Experts identified water quality, manure, good handling practices (including personal hygiene and equipment sanitation), and traceability as critical farm problem areas that, if addressed, are likely to decrease risk associated with microbial contamination of fresh produce from all scales of agriculture. However, the diverse nature of production strategies used by produce farmers presents multiple options for addressing foodborne illness issues while simultaneously creating potential complications. We use a mental models methodology to enhance our understanding of the underlying factors and assumptions (...) of small, medium, and large produce growers that influence their decision-making processes for contamination prevention and control. This empirical evidence demonstrates how challenges and opportunities to food safety are related to the scale of production and marketing strategies. We believe that refining the development of standards and existing extension and outreach food safety programs are important to both consumer protection and supporting agricultural communities. Additionally, this approach will help develop and refine food safety programs that will result in empirically grounded recommendations based on identified grower information needs. (shrink)

Incapacitated adult patients are commonly divided into two groups for purposes of decision making; those with a surrogate and those without. Respectively, these groups are often referred to as represented and unrepresented, and the relative ethics of decision making between them raises two particular issues. The first issue involves the differential application of the best interests standard between groups. Second is the prevailing notion that representedness and unrepresentedness are categorical phenomena, though it is more aptly understood as a multidimensional and (...) continuous variable based on relational moral authority. This paper examines the nature of representedness as it relates to ethical norms of surrogate decision making. (shrink)

Volume 20, Issue 3, March 2020, Page W1-W2.

With narrow exception, physicians’ treatment of incapacitated patients requires the consent of health surrogates. Although the decision-making authority of surrogates is appropriately broad, their moral authority is not without limits. Discerning these bounds is particularly germane to ethically complex treatments and has important implications for the welfare of patients, for the professional integrity of clinicians, and, in fact, for the welfare of surrogates. Palliative sedation is one such complex treatment; as such, it provides a valuable model for analyzing the scope (...) of surrogates’ moral authority. Guidelines for palliative sedation that present it as a “last-resort” treatment for severe and intractable suffering yet require surrogate consent in order to offer it are ethically untenable, precisely because the moral limits of surrogate authority have not been considered. (shrink)

Volume 20, Issue 7, July 2020, Page 112-114.

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Preface : plant theory? -- The first birth of biopower : from plant to animal life in Foucault -- Thinking plants, with Aristotle and Heidegger -- Animal and plant, life and world in Derrida, or, The plant and the sovereign -- From the world to the territory : vegetable life in Deleuze and Guattari, or, What is a rhizome? -- Coda : what difference does it make?

Current guidelines treat palliative sedation to unconsciousness as an effective medical treatment for terminally ill patients who need relief from severe symptoms, yet also restrict its use in ways that are extraordinary for medical treatments. A closer look at the kinds of cases in which palliative sedation is used suggests a way of adjusting the guidelines to resolve this seeming contradiction.

This essay traces an astonishing shift in Denny Schmidt’s work, from his emphasis on tragedy and death in 2005’s Lyrical and Ethical Subjects, to an emphasis on the comic possibilities of life in Between Word and Image (2012). Simply put, his earlier book pivots most decisively on language and, as he writes, the ways that language “bears witness to finitude” (2). Between Word and Image, on the other hand, pivots decisively on the image and reveals for us the possibility that (...) “painting is at its heart the presentation of the movement of life” (96). The essay ends with some questions about the specifically political upshot of Schmidt’s work on the relations among aesthetic experience and “life.”. (shrink)

Since the path-breaking work of Karl Deutsch on security communities and Ernst Haas on European integration, it has been clear that international institutions may create senses of community and belonging beyond the nation state. Put differently, they can socialize. Yet the mechanisms underlying such dynamics have been unclear. This volume explores these mechanisms of international community building, from a resolutely eclectic stand point. Rationalism is thus the social theory of choice for some contributors, while others are more comfortable with social (...) constructivism. This problem-driven perspective and the theoretical bridge building it are the cutting edge in international relations theory. By providing more fined-grained arguments on precisely how international institutions matter, such an approach sheds crucial light on the complex relationship between states and institutions, between rational choice and social constructivism, and, in our case, between Europe and the nation state. (shrink)

