Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

The paper is an attempt to connect the primary concerns of an extensionalist to a solution to the problems raised by the apparent intensionality of contents involving the propositional attitudes. The author begins with an overview of what the extensionalist is, At bottom, Committed to ("hard-Core extensionalism") and its connection with a theory of truth. He considers the attitude of belief as generating problems for such commitments and rejects various solutions to these problems. He outlines a proposal which may be (...) viewed as both consistent with hard-Core extensionalism and our intuitions about belief. The account shares features with fodor's and field's accounts of belief. (shrink)