Introduction to healthcare ethics committees / D. Micah Hester and Toby Schonfeld -- Brief introduction to ethics and ethical theory / D. Micah Hester and Toby Schonfeld -- Ethics committees and the law / Stephen Latham -- Cultural and ...
Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)
The behavior of some nightlife-setting patrons would be unacceptable in workplaces or public settings and could cause distress to other patrons. This quantitative study determined 381 young Australian’s descriptive and personal norms regarding four types of sexual behavior. Participants’ personal norms were that these behaviors are wrong, but they reported that the behaviors are common in a nightlife setting. Behaviors such as these could theoretically be prevented by modifying patrons’ descriptive norms with evidence that their beliefs are contrary to individuals’ (...) personal norms of acceptable behavior in nightlife settings. (shrink)
In this study, we examined the effects of emotional experience, a relatively new dimension of emotional knowledge that gauges the ease with which words evoke emotional experience, on abstract word processing in the Stroop task. In order to test the context-dependency of these effects, we accentuated the saliency of this dimension in Experiment 1A by blocking the stimuli such that one block consisted of the stimuli with the highest emotional experience ratings and the other block consisted of the stimuli with (...) the lowest emotional experience ratings. We attenuated the saliency of this dimension in Experiment 1B by intermixing the stimuli. We observed slower color naming performance for words with higher emotional experience ratings only in Experiment 1A, suggesting that the dimension of emotional experience is an aspect of semantic representation for abstract words but that its influence can be modulated by context. We interpret these results more generally using Vigliocco, Meteyard, Andrews, and Kousta's framework of semantic representation, and more specifically using Cohen, Dunbar, and McClelland's model of Stroop task performance. (shrink)
Originally published in 1773 in two volumes, and now reissued here together in one, this work by the writer Hester Chapone, a renowned proponent of female education, contains advice delivered in the form of letters to her niece. The first volume deals primarily with matters of religion and morality, while the second volume addresses questions of behaviour and schooling. Unusually for self-improvement books of this era, Chapone recommends that a young woman should have a rigorous education in a wide (...) variety of subjects, including ancient history and geography, as well as instruction in ladylike deportment and mastery of household matters. She exhorts young ladies to avoid vanity and other vices through devoted study of scripture, and writes of the importance of choosing worthy and sensible friends who can be trusted to offer good advice. Chapone's posthumously published works, in two volumes, are also reissued in this series. (shrink)
The form of Western mainstream film is the crux of its ideological efficiency: by using established formal techniques, films ensure audiences un- derstand that aesthetic decisions support and clarify the narrative to ensure maximum spectatorial satisfaction. However, some films exploit their formal aesthetics in order to prevent clarification, thwarting satisfaction in favour of viewing practices that can be considered perverse in that they withhold, suspend or obstruct immediate pleasure. Contemporary Western filmmaking in the mid-1990s witnessed the emergence of a distinct (...) group of filmmakers and films that, in the popular discourse of cinematic criticism, were together coded as difficult or perverse. These films were, as a result of the characteristics we identify below, situated obliquely in relation to the larger economic and artistic struc- tures of a commercially oriented mainstream cinema. Included in this new form of cinematic production were films from directors such as Tim Burton: Edward Scissorhands ; David Cronenberg: eXistenZ ; David Fincher: Se7en ; Peter Greenaway: The Baby of Maçon ; David Lynch: Lost Highway ; Quentin Tarantino: Pulp Fiction and Lars von Trier: Breaking the Waves . Whilst Western cinema as a whole has a long history of exploring difficult or perverse material within the overt or covert content of narrative, plot and story, such films demonstrate a particular relationship between the content being explored and the specific formal characteristics utilised in the delivery of that content. Thus where previous examples would utilise standardised formal techniques as a way of both delivering and containing the difficult or objectionable material, the films instead offer instances where the material of the narrative content seems to bleed backwards, affecting the form and rendering the very materiality of the film itself suspect and problematic. (shrink)
Governments are increasingly inviting patient organizations to participate in healthcare policymaking. By inviting POs that claim to represent patients, representation comes into being. However, little is known about the circumstances under which governments accept POs as patient representatives. Based on the analysis of relevant legislation, this article investigates the criteria that self-help organizations, a special type of PO, must fulfil in order to be accepted as patient representatives by governments in Austria and Germany. Thereby, it aims to contribute to the (...) discussion on the role of governments in steering SHOs. There are different degrees of regulation. Governments in both countries not only formulate explicit criteria for SHOs with respect to patient representation but also guide SHOs representing patients through implicit criteria for associations. We discuss the findings against concepts of responsiveness, authorization, and accountability. Our findings indicate that governmental steering is not negative per se as indicated by previous research but—depending on legislative criteria—can promote transparency and democratic quality in patient representation. (shrink)
Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn (...) more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable. (shrink)
Starting from the insights of classical American pragmatism, this book argues for a higher notion of the relationship between individuals and their communities. This newly enriched notion supports a more participatory engagement between physicians and patients which takes ethical medicine to be a community of healing enjoyed by health care professionals and those they care for.
