HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka’s _Metamorphosis_ advance understandings of HIV stigma in medical health education? _Metamorphosis_ amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. _Metamorphosis_ (...) may ultimately promote medical health humanities’ social mission—allowing literature to unfold such revelations towards greater equity in health. (shrink)

New vaccines to prevent COVID-19 and malaria underscore the importance of scientific advances to promote public health globally. How is credit for such scientific discoveries attributed, and who benefits? The complex narrative of Amitav Ghosh’s _The Calcutta Chromosome_, both historical and speculative, demonstrates how medicine has come to value particular kinds of advances over others, prompting readers to question who controls access to resources and at what cost to global populations. In Ghosh’s imagined world, scientific discovery is evaluated and rewarded—and (...) ultimately deemed necessary—for its ability to serve communal, public health needs. (shrink)

Federal law under the Individuals with Disabilities in Education Improvement Act stipulates that services provided to students with diagnosed disabilities must be individualised based on the as...

The way metrologists conceive of measurement has undergone a major shift in the last two decades. This shift can in great part be traced to a change in the statistical methods used to deal with the expression of measurement results, and, more particularly, with the calculation of measurement uncertainties. Indeed, as we show, the incapacity of the frequentist approach to the calculus of uncertainty to deal with systematic errors has prompted the replacement of the customary frequentist methods by fully Bayesian (...) procedures. The epistemological ramifications of the Bayesian approach merge with a deep empiricist mood tantamount to an “epistemic turn”: measurement results are analysed in terms of degrees of belief, and central concepts such as error and accuracy are called into question. We challenge the perspective entailed by this epistemic turn: we insist on the centrality of the concepts of error and accuracy by underlining the intentional character of measurement that is intimately linked to the process of correction of experimental data. We further circumvent the difficulties posed by the classical analysis of measurement by stressing the social rather than the epistemic dimension of measurement activities. (shrink)

In November 2018, the practice of health care ethics consultation crossed a major threshold when 138 candidates took the inaugural Healthcare Ethics Consultant Certification Examination. This accomplishment, long in the making, has had and continues to have both advocates and critics. The Healthcare Ethics Consultant Certification Commission, a functionally autonomous body created and funded by the American Society for Bioethics and Humanities, was charged with overseeing creation of the certification process, developing the exam, and formulating certification standards and policies to (...) assess candidates’ qualifications. In this essay, as members of the commission, we describe the process of developing, administering, and scoring the certification examination as well as the historical context and the outlook for certification. By detailing the decisions and actions of the commission, we aim to provide a transparent account of the commission's efforts to develop a psychometrically sound, reliable, and secure examination through a deliberative, fair, and data‐driven process. (shrink)

We describe the ethics consultation service (ECS) at the Cleveland Clinic and report on its activities over a 24-month period in which 478 consultations were performed. To our knowledge, this is the largest case series of ethics consultations reported to date. Established more than 25 years ago, the ECS at the Cleveland Clinic is staffed by multiple consultants with advanced training in bioethics. Several of these ethicists work closely with specialized clinical units and research departments, where they participate in multidisciplinary (...) meetings and provide specialized assistance. This combination of historical experience, large numbers of consultation requests, and specialized clinical ethicists suggests that the experience at the Cleveland Clinic may be helpful to ethicists and others who may be considering how to structure and sustain a vibrant ECS. Our results highlight the diversity of activities performed by a high-volume ECS at a tertiary care facility. Our hope in sharing the inner workings of the ECS at the Cleveland Clinic is to promote dialogue on common practices and approaches across medical institutions that support ethics consultation. (shrink)

Systems of units still fail to attract the philosophical attention they deserve, but this could change with the current reform of the International System of Units. Most of the SI base units will henceforth be based on certain laws of nature and a choice of fundamental constants whose values will be frozen. The theoretical, experimental and institutional work required to implement the reform highlights the entanglement of scientific, technological and social features in scientific enterprise, while it also invites a philosophical (...) inquiry that promises to overcome the tensions that have long obstructed science studies. (shrink)

It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients’ medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees (...) in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation. (shrink)

