayed widely ranging reactions to giving birth in the hospital. Describing their experiences, these women often emphasized pain and anxiety. Both conditions appear to have been relieved as effectively by social support as by medical assistance. Furthermore, women who had generally supportive partners were less likely to receive medical intervention during the birth and less likely to suffer postpartum depression. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Bonnie Burstow; Sartre: a possible foundation for educational theory, Journal of Philosophy of Education, Volume 17, Issue 2, 30 May 2006, Pages 171–185, https.

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in (...) this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

Non-Western Christian missionaries from a variety of backgrounds represent Europe as being in decline in terms of its religiosity and morals. Such evaluations are set against a backdrop of Christian demographic shift from the global North to the global South and secularization theory. The shift in demographics is, however, unfinished, as is the inversion of relations implied by the vocal, critical presence of Southern Christians in Europe. There is great religious variety within Europe, the West and the global South. Hence (...) scholars are developing fresh theoretical lenses to take better account of contexts and connections in analyses, and further research into the relationship between rhetoric and reality is called for. (shrink)

Bonnie Honig invigorates debate over the politics of refusal by insisting that withdrawal from unjust political systems be matched with collective action to change them. Historical and fictional characters from Muhammad Ali to the Bacchants of ancient Greek tragedy teach us how to turn rejection into transformative efforts toward self-governance.

What does it mean to know another person, and how is such knowledge different from other kinds of knowledge? These questions constitute an important part of what I call ‘second-person epistemology’ – the study of how we know other people. I claim that knowledge of other people is not only central to our everyday lives, but it is a kind of knowledge that is unlike other kinds of knowledge. In general, I will argue that second-person knowledge arises from repeated interactions (...) with another person, and that it also requires employment of certain cognitive abilities and a unique kind of second-order knowledge. This paper provides the framework for a second-person epistemology by examining some of our ordinary claims about what it means to know another person. I describe four conditions that typically characterize knowing another person. Then I describe the psychological grounds of knowing a person. Finally, I conclude with some thoughts about the unique symmetries of second person knowledge and the role of such knowledge in our broader epistemological endeavours. (shrink)

Curiously, two central areas are unaddressed by Epstein et al.: (i) L1A–L2A differences; (ii) L2 development. Here, findings relevant to (i) and (ii) – as well as their significance – are discussed. Together these form the basis for contesting Epstein et al.'s “Full Access” approach, but nonetheless analyses of the L2 data argue for UG-constrained L2A. Also discussed is the inadequacy of accounts (like Epstein et al.'s) without an explicit and prominent role for the L1.

Stemming from a study of social aesthetics, in which public reaction to human physical appearance is addressed, the present analysis considers the practice of humans associating themselves with nonhuman animals on the basis of the latter's appearance. The study found these nonhuman animals are intended to serve as a positive reflection on the humans who deliberately choose them for their “special” traits, which the humans then utilize to enhance their own social standing. The study compares this to the same practice (...) used by humans to associate themselves with attractive humans and serves the similar purpose of amassing social status by virtue of the association. This paper explains the phenomenon in theoretical terms; namely, symbolic interactionism, paying special attention to impression-management and dramaturgy, along with other interactionist features of attribution and social exchange. Where available, the paper uses scholarly, empirical work on the topic, supplemented by popular media observations and news articles. Viewed from an interactionist perspective, these empirical and non-empirical examples provide a novel picture of human-and-animal society as a unidirectional, status-seeking interaction intended to benefit human actors. (shrink)

Through examining practices of torture, extra-judicial assassination, and first person accounts of soldiers on the ground, Bonnie Mann develops a new theory of gender.

In a recent paper1 I argued that observation can be thought of as the result of a properly composed and functioning observation system. In brief, such a system must be composed of a source object and one or more devices which interact with a receptor. If we think of observation as the result of interaction among components are differing functions, we can approach the problem of describing human sense perception as that of describing one type of observation, differentiated from other (...) types by the organic and species specific nature of the receptor devices. Receptor devices are typed by their specific range of sensitivity, which is best thought of as a limit on the type of devices with which the receiver can interact. One consequence of this view is that observation can be achieved in all sorts of ways by all sorts of organic and non-organic systems as long as they satisfy functional conditions. (shrink)

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

CRISPR/Cas9 is quickly becoming one of the most influential biotechnologies of the last five years. Clinical trials will soon be underway to test whether CRISPR/Cas9 can edit away the genetic mutations that cause sickle cell disease (SCD). This article will present the background of CRISPR/Cas9 gene editing and SCD, highlighting research that supports the application of CRISPR/Cas9 to SCD. While much has been written on why SCD is a good biological candidate for CRISPR/Cas9, less has been written on the ethical (...) implications of including SCD in CRISPR/Cas9 research. This article will argue that there is a strong case in favor of including SCD. Three benefits are achieving distributive justice in research, continuing to repair the negative relationship between patients with SCD and the health‐care system, and benefit‐sharing for those who do not directly participate in CRISPR/Cas9 research. Opponents will argue that SCD is a risky candidate, that researchers will not find willing participants, and that the burden of SCD is low. Of this set of arguments, the first gives pause. However, on balance, the case in favor of including SCD in CRISPR/Cas9 research is stronger than the case against. Ultimately, this article will show that the historic and sociopolitical injustices that impede progress in treating and curing SCD can be alleviated through biotechnology. (shrink)

