Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, (...) we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. (shrink)

Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members (...) of higher administration. These data will be of use to educators as well as to fellows who advocate for elements of training in preparation for their first position. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Kimberly et al. (2005) have examined an important issue surrounding end-of-life decision-making, that of honoring do-not-resuscitate (DNR) orders in the non-medical setting of public schools. Their...

In lieu of an abstract, here is a brief excerpt of the content:Imaginary Interview*Jillian WeiseQ:Are you disabled?A:It depends. I need context.Q:Are you rendered incapable?A:I am awake and sober.Q:Are you limited by parts of the body?A:My arms are not wings.Q:Are you entitled to certain rights?A:Yes, I am disabled.Q:The U.S. Government disagrees.A:You read the letter?Q:“Due to the subject’s advanced education, the subject is no longer disabled.”1A:It was a love letter. They could have written it better. I would’ve preferred something with a little (...) more feeling, such as: “Dear Jillian: We are breaking up. We saw you outside the building with the statue of the lion. We saw you trespass through the halls and take from the shelves a number of hardbacks and take from the woman with glasses her suggestions. You have been made too erudite, too learned. If you want to protest, if you want to continue our relationship, then un–educate yourself. It would be helpful if you worked at a factory or could not find work. It would be helpful for something inside you to hurt.”Q:You seem bothered by the letter from the government.A:No more bothered, I guess, than if the government sent a letter rescinding my name.Q:The name disability is important to you then?A:It is important. It is very, very important. No, it is not important. I hardly think of it. It vexes me and I need it and I should not say it that often. Today, for example, I said: You must not use the word disability too much in this interview. After all, you do not like the word, and you have named yourself cyborg, so there is no reason to use the word you already rejected. After that thought came the voice of the Director, who said, “When you use the word disability, people think accommodations, people think favors. Best not to use it.” And after that came the voice of a writing mentor: “I just don’t like the word disabled in this piece. Is there a way to write the piece without using the word?”Q:What is disability like?A:It is like crowding under an umbrella, except your head sticks out, and your hair gets wet, and there are no cabs. Plus, this is somebody else’s umbrella.Q:Respond to this symbol.A:That is where I park my car.Q:What do you have?A:I do not know. The doctors named the condition. They gave it a three–word, nine syllable Latin name. Now I go to other doctors and they say, “What do you have?” and I say the Latin name, and they say, “What?” and I repeat the name, and they say, “How do you spell it?” Also—and I think this is important—the prognosis for the condition reads, “No reported cases have survived past the age of two.” Therefore, I am either dead with the condition. Or I am alive with a different one. Or the medical dictionary is fiction.Q:What is the condition?A:I am a cyborg.Q:When did you begin calling yourself a cyborg?A:Rephrase the question. [End Page 219]Q:When did you become a cyborg?A:2007.Q:Where?A:I cannot say the name of the office. The prosthetist posted a photo of me online, and in the photo I am not wearing any pants. I am wearing the cyborg leg for the first time and without any pants. I am so embarrassed. I do not want you to find the photo online. This is before we knew each other. This is before we knew what we meant to each other.Q:I have to tell you: when I first saw you, I thought, “She looks like a woman who could be taken advantage of online.”A:Yes, that is the problem with having it physical. When it is physical, people make all kinds of assumptions. She needs help. She is lop–sided. She must be so, so sad. I thought of another definition: looked at, done to, and dissed... (shrink)

In Geneva, since the beginning of pre-service secondary teacher training at university, two different types of students in teacher preparation coexist: some of them have got part-time classes, others have no teaching assignment. In an introduction to the teaching profession, students from different disciplines of the two types take a course on the same sources of professional knowledge. By analyzing the representations of the teaching profession, we find that the process of construction of their professional identity varies according to whether (...) they have a student teaching placement or not. : A Genève, depuis l’universitarisation de la formation des enseignants du secondaire, deux statuts d’étudiants en formation initiale à l’enseignement coexistent : les uns à mi-temps en responsabilité de classe, les autres sans contact avec le terrain. Dans une unité de formation d’introduction à la profession enseignante, des étudiants de disciplines différentes des deux statuts suivent un dispositif de formation identique portant sur les savoirs de référence constitutifs de la profession. En analysant les représentations du métier d’enseignant des étudiants, on constate que l’identité professionnelle en construction de ceux-ci évolue différemment selon s’ils sont sur le terrain ou non. (shrink)