While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees , almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.
This CQ department is dedicated to bringing noted bioethicists together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact “The Great Debates” department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St., #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.
While the bioethics literature demonstrates that the field has spent substantial time and thought over the last four decades on the goals, methods, and desired outcomes for service and training in bioethics, there has been less progress defining the nature and goals of bioethics research and scholarship. This gap makes it difficult both to describe the breadth and depth of these areas of bioethics and, importantly, to gauge their success. However, the gap also presents us with an opportunity to define (...) this scope of work for ourselves and to help shape the broader conversation about the impact of academic research. Because of growing constraints on academic funding, researchers and scholars in many fields are being asked to demonstrate and also forecast the value and impact of their work. To do that, and also to satisfy ourselves that our work has meaningful effect, we must understand how our work can motivate change and how that change can be meaningfully measured. In a field as diverse as bioethics, the pathways to and metrics of change will likewise be diverse. It is therefore critical that any assessment of the impact of bioethics research and scholarship be informed by an understanding of the nature of the work, its goals, and how those goals can and ought to be furthered. In this paper, we propose a conceptual model that connects individual bioethics projects to the broader goals of scholarship, describing the translation of research and scholarly output into changes in thinking, practice, and policy. One of the key implications of the model is that impact in bioethics is generally the result of a collection of projects rather than of any single piece of research or scholarship. Our goal is to lay the groundwork for a thoroughgoing conversation about bioethics research and scholarship that will advance and shape the important conversation about their impact. (shrink)
This CQ department is dedicated to bringing noted bioethicsts together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St. #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.
Health care has become increasingly patient-centred and medical guidelines are considered to be one of the instruments that contribute towards making it so. We reviewed the literature to identify studies on this subject. Both normative and empirical studies were analysed. Many studies recommend active patient participation in the process of guideline development as the instrument to make guidelines more patient-centred. This is done on the assumption that active patient participation will enhance the quality of the guidelines. We found no empirical (...) evidence, however, to support this assumption. Moreover, the studies show that patients experience several difficulties in the participation process, which cannot solely be traced back to flawed practices. Given this poor track record we conclude that the plea to actively involve patients in the guideline development process should be reconsidered. (shrink)
In many countries patient involvement is high on the healthcare policy agenda, which includes patient representation in collective decision-making. Patient organizations are generally considered to be important representatives of patients. Other actors also claim to represent patients in decision-making, such as politicians, healthcare professionals, and client advisory councils. In this paper we take a broad view of patient representation, examining all the actors claiming to represent patients in the Dutch debate on the decentralization of care. We conclude that variety in (...) forms of representation could help do justice to the variety of patient preferences. In addition we conclude that in order to ensure the democratic quality of patient representation, actors making representative claims have to reflect on how their claims relate to each other and how they can ensure authorization and accountability in the representative relationship with those they claim to represent. (shrink)
Scholars have explored the influence of the field of cybernetics on scientific thought and disciplines. However, from the inception of the field, ‘‘cyberneticians’’ had explicitly envisioned applications reaching beyond the purview of scientific disciplines; cybernetics was remarkable for its portability and potential application in a wide variety of contexts. This article explores connections between cybernetics and experimental music from 1950-1980, which was a period of experimentation with electronic techniques in recording, composition, and sound production and manipulation. Examples include musicians, engineers, (...) instrument builders, composers, and scientists in collaboration with musicians who invoked cybernetic themes in their work. These uses of cybernetics were more diverse than accounts of cybernetics within the sciences suggest, presenting a major difficulty in addressing cybernetics as a homogeneous or monolithic discourse. In particular, cybernetic discourse in music often exhibited themes of openness and indeterminacy, rather than the ‘‘command and control’’ of the ‘‘closed world.’’. (shrink)
In April of 2001 I published a brief commentary in the journal Academic Medicine questioning the current character and functioning of the National Residency Matching Program. The purpose of the article was to stimulate a rethinking of process. At 50 years old, the environment through which the match operates has changed, and as such I thought it time to ask ourselves whether or not the match, its algorithm, and, more important, the values it manifests might well need an overhaul.