This article argues that the meaning of the word ‘autism’ experienced a radical shift in the early 1960s in Britain which was contemporaneous with a growth in epidemiological and statistical studies in child psychiatry. The first part of the article explores how ‘autism’ was used as a category to describe hallucinations and unconscious fantasy life in infants through the work of significant child psychologists and psychoanalysts such as Jean Piaget, Lauretta Bender, Leo Kanner and Elwyn James Anthony. Theories of autism (...) were then associated both with schizophrenia in adults and with psychoanalytic styles of reasoning. The closure of institutions for ‘mental defectives’ and the growth in speech therapy services in the 1960s and 1970s encouraged new models for understanding autism in infants and children. The second half of the article explores how researchers such as Victor Lotter and Michael Rutter used the category of autism to reconceptualize psychological development in infants and children via epidemiological studies. These historical changes have influenced the form and function of later research into autism and related conditions. (shrink)

Sophocles' Antigone is a touchstone in democratic, feminist and legal theory, and possibly the most commented upon play in the history of philosophy and political theory. Bonnie Honig's rereading of it therefore involves intervening in a host of literatures and unsettling many of their governing assumptions. Exploring the power of Antigone in a variety of political, cultural, and theoretical settings, Honig identifies the 'Antigone-effect' - which moves those who enlist Antigone for their politics from activism into lamentation. She argues (...) that Antigone's own lamentations can be seen not just as signs of dissidence but rather as markers of a rival world view with its own sovereignty and vitality. Honig argues that the play does not offer simply a model for resistance politics or 'equal dignity in death', but a more positive politics of counter-sovereignty and solidarity which emphasizes equality in life. (shrink)

We argue in this article that many common adverbial phrases generally taken to signal a discourse relation between syntactically connected units within discourse structure instead work anaphor- ically to contribute relational meaning, with only indirect dependence on discourse structure. This allows a simpler discourse structure to provide scaffolding for compositional semantics and reveals multiple ways in which the relational meaning conveyed by adverbial connectives can interact with that associated with discourse structure. We conclude by sketching out a lexicalized grammar for (...) discourse that facilitates discourse interpretation as a product of compositional rules, anaphor resolution, and inference. (shrink)

In this paper, we engage with Chinese diasporas research through recourse to Bourdieu’s relational, reflexive sociology. We start with the historical and recent developments of Chinese diasporas research and point out the potential of using Bourdieu to strengthen the theoretical underpinnings of this research. While we see a steady stream of Bourdieu-informed Chinese diasporas studies and acknowledge their contribution and innovation, we observe that some studies use Bourdieu’s capital and/or habitus without field. In response, we draw on Bourdieu’s relationalism to (...) highlight the significance of ‘fielding’ Chinese diasporas research. In addition, we turn field analysis onto Chinese diasporas researcher-selves through Bourdieu’s reflexive tool of participant objectivation. In this vein, we ponder over the positions and position-takings of Chinese diasporas researchers within and beyond the academic field of Chinese diasporas. To conclude the paper, we make a call to shift the intellectual landscape by developing a research agenda to sociologise Chinese diasporas challenged by complex and difficult issues of power, politics, and participation. Our critical sociological approach may have implications for doing scholarship reflexively and relationally in other research fields. (shrink)

The use of cochlear implants, especially for prelingually deafened children, has aroused heated debate. Members and proponents of Deaf culture vigorously oppose implants both as a seriously invasive treatment of dubious efficacy and as a threat to Deaf culture. Some find these arguments persuasive; others do not. And in this context arise questions about the extent to which individuals with disabilities may decline treatments to ameliorate disabling conditions. When they do so, to what extent may they call upon society to (...) provide supportive services and accommodations? (shrink)

Philosophers generally recognize pragmatism as a philosophy of progress. For many commentators, pragmatism is linked to a notion of historical progress through its embrace of meliorism – a forward-looking philosophy that places hope in the future possibility of improvement. This paper calls pragmatism’s progressivism into question by outlining an alternative account of meliorism in the work of William James. Drawing on his ethical writings from the 1870s and 1880s, I argue that James’s concept of hope does not imply an embrace (...) of historical progress, but remains detached from such a notion precisely insofar as it relies on a non-progressive temporality that encourages a rethinking of historical change. This form of hope is significant, I suggest, for the work of conceptualizing a non-progressive pragmatist approach to history and historiography. (shrink)

The lies about the reasons for the U.S. war against Iraq provoked no mass public outcry in the United States against the war. What is the process of justification for this war, a process that seems to need no reasons? Mann argues that the process of justification is not a process of rational deliberation but one of aesthetic self-constitution, of rebuilding a masculine national identity. Included is a feminist reading of the National Defense University document Shock and Awe.