The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

The philosophical significance attached to the construction of systems of units has traditionally been confined to the notion of convention, while their adoption was considered to be the exclusive province of the history and sociology of science. Against this tradition, a close articulation between history, philosophy, and sociology of science is needed in order to analyse the recent reform of the International system of units. In the new SI, units are redefined on the basis of certain fundamental constants of nature, (...) established by physical theories, whose values are fixed without uncertainty. The purpose of this article is to show that the redefinition of SI units, far from being a convention, involves a holistic reconstruction of our concepts of quantities from accepted theoretical laws. Fixing the values of the defining constants stabilizes these laws within the framework of physics through a twofold adjustment procedure that ensures both a semantic coordination between theory and world and an intersubjective coordination between human agents required by social activities. This double adjustment implies a treatment of uncertainties that results in closely entwining the pursuit of truth as correspondence and truth as coherence which turn out to be complementary, thus highlighting the anthropological underpinnings of scientific realism. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The guest editors would like to thank the University of Paris and the ENSA Paris-Val de Seine for having provided premises to successfully host the 2018 "Measurement at the Crossroads" conference in Paris.Our thanks extend to our funding sources: the conference was made possible thanks to the generous support of the Institut Humanités, Sciences et Sociétés, the SPHERE laboratory and the Laboratoire Matériaux et Phénomènes Quantiques of the University of Paris, the department of History and Philosophy of Science of the (...) University of Paris, the Laboratoire National de métrologie et d'Essais, and the University of Geneva.We would like to thank the many people who contributed to the organization of... (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for (...) critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry (SPEP Studies in Historical Philosophy)Rosamond Kent SpragueFrancisco J. Gonzalez. Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry (SPEP Studies in Historical Philosophy). Evanston, IL: Northwestern University Press, 1998. Pp. 418. Paper, $29.95.What this rich and independent-minded book asks us to do is to give serious consideration to the question, "What, in Plato's view, are we doing when we philosophize?" (1) (...) If we employ our own conceptions of philosophy as the models for formulating and discussing specific Platonic questions, we may be imposing upon him ways of thinking that are foreign to his thought. To do this is particularly distorting in the case of dialectic.Gonzalez has chosen to confine himself to the early and middle dialogues, so that his book is a direct challenge to the work of Richard Robinson. Of the important views that have more recently arisen, Gonzalez allies himself most nearly with the non-doctrinal approach, but not to the extent of embracing scepticism. There is much philosophical knowledge in the dialogues, but such knowledge is primarily non-propositional. As for the esotericist and the developmentalist, both are misguided in proceeding on the assumption that Plato is attempting to formulate definitions and to arrive at a systematic philosophy; they regard the dialogues as treatises, which they are not. As Gonzalez quite justly inquires, "can there be any form of writing less suited to presenting a systematic philosophy than Plato's dramatic dialogues?" (4)In contrast to Robinson, who relies on the analysis of passages taken out of context, Gonzalez focusses mainly on whole dialogues, taking them to be dramatic portrayals of dialectic at work. He begins with detailed studies of the Laches and Charmides. In both cases, Socrates starts with ordinary knowledge (in the persons of the title characters), but "clearly intends to transcend it" (20). Neither will he accept "the 'sophistic' understanding that attempts to substitute definitions for this experience" (21) on the part of Nicias and Critias. The knowledge sought by Socrates by means of the dialectical method is shown to thave three characteristics: it is "knowledge how," it is "self-knowledge," and it is "non-propositional" (61).The next chapters consider three presuppositions of Plato's dialectic: words (in the Cratylus), arguments (in the Euthydemus), and images (in Republic X). All three are necessary to the dialectical enterprise, but, like ordinary knowledge in the aporetic dialogues, are transcended.Gonzalez' confrontation with Robinson naturally requires that he address the topic [End Page 113] of the method of hypothesis in the Meno, Phaedo, and Republic. This is a method that does yield propositional results, but it remains at the level of poion ti and fails to provide similar knowledge of the ti. Gonzalez' interpretation of the divided line is of particular interest here: as he sees it, dialectic is not intended as simply an extension continuous with the method of hypothesis. To take it this way is, with Robinson, to collapse dialectic into mathematics, making the former