In Geneva, since the beginning of pre-service secondary teacher training at university, two different types of students in teacher preparation coexist: some of them have got part-time classes, others have no teaching assignment. In an introduction to the teaching profession, students from different disciplines of the two types take a course on the same sources of professional knowledge. By analyzing the representations of the teaching profession, we find that the process of construction of their professional identity varies according to whether (...) they have a student teaching placement or not. A Genève, depuis l’universitarisation de la formation des enseignants du secondaire, deux statuts d’étudiants en formation initiale à l’enseignement coexistent : les uns à mi-temps en responsabilité de classe, les autres sans contact avec le terrain. Dans une unité de formation d’introduction à la profession enseignante, des étudiants de disciplines différentes des deux statuts suivent un dispositif de formation identique portant sur les savoirs de référence constitutifs de la profession. En analysant les représentations du métier d’enseignant des étudiants, on constate que l’identité professionnelle en construction de ceux-ci évolue différemment selon s’ils sont sur le terrain ou non. (shrink)

We congratulate Fox and her colleagues (2007) for contributing to the published empirical literature on ethics consultation in United States hospitals. Their study demonstrates the continued wide v...

While consensus exists among many practitioners of ethics consultation about the need for and identification of core competencies and standards, there has been virtually no attempt to determine how these competencies and standards are best taught and assessed. We believe that clinical ethics consultation has reached a state of sufficient maturity that expert practitioners can evaluate those who are new to the field. We will outline several steps that can facilitate the creation of a certification process for clinical ethics consultants, (...) assuring the competency and quality of consultation for the patients, families, and healthcare professionals who utilize ECSs. (shrink)

The earthquakes which struck Nepal’s capital in 2015 were humanitarian disasters. Not only did they inflict tragic loss of life and livelihoods, they also destroyed parts of the Kathmandu Valley’s unique UNESCO World Heritage site. These monuments were not just ornate structures but living monuments playing central roles in the daily lives of thousands, representing portals where the heavens touch earth and people commune with guiding deities. Their rehabilitation was also of economic importance as they represent a major source of (...) tourist income and employment. Unfortunately, the social and political desire for rapid reconstruction resulted in the swift removal of many traditionally constructed foundations and their replacement with modern materials without assessments of whether they contributed towards the collapse of individual monuments. These actions, combined with the wholesale removal, mixing and dumping of modern and historic debris, contributed to a second, equally destructive, cultural catastrophe – irreversible damage to Kathmandu’s Medieval fabric, in a process which frequently excluded local communities and custodians. This case study draws from our collective reflections and lessons learned from our attempts to enable equitable and ethical research partnerships between UK and Nepali colleagues as well as local communities in the debris of the Kasthamandap, Kathmandu’s eponymous monument. After briefly describing the potential of mobilising archaeologists in post-disaster contexts and outlining the challenges of undertaking research in such a setting, our case study utilises the TRUST Code to assess the character and success of our multidisciplinary collaboration in a time of crises. (shrink)

Ethik-Komitees gehören zum festen Bestandteil des Ethikmanagements und der Organisationsethik in klinischen Einrichtungen des Gesundheitswesens. Entsprechende Ethikstrukturen und die damit verbundenen Angebote stoßen hinsichtlich ihrer Wirksamkeit allerdings an ihre Grenzen. Ihre Arbeitsweisen sind häufig reaktiv und eine Verankerung in den entsprechenden Organisationsebenen fehlt. Ausgehend von diesen Limitationen der klinischen Ethikberatung hat sich die multiprofessionelle „Arbeitsgruppe Ethik“ am Universitätsklinikum Tübingen um die Konzeption und Implementierung eines neuen Ansatzes zur nachhaltigen Integration von ethischen Reflexions- und Entscheidungsprozessen auf den Stationen des UKT bemüht. (...) Mit dem Tübinger Modell der Ethikbeauftragten der Station verfolgt sie ein Pilotprojekt, das speziell geschulte Pflegekräfte aus allen Stationen des UKT als AnsprechpartnerInnen für ethische Fragen einsetzt. Damit stellen die Ethikbeauftragten eine Erweiterung zu etablierten Strukturen der Ethikberatung dar und ergänzen vorhandene Top-Down-Strategien. Der vorliegende Beitrag stellt die Zielsetzungen des Tübinger Modells dar und schildert erste Erfahrungen in der Umsetzung. Neben der Einbettung in organisationale Strukturen der Ethikberatung werden die stationsinternen und stationsübergreifenden Aufgaben der Ethikbeauftragten dargestellt. Zudem wird das Qualifikationsprogramm für Ethikbeauftragte sowie ein Train-the-Trainer-Konzept vorgestellt, welche eine vertiefende Entwicklung von pflege- und medizinethischer Kompetenzen unterstützen und Sicherheit in den stationsbezogenen Reflexions- und Entscheidungsprozessen vermitteln. (shrink)