This collection contains twenty-one thought-provoking essays on the controversies surrounding the moral and legal distinctions between euthanasia and "letting die." Since public awareness of this issue has increased this second edition includes nine entirely new essays which bring the treatment of the subject up-to-date. The urgency of this issue can be gauged in recent developments such as the legalization of physician-assisted suicide in the Netherlands, "how-to" manuals topping the bestseller charts in the United States, and the many headlines devoted to (...) Dr. Jack Kevorkian, who has assisted dozens of patients to die. The essays address the range of questions involved in this issue pertaining especially to the fields of medical ethics, public policymaking, and social philosophy. The discussions consider the decisions facing medical and public policymakers, how those decisions will affect the elderly and terminally ill, and the medical and legal ramifications for patients in a permanently vegetative state, as well as issues of parent/infant rights. The book is divided into two sections. The first, "Euthanasia and the Termination of Life-Prolonging Treatment" includes an examination of the 1976 Karen Quinlan Supreme Court decision and selections from the 1990 Supreme Court decision in the case of Nancy Cruzan. Featured are articles by law professor George Fletcher and philosophers Michael Tooley, James Rachels, and Bonnie Steinbock, with new articles by Rachels, and Thomas Sullivan. The second section, "Philosophical Considerations," probes more deeply into the theoretical issues raised by the killing/letting die controversy, illustrating exceptionally well the dispute between two rival theories of ethics, consequentialism and deontology. It also includes a corpus of the standard thought on the debate by Jonathan Bennet, Daniel Dinello, Jeffrie Murphy, John Harris, Philipa Foot, Richard Trammell, and N. Ann Davis, and adds articles new to this edition by Bennett, Foot, Warren Quinn, Jeff McMahan, and Judith Lichtenberg. (shrink)

Background:The perceptions of core professional nursing values of men in baccalaureate nursing programs are poorly understood.Objective:The study purpose was to understand and interpret the meaning of core professional nursing values to male baccalaureate nursing students.Research design and context:One-to-one interviews were conducted with male nursing students from a public university in the Midwest, following interpretive phenomenology.Ethical considerations:Measures to protect participants included obtaining Institutional Review Board approval, obtaining signed informed consent, and maintaining confidentiality.Findings:The study revealed five themes and several subthemes under an (...) overarching finding of caring. Acquisition of professional nursing values began prior to the nursing program and continued to varying degrees throughout the program.Discussion:Several implications are offered for nursing education, nursing practice, research, and public policy. These include identification of common values, teaching-learning strategies, inclusive environments, teamwork, and conflict resolution.Conclusion:Caring was revealed using a metaphor of a puzzle. (shrink)

This book intervenes in contemporary debates about the threat posed to democratic life by political emergencies. Must emergency necessarily enhance and centralize top-down forms of sovereignty? Those who oppose executive branch enhancement often turn instead to law, insisting on the sovereignty of the rule of law or demanding that law rather than force be used to resolve conflicts with enemies. But are these the only options? Or are there more democratic ways to respond to invocations of emergency politics? Looking at (...) how emergencies in the past and present have shaped the development of democracy, Bonnie Honig argues that democracies must resist emergency's pull to focus on life's necessities because these tend to privatize and isolate citizens rather than bring us together on behalf of hopeful futures. Emphasizing the connections between mere life and more life, emergence and emergency, Honig argues that emergencies call us to attend anew to a neglected paradox of democratic politics: that we need good citizens with aspirational ideals to make good politics while we need good politics to infuse citizens with idealism.Honig takes a broad approach to emergency, considering immigration politics, new rights claims, contemporary food politics and the infrastructure of consumption, and the limits of law during the Red Scare of the early twentieth century. Taking its bearings from Moses Mendelssohn, Franz Rosenzweig, and other Jewish thinkers, this is a major contribution to modern thought about the challenges and risks of democratic orientation and action in response to emergency. (shrink)

Hospital ethics committees are common, but not universal, in small hospitals. A needs assessment was completed at a 155-bed community hospital in order to adapt an academic tertiary center model for a clinical ethics committee to fit the needs of the small hospital community. Of 678 questionnaires distributed, 209 were completed. Data suggested that clinical staff frequently experienced ethical dilemmas. Significantly more nonphysicians indicated that they would utilize a consultation service, if available, compared to physicians (p = 0.0067). The data (...) also indicated that the majority of staff (>80 percent) desired more education in clinical ethics. Physicians preferred annual or bi-annual hospital-wide grand rounds, compared to nonphysicians, who preferred more frequent department-based teaching (p < 0.001). The data presented in this article were used to subsequently develop a clinical ethics support committee, the process of which is also described. (shrink)