Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

Epistemic justifications for democracy have been offered in terms of two different aspects of decision-making: voting and deliberation, or ‘votes’ and ‘talk.’ The Condorcet Jury Theorem is appealed to as a justification in terms votes, and the Hong-Page “Diversity Trumps Ability” result is appealed to as a justification in terms of deliberation. Both of these, however, are most plausibly construed as models of direct democracy, with full and direct participation across the population. In this paper, we explore how these results (...) hold up if we vary the model so as to reflect the more familiar democratic structure of a representative hierarchy. We first recount extant analytic work that shows that representation inevitably weakens the voting results of the Condorcet Jury Theorem, but we question the ability of that result to shine light on real representative systems. We then show that, when we move from votes to talk, as modeled in Hong-Page, representation holds its own and even has a slight edge. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

Agent-based models have played a prominent role in recent debates about the merits of democracy. In particular, the formal model of Lu Hong and Scott Page and the associated “diversity trumps ability” result has typically been seen to support the epistemic virtues of democracy over epistocracy (i.e., governance by experts). In this paper we first identify the modeling choices embodied in the original formal model and then critique the application of the Hong-Page results to philosophical debates on the relative merits (...) of democracy. In particular we argue that the “best-performing agents” in Hong-Page model should not be interpreted as experts. We next explore a closely related model in which best-performing agents are more plausibly seen as experts and show that the diversity trumps ability result fails to hold. However, with changes in other parameters (such as the deliberation dynamic) the diversity trumps ability result is restored. The sensitivity of this result to parameter choices illustrates the complexity of the link between formal modeling and more general philosophical claims; we use this debate as a platform for a more general discussion of when and how agent-based models can contribute to philosophical discussions. (shrink)

Purpose: This review identifies the prominent topics in the literature pertaining to the ethical, legal, and social issues raised by research investigating personalized genomic medicine. Methods: The abstracts of 953 articles extracted from scholarly databases and published during a 5-year period were reviewed. A total of 299 articles met our research criteria and were organized thematically to assess the representation of ELSI issues for stakeholders, health specialties, journals, and empirical studies. Results: ELSI analyses were published in both scientific and ethics (...) journals. Investigational research comprised 45% of the literature reviewed and the remaining 55% comprised normative analyses. Traditional ELSI concerns dominated the discourse including discussions about disclosure of research results. In fact, there was a dramatic increase in the number of articles focused on the disclosure of research results and incidental findings to research participants. Few papers focused on particular disorders, the use of racial categories in research, international communities, or special populations. Conclusion: Considering that strategies in personalized medicine increasingly target individuals’ unique health conditions, environments, and ancestries, further analysis is needed on how ELSI scholarship can better serve the increasingly global, interdisciplinary, and diverse PGM research community. (shrink)

In a series of formal studies and less formal applications, Hong and Page offer a ‘diversity trumps ability’ result on the basis of a computational experiment accompanied by a mathematical theorem as explanatory background (Hong & Page 2004, 2009; Page 2007, 2011). “[W]e find that a random collection of agents drawn from a large set of limited-ability agents typically outperforms a collection of the very best agents from that same set” (2004, p. 16386). The result has been extremely influential as (...) an epistemic justification for diversity policy initiatives. Here we show that the ‘diversity trumps ability’ result is tied to the particular random landscape used in Hong and Page’s simulation. We argue against interpreting results on that random landscape in terms of ‘ability’ or ‘expertise.’ These concepts are better modeled on smother and more realistic landscapes, but keeping other parameters the same those are landscapes on which it is groups of the best performing that do better. Smoother landscapes seem to vindicate both the concept and the value of expertise. Change in other parameters, however, also vindicates diversity. With an increase in the pool of available heuristics, diverse groups again do better. Group dynamics makes a difference as well; simultaneous ‘tournament’ deliberation in a group in place of the ‘relay’ deliberation in Hong and Page’s original model further emphasizes an advantage for diversity. ‘Tournament’ 2 dynamics particularly shows the advantage of mixed groups that include both experts and non-experts. As a whole, our modeling results suggest that relative to problem characteristics and conceptual resources, the wisdom of crowds and the wisdom of the few each have a place. We regard ours as a step toward attempting to calibrate their relative virtues in different modelled contexts of intellectual exploration. (shrink)

