Book reviewed in this article: Case Studies in Nursing Ethics. By Robert M. Veatch and Sara T. Fry.

National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In (...) this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations , which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate that (...) certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations, which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate that certain (...) types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress (...) phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments. (shrink)

SummaryA general definition is given of what is comicality. Molière's Misanthrope then appears as a comedy on comedy. It is because of his universal and indignant censure of laugh that Alceste is ridiculous.

Two different methods of approach, currently under investigation, are suggested for calculating the eikonal function corresponding to quark-quark scattering at very high energies and small momentum transfers. These methods illustrate the realistic, dynamical complexities inherent in QCD scattering problems.

Managers conduct open market repurchases for many different reasons, including to distribute excess cash. However, the most widely discussed explanation for OMRs is the “signaling theory:” that managers announce OMRs to signal that the stock is underpriced. The first purpose of this paper is to show that the signaling theory is theoretically problematic—in part because it assumes managers deliberately sacrifice their own wealth to increase that of shareholders—as well as inconsistent with much of the empirical evidence. The second purpose of (...) the paper is to put forward an alternative explanation for managers’ use of OMRs: the managerial-opportunism theory. This theory, which assumes that managers seek to maximize their own wealth, predicts that managers announce OMRs both when the stock is underpriced and when it is not. When the stock is underpriced, managers may announce and conduct an OMR to transfer value to themselves and other remaining shareholders. When managers wish to sell a large portion of their shares, they announce an OMR to boost the stock price before selling their shares. The paper shows that managerial opportunism is not only a more plausible motive for OMRs than is signaling, it is also more consistent with the empirical data. The paper concludes by describing some testable predictions of the theory. (shrink)

Unlike other ways of coming to act, for example as a result of habit or impulse, practical reasoning imprints our actions with the distinctive mark of rational full-blooded agency. This entry enquires into what practical reasoning consists in. First, we lay out four basic criteria—mentality, evaluation, practicality, attributability—that adequate accounts of practical reasoning ought to satisfy in order to capture essential features of the phenomenon. Specifically, practical deliberation is a by and large conscious mental process answerable to a range of (...) evaluative standards. Moreover, this process is aimed at settling what to do. Lastly, reasoning does not merely occur to the practical reasoner but is instead something that they do. -/- We then turn to John Broome’s influential account of reasoning which satisfies the aforementioned criteria. On his view, practical reasoning is the rule-guided activity by which we bring our mental attitudes (especially our intentions) to satisfy requirements of practical rationality. We then focus on three challenges to Broome’s account that have been the topic of recent debate. First, we discuss the role that autobiographical considerations of the sort ‘I’d like to φ’, or ‘I intend to φ’ might play in practical reasoning. Broome, perhaps, is wrong in giving them very little place. Second, we discuss Jonathan Dancy’s proposal that practical reasoning does not conclude in the formation of intentions but in action. Third, we consider whether assessments of rationality can come in degrees and why we should care about satisfying rational requirements in the first place. (shrink)

In this article, we provide a description of the good in health promotion based on an empirical study of health promotion practices in New South Wales, the most populous state in Australia. We found that practitioners were unified by a vision of the good in health promotion that had substantive and procedural dimensions. Substantively, the good in health promotion was teleological: it inhered in meliorism, an intention to promote health, which was understood holistically and situated in places and environments, a (...) commitment to primary rather than secondary prevention and engagement with communities more than individuals. Procedurally, the good in health promotion arose from qualities of practices that they developed over time in respectful relationships, were flexible and responsive to communities, built capabilities in communities and were sustainable. We discuss our findings with reference to Martha Nussbaum’s normative list of functional capabilities for a good human life, David Buchanan’s vision for health promotion ethics and common concerns in health promotion ethics regarding the relationship between paternalism and freedom. Our thick, vague conception of the good in health promotion, founded in the values and practical reason of people engaged daily in health promotion work, contributes to the development of a more complete theory of health promotion ethics. (shrink)

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

This first supplement to my An Annotated Bibliography on Ibn Sînâ , published in 1991, informs the reader about all new studies on Ibn Sînâ published in the period 1990-1994, and also offers corrigenda and addenda to the former bibliography. Also in the supplement, attention is paid to Western, and to non-Western publications. Moreover, it has been tried to be even more exhaustive by including publications, which have not Ibn Sînâ in the title, but which nevertheless are offering important and (...) innovative information about his life or thought. First, an overview is given of the new editions and/or translations of Ibn Sînâ's works, which are once more identified according to the classic bibliographies of G.C. Anawati and M.Mehdavî. Hereafter, separate chapters are dedicated to studies of a biographical and a bibliographical nature. No less than ten chapters are devoted to materials dealing with Ibn Sînâ's philosophical thought . Finally, materials dealing with in two separate chapters. It has to be noted that almost all publications are annotated with a summary of their most original points and a short critical evaluation. An index, which includes the names of all authors, ancient, medieval and contemporary, has been added. In sum, this work aims at providing a clear, concise and comprehensive work- instrument for all future Avicenna research. It is not only of great interest for all scholars working in Arabic-Islamic philosophy, science and medicine, but also for historians of philosophy and mediaevalists. "Hay que felicitar al autor de este minucioso trabajo que, como su anterior bibliografía, es de un valor incalculable para todos aquellos que nos consagramos al estudio del pensamiento del gran filósofo islámico, al ser instrumento necesario con el que contar para futuras investigaciones sobre Avicena". (shrink)

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).