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)

A number of distinct definitions ofsustainable agriculture have been proposed. In this paper we criticize two such definitions, primarily for conflating sustainability with other objectives such as economic viability and ecological integrity. Finally, we propose and defend a definition which avoids our objections to the other definitions.

The origin of Rudolf Hagelstange’s cycle of sonnets "Venezianisches Credo" was Venice, while he was temporarily stationed in northern Italy in 1944 as a soldier. Twenty-four sonnets were written in the lagoon city, four more in Breganze, the remainder in Verona, where a limited edition was published in spring 1945, after some of the sonnets had already been distributed in military circles over some months. This contribution attempts on the one hand to analyze Hagelstange’s choice of the sonnet–form – a (...) classical type of lyric poetry, guaranteeing tradition and continuity –, claiming that at that time sonnets had become a fashionable form of oppositional poetry; on the other hand, the content of the three dozen sonnets will be analyzed, in which, over long stretches discordance prevails. For the author initially presents a damning indictment of the criminal activities of the NS-regime, until he eventually proclaims – with reference to Schiller – that the contemporary spiritual and moral crisis can yet be overcome by an ‚other Germany‘. In the final analysis, Hagelstange brilliantly succeeded – by means of an interaction of continuity and dissonance – to merge aesthetic and ethical aspects and thereby managed to create one of the most outstanding lyrical documents near the end of World War II. (shrink)

From the mid-1600s to the beginning of the eighteenth century, there were two main circles of German scholars which focused extensively on diagrammatic reasoning and representation in logic. The first circle was formed around Erhard Weigel in Jena and consists primarily of Johann Christoph Sturm and Gottfried Wilhelm Leibniz; the second circle developed around Christian Weise in Zittau, with the support of his students, particularly Samuel Grosser and Johann Christian Lange. Each of these scholars developed an original form of (...) using geometric diagrams in logic. In this paper, I will trace the historical notes of John Venn and other modern logicians back to the original works published in the Weigel and Weise circles and describe the development of using geometric figures for logical reasoning and representation in that period of time. (shrink)

Mit der folgenden Skizze soll die Aufmerksamkeit auf einen Aspekt des Fichteschen Naturdenkens gelenkt werden, der bislang nicht gerade im Zentrum des ohnehin eher spärlichen Interesses an der Naturphilosophie des großen Wissenschaftslehrers stand. Trotzdem könnte gerade dieser Aspekt in systematischer Hinsicht, und zwar speziell für die stets aktuelle Frage nach einem genuin philosophischen Zugang zum Thema Natur, von einigem Gewicht sein. Ich gebe, um die Entwicklung der These im Rahmen des hier zur Verfügung stehenden Raumes zu erleichtern, einige einleitende Hinweise, (...) die im Sinne eines Vorbegriffs in etwa die Richtung anzeigen sollen, in die sich die folgenden Überlegungen bewegen werden. (shrink)

Mit der folgenden Skizze soll die Aufmerksamkeit auf einen Aspekt des Fichteschen Naturdenkens gelenkt werden, der bislang nicht gerade im Zentrum des ohnehin eher spärlichen Interesses an der Naturphilosophie des großen Wissenschaftslehrers stand. Trotzdem könnte gerade dieser Aspekt in systematischer Hinsicht, und zwar speziell für die stets aktuelle Frage nach einem genuin philosophischen Zugang zum Thema Natur, von einigem Gewicht sein. Ich gebe, um die Entwicklung der These im Rahmen des hier zur Verfügung stehenden Raumes zu erleichtern, einige einleitende Hinweise, (...) die im Sinne eines Vorbegriffs in etwa die Richtung anzeigen sollen, in die sich die folgenden Überlegungen bewegen werden. (shrink)