Is inheritable genetic modification the new dividing line in gene therapy? The editors of this searching investigation, representing clinical medicine, public health and biomedical ethics, have established a distinguished team of scientists and scholars to address the issues from the perspectives of biological and social science, law and ethics, including an intriguing Foreword from Peter Singer. Their purpose is to consider how society might deal with the ethical concerns raised by inheritable genetic modification, and to re-examine prevailing views about (...) whether these procedures will ever be ethically and socially justifiable. The book also provides background to define the field, and discusses the biological and technological potential for inheritable genetic modification, its limitations, and its connection with gene therapy, cloning, and other reproductive interventions. For scientists, bioethicists, clinicians, counsellors and public commentators, this is an essential contribution to one of the critical debates in current genetics. (shrink)

In The Ethics of Food, Gregory E. Pence brings together a collection of voices who share the view that the ethics of genetically modified food is among the most pressing societal questions of our time. This comprehensive collection addresses a broad range of subjects, including the meaning of food, moral analyses of vegetarianism and starvation, the safety and environmental risks of genetically modified food, issues of global food politics and the food industry, and the relationships among food, evolution, and human (...) history. (shrink)

In the eighteenth century the category of the aesthetic sought to bridge the gap between the prevalent dualities of Cartesian thought: art and science, history and science, prejudice and truth. This special issue of _boundary 2_ addresses current debates about the status of art in the context of global modernity. The range of arguments represented here cover a broad historical scope—from Cartesianism to present-day global modernity—of cultural discourse on the aesthetic to bring a focus to contemporary discussions of the corollary (...) concepts of beauty, virtue, taste, and truth. These essays present a rich and provocative account of the place of the aesthetic in late-twentieth-century culture. Included in this volume are considerations of the relation between theories of art and the avant-garde; art’s relation to cognition; the aesthetic as history; the aesthetic as a unique access to modernity; and its impact on problems of identity formation, ideology, and resistances to the institutional powers inherent in dominant social formations. _Contributors. _Charles Altieri, Peter Burger, David Carroll, Anthony J. Cascardi, Howard Caygill, Allen Dunn, Eric Gans, Agnes Heller, Ronald A. T. Judy, Marie-Rose Logan, Daniel T. O’Hara, Donald E. Pease, Alan Singer. (shrink)

Nous considérons la structure dans son rapport au temps : sous ce rapport, la structure est normative, et l’avenir aide à constituer le présent et le passé. Des exemples sont empruntés à l’embryologie et à la géologie. On explique pourquoi il est difficile de concevoir une structure cosmique spatio-temporelle, et comment le développement récent de la physique nous y aide ; dans cette physique, la notion de structure cosmique a un rôle éminent. Il en résulte que seules sont viables les (...) combinaisons qui sont dans La ligne historique de la nature. (shrink)

A first-of-its-kind book that seriously and profoundly examines what it means philosophically to be Latino and where Latinos fit in American society. Offers a fresh perspective and clearer understanding of Latin American thought and culture, rejecting answers based on stereotypes and fear Takes an interdisciplinary approach to the philosophical, social, and political elements of Hispanic/Latino identity, touching upon anthropology, history, cultural studies and sociology, as well as philosophy Written by Jorge J. E. Gracia, one of the most influential thinkers of (...) Hispanic/Latino descent. (shrink)

L’on considère quelques raisons en faveur du pessimisme et de l’optimisme ; et l’on arrive à ce résultat, qu’elles restent sur un terrain subjectif, où une décision scientifique entre les diverses conceptions est impossible. Pour faire de la question du pessimisme et de l’optimisme une question scientifique, il faut prendre pour problème la possibilité et la validité de l’évaluation, dans toute son étendue. Pessimisme et optimisme se transforment alors en positions, opposées l’une à l’autre, de la philosophie des valeurs, le (...) pessimisme niant totalement la validité des jugements de valeur, que l’optimisme affirme. (shrink)

Name der Zeitschrift: Der Islam Jahrgang: 93 Heft: 1 Seiten: 262-264.