The ‘best interests’ decision making standard is used in clinical care to make necessary health decisions for non-capacitated individuals for whom neither explicit nor inferred wishes are known. It has been also widely acknowledged as a basis for enrolling some non-capacitated adults into clinical research such as emergency, critical care, and dementia research. However, the best interests standard requires that choices provide the highest net benefit of available options, and clinical research rarely meets this criterion. In the context of modern (...) norms of bioethics, the best interests standard rarely supports surrogate consent for research and should not be accepted as a routine provision. (shrink)

Discussions about resource allocation commonly invoke concerns of unfair and variable decisions when physicians ration at the bedside. This concern is no less germane in disaster medicine, in which physicians make triage and allocation decisions under duress, and patients and their families may be challenged to self-advocate. Unfortunately, a real-time mechanism to support a process for ethical decision making may not be available to medical relief workers. Yet, resources for ethics decision support can be important for the moral well-being of (...) the clinician, the ethical integrity of the relief effort, and to bolster the trust and confidence of the population receiving medical services. The need for clinical ethical support should be anticipated in disaster preparedness planning. (shrink)

Controlled human infection studies (CHIs) involve the intentional infection of human subjects for a scientific aim. Though some past challenge trials have involved serious ethical abuses, in the last few decades, CHIs have had a strong track record of safety. Despite increased attention to the ethics of CHIs during the COVID‐19 pandemic, CHIs remain controversial, and there has been no in‐depth treatment of CHIs through the lens of virtue ethics. In this article, we argue that virtue theory can be helpful (...) for addressing CHIs that present a constellation of controversial, unresolved, and/or under‐regulated ethical issues. We begin with some brief background on virtue ethics. We then substantiate our claim that some CHIs raise a constellation of ethical issues that are unresolved in the ethics literature and/or lack adequate regulatory guidance by demonstrating that CHIs can present indeterminate social value, risks to third parties, limitations on the right to withdraw from research, and questions about the upper limit of allowable risk. We argue that the presence of a virtuous investigator, with virtues such as prudence, compassion, and integrity, is especially important when these unresolved research ethics issues arise, which is the case for certain types of controlled human infection studies. We use the historical example of Walter Reed and the Yellow Fever Commission to illustrate this claim, and we also highlight some contemporary examples. We end by sketching some practical implications of our view, such as ensuring that investigators with experience running CHIs are involved in novel CHI models. (shrink)

Preparations for large-scale disasters have tended to focus on triage schema, stockpiling of materials, and other logistical concerns. Less attention has been given to the myriad of distressing and almost unthinkable ethically charged dilemmas that will emerge at the bedside during a catastrophe, and how they may be best managed. Yet, it is these bedside issues that may limit or thwart the effectiveness of disaster planning, and, therefore, they ought to be carefully considered.

A commentary on “Must We Be Courageous?,” by Ann Hamric, John Arras, and Margaret Mohrmann, and on “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?,” by Alexandra Junewicz and Stuart J. Youngner, bothin the May-June 2015 issue.

(2010). Insult to Injury: Ethical Confusion in American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The American Journal of Bioethics: Vol. 10, No. 1, pp. 68-70.

During a catastrophe that disables the health system, ethically charged situations will undoubtedly emerge that will challenge patients, relatives, clinicians, and others involved in health delivery. This second of two special sections of The Journal of Clinical Ethics includes discussions of the implications of a system collapse on particularly vulnerable member of society, children, pregnant women, and those who are socio-economically, culturally, and linguistically disempowered. Additionally, it offers insights into the processes used by committees to plan for catastrophic care.

Robert Hopkins _Picture, Image, and Experience_ Cambridge: Cambridge University Press, 1998 ISBN 0521-58259-8 (hbk) 205 pp.

A powerful new examination of the performative that asks "what's next?" for this well-worn concept.