as deductive as the latter. The good (which "is not for Plato an exclusively moral term" 216) is "already there before the inquiry as the ground of its possibility" (236); this is what "unhypothesized" means. The movement of thought is circular, but not with a vicious circularity; "reflexivity" is the term preferred.To my mind the most rewarding and most convincing section of the book is the concluding chapter on the philosophical digression in the Seventh Letter. (The issue of authenticity is not significant, since, if the Letter is a forgery, "this forger had a better understanding of Plato than many other scholars, both ancient and contemporary" (246). Although "the subject of this wisdom simply cannot be expressed in words" (252) (and here Gonzalez emphasizes that Plato means spoken as much as written words), there is no contradiction in being able to talk or write about it. If "our only means of attaining true knowledge of a thing have the defect of being unable to express this nature" (263), Plato suggests an up and down movement which transcends this defect. The nature of this movement he describes as tribein, a process... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Plato’s CratylusRosamond Kent SpragueDavid Sedley. Plato’s Cratylus. New York: Cambridge University Press, 2003. Pp. xi + 190. Cloth, $60.00Discussion of Plato's Cratylus, to which this book is a notable contribution, must straightway come to terms with the question of Plato's seriousness (or lack thereof) in the etymology sections of the dialogue. Professor Sedley is a strong advocate of the seriousness of the etymologies, a position which, he remarks, (...) will not surprise most classicists, although it "may cause apoplexy among many of Plato's philosophical admirers" (23). More colloquially he writes, "if Plato was joking, the joke flopped" (39).But need we assume that Plato was either serious or joking? His sense of humor was peculiar, and seems to me nicely characterized by Guthrie when, in commenting on the present dialogue, he speaks of Plato as "tumbling together with an equally straight face absurdities and deeply held convictions" (History V, 25). I also incline more than Sedley to the frequent topicality of Plato's work.Nevertheless, the Sedley thesis may be seen to pay rich rewards. Perhaps most notable is the perception that the etymologies constitute a philosophical curriculum, moving along a well-defined trace from cosmology to the consideration (a watershed here) of ethical terms. This progression is especially significant in marking the emancipation of Plato from his early association with Cratylus and his subsequent allegiance to Socrates.Another mandatory topic is, of course, chronology. The Cratylus is seen to be unusual here in that what we have is most probably a reedited version. (A substantive point is at issue because the earlier version fails to distinguish clearly between the lawmaker and the [End Page 490] dialectician.) Thus to the question, where does the Cratylus fit in the traditional chronology, Sedley's answer is, "not in any one place" (7). As to the projected time of the revision, proximity to the Sophist is most likely.Sedley's general approach to the etymologies is hierarchical (here he identifies two important principles, Uniformity and Groundedness) rather than one of mutual support. He writes that the "'imitation' relation between sounds and things will be found [at] not just the primary level, but all the way up the chain" (126). Similarly with Socrates' painting analogy: "the primary pigments which the painter uses already imitate the simplest objects of vision" (128). In both cases the principles of Uniformity and Groundedness "are to some extent permitted to merge" (127).The business of name-making is of course a techne, as is that of painting. That both of these arts are approximate in nature is not an "ad hoc postulate [but] lies at the heart of Platonic metaphysics," since "any craftsman's embodiment of a Form in matter is necessarily less than perfect" (45). (As Sedley tellingly points out, "it is the Sophist Thrasymachus, and not Socrates, who proposes that a craftsman, qua craftsman, never gets anything wrong" [44].) As for Socrates' final position, it is "not the reversion to conventionalism that it has so often been taken to be" (145). Convention does play some part in signification, but it is also the case that names are some kind of vocal imitations, "a thesis, massively documented in the etymological section, from which Socrates never retreats" (145).One point on which I would like to have had Sedley's comments is the following: what does he think of Diogenes Laertius's remark (III, 6) that not only did Plato, after the death of Socrates, "attach himself to Cratylus the Heraclitean," but also to Hermogenes "who professed the philosophy of Parmenides"? Now the only real Parmenideanism in the dialogue (the position that a name is either a true name or not a name at all) is attributed not to Hermogenes but to Cratylus! (Is Descartes an empiricist? Is Hume a rationalist?) Furthermore, even though Cratylus adopts this position on a variety of occasions (429d, 432a, 433c, 436c, and 438c), he is too flighty (or, one might say, too fluxy) to stick with it, and continually relapses (431a, 432d, 433b, 435e, for instance). At the risk of being categorized as a non-serious reader of the Cratylus (which I am not... (shrink)

Patients who enter the health care system for acute care may become “permanent” patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. Legal, professional, and ethical norms prohibit physician and acute care hospital “dumping” of these patients. However, limitless use of hospital resources for indefinite stays is untenable. In the absence of hospital policy addressing this specific issue, the availability of financial support will be determined by health care professionals' willingness to (...) advocate for the patient and negotiate with hospital administrators and the ability and willingness of administrators to authorize the use of hospital resources. We propose five mid-level ethical principles to guide advocacy and administrative decision-making about provision of financial support for post-acute care for those patients who cannot afford it. We use two actual, de-identified cases to illustrate how these principles can be used to make reasoned, consistent decisions about the provision of post-acute financial support. (shrink)

Patients who enter the health care system for acute care may become “permanent” patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. The care of these patients contributes to the rising costs of health care and will remain largely unaffected by the Affordable Care Act. For example, some resources may be available for treatment of undocumented persons, but Medicaid enrollment is unavailable for this population. Even where patients have access to Medicaid, (...) it takes up to three months between applying for and actually receiving Medicaid benefits. During that time, patients may be ready for hospital discharge. However, post-acute care facilities have no financial incentive or legal obligation to accept patients with no insurance or only pending Medicaid coverage. (shrink)

Despite the interpersonal nature of family meetings and the frequency in which they occur, the clinical ethics literature is devoid of any rich descriptions of what clinical ethicists should actually be doing during family meetings. Here, we propose a framework for describing and understanding “transitioning” facilitation skills based on a retrospective review of our internal documentation of 100 consecutive cases wherein a clinical ethicist facilitated at least one family meeting. The internal documents were analyzed using qualitative methodologies, i.e., “codes”, to (...) identify emergent themes. We identified four different transitioning strategies clinical ethicists use to reach a meaningful resolution. These transitioning strategies serve as a jumping-off point for additional analyses, future research, evaluating clinical ethics consultation, and overall performance improvement of a consultation service. (shrink)

The clinical ethicist met with Ms. H to clarify what information she wants and does not want to know. First, she wants to receive any treatment that could prolong her life, regardless of how the treatment affects her ability to engage in activities of daily living. Second, she wants to be included in the decision‐making process as much as possible, as long as clinicians use only “positive” language. Ms. H considers the words “dying,” “chemotherapy,” “radiation,” and “cancer” to be “bad (...) words.” For conversations in which these words cannot be avoided, she wants her clinicians to talk to her son. Her desired engagement includes hearing about risks, benefits, and alternatives to treatments if clinicians use only “positive” language. Finally, she says that she rarely sees doctors and that she is “very scared” of hospitals, despite exhibiting a comfortable demeanor.Should clinicians honor Ms. H's waiver of specified information and, if so, to what degree? (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

In their article “Structuring a Written Examination to Assess ASBH Health Care Ethics Consultation Core Competencies” (2014), White, Jankowski, and Shelton argue that a written examination to evalu...

BackgroundRandomized Controlled Trials are the gold standard for assessing whether an intervention is effective; however, they require large sample sizes in order to detect small effects. For rare or complex populations, we advocate a case series approach as a more realistic and useful first step for intervention evaluation. We consider the importance of randomization to such designs, and advocate for the use of Randomization Tests and Between Case Effect Sizes to provide a robust and statistically powerful evaluation of outcomes. In (...) this tutorial, we describe the method, procedures, and analysis code necessary to conduct robust single case series, using an empirical example with minimally verbal autistic children.MethodWe applied a pre-registered randomized baseline design with between-case effect size to a case series, to test the efficacy of a novel, parent-mediated, app-based speech production intervention for minimally verbal autistic children. Parent-rated probe scores were used to densely sample performance accuracy over time.ResultsParents were able to reliably code their children’s speech productions using BabbleBooster. A non-significant Randomization Test and small Between-Case Effect Size, suggested there was no evidence that BabbleBooster improved speech production in minimally verbal autistic children, relative to baseline scores, during this brief period of intervention.ConclusionThe current analyses exemplify a more robust approach to examining treatment effects in rare or complex populations, where RCT may be difficult or premature to implement. To facilitate adoption of this method by researchers and practitioners, we provide analysis code that can be adapted using open source R packages. Future studies could use this case series design to evaluate interventions aiming to improve speech and language outcomes for minimally verbal autistic children, and other heterogeneous and hard to reach populations. (shrink)