Several arguments have been put forward about the benefits of young people carrying out their own social science research in terms of empowering their voices and their participation. Much less attention has been paid to investigating the understandings young people develop about the research process itself. Seven twelve-year olds carried out self-directed social science research into a topic of their choice. Towards the end of their six months experience, we used a questionnaire and follow-up semi-structured interviews to investigate, from a (...) sociocultural perspective, what the young people thought about being a researcher. Thematic analysis of the interviews identified three themes and eight subthemes suggesting that they were aware of: the need to demonstrate researcher/research integrity ; the need for good interpersonal skills and standards, and good self-management skills (be resilient, agentic, committed and go... (shrink)

Increasing numbers of news organizations have formal codes of ethics for their personnel. This paper looks at the content of media ethics codes, how these codes are written and what comprises a news organization's fixed value system. Results show that many written policies were devised in recent years, and a noticeable number of other news organizations said they have firmly established unwritten policies. The written codes represented in this survey clearly draw lines around certain activities and label them as acceptable (...) or unacceptable for journalists. Teaching, unpaid appearances (such as on a television talk show), and participation in charitable activities are outside interests more acceptable than political activities in behalf of another person, or holding elected or appointed office. Certain activities which remain as unfinished business include: uniformity of enforcement, management ethics, financial interests, and spouse or friend conflict of interest. (shrink)

Scholars of color have been instrumental in advancing nursing knowledge development but find limited spaces where one can authentically share their philosophical perspective. Although there is a call for antiracism in nursing and making way for more diverse and inclusive theories and philosophies, our voices remain at the margins of nursing theory and philosophy. In nursing philosophy, there continues to be a lack of racial diversity in those who are given the platform to share their scholarship. Five nurse scholars of (...) color attended the International Nursing Philosophy Conference in August 2022. We established a collective system of support by sharing our experiences as researchers, scholars, and educators with each other. The theory of emancipatory nursing praxis informed this process. In this dialogue, we reflected on what it is like to present at and attend predominantly white nursing conferences. We shared our experiences of how we exist as nurse scholars, our philosophical views, and our thoughts on how we create spaces where scholars of color can feel welcomed and acknowledged for their contributions to advancing nursing knowledge. (shrink)

Black women are 3–4 times more likely to die from a pregnancy‐related complication and twice as likely to experience severe maternal morbidity when compared to white women in the United States. The risks for pregnancy‐related maternal mortality are well documented, yet Black women's experiences of life‐threatening morbidity are essentially absent in the nursing literature. The purpose of this interpretive phenomenological study was to understand the experiences of Black women who developed severe maternal morbidity. Face‐to‐face, one‐to‐one, in‐depth conversational interviews were conducted (...) with nine Black women who experienced life‐threatening complications during childbirth or postpartum. Five essential themes emerged (1) I Only Know What I Know; (2) How You Cared for Me; (3) Race Matters; (4) Faced with Uncertainty; and (5) Still Healing. These themes illuminate the complexity of Black women's subjective interpretations of severe maternal morbidity, and reveal ways in which racism, not race, places Black women at risk for poor maternal health outcomes. The author envisions greater equity for Black mothers entrusted to nursing care, guided by nursing theories informed by these study findings. (shrink)

Recent efforts to talk about the self in a postmodern dialect have created a dilemma: How can one conceptualize the human self as multiple, fluid, contextual, and radically relational while also maintaining that it is intentional, private, focused, and accountable? Creative Dwelling weaves elements of feminist psychology and process theology into a dynamic interdiscplinary dialogue about human subjectivity. The result brings a new coherence and vitality to our search for more inclusive and adequate ways of understanding our humanity. The theologicl (...) implications are profound: the dynamics of empathy and clarity impel the author to reframe characteristics of the divine nature, sin, salvation, and spirituality. The book culminates in a study of "dwelling" as a new, iconoclastic, and visionary metaphor for our experiences of the ever-emerging self. (shrink)

Ender’s Game, Orson Scott Card’s award-winning 1985 novel, has been discovered and rediscovered by generations of science fiction fans, even being adopted as reading by the U.S. Marine Corps. Ender's Game and its sequels explore rich themes — the violence and cruelty of children, the role of empathy in war, and the balance of individual dignity and the social good — with compelling elements of a coming-of-age story. Ender’s Game and Philosophy brings together over 30 philosophers to engage in wide-ranging (...) discussion on issues such as: the justifiability of pre-emptive strikes; how Ender’s disconnected and dispassionate violence is mirrored in today’s drone warfare; whether the end of saving the species can justify the most brutal means; the justifiability of lies and deception in wartime, and how military schools produce training in virtue. The authors of Ender’s Game and Philosophy challenge readers to confront the challenges that Ender’s Game presents, bringing new insights to the idea of a just war, the virtues of the soldier, the nature of childhood, and the serious work of playing games. (shrink)

Volume 20, Issue 3, March 2020, Page 24-27.

Politik und Moral, von A. Rüstow.--Die Staatsverfassung als moralische Anstalt betrachtet, von A. Rüstow.--Macht und Moral, von M. J. Hillenbrand.--Ethik und Aussenpolitik, von F. A. Hermens.

This article examines the operation of “reasonable steps” as a statutory standard for analysis of the availability of the defence of belief in consent in sexual assault cases and concludes that application of section 273.2(b) of the Criminal Code, as presently worded, often undermines the legal validity and correctness of decisions about whether the accused acted with mens rea, a guilty, blameworthy state of mind. When the conduct of an accused who is alleged to have made a mistake about whether (...) a complainant communicated consent is assessed by the hybrid subjective-objective reasonableness standard prescribed by s. 273.2, many decision-makers rely on extra-legal criteria and assumptions grounded on their personal experience and opinion about what is reasonable. In the midst of debate over what the accused knew and what steps were “reasonable” given what the accused knew, the legal definition of consent in section 273.1 is easily over-looked and decision-makers focus on facts that are legally irrelevant and prejudice rational deliberation. -/- That is precisely what we see here; the result is often failure to enforce the law. The author proposes: -/- (a) that section 273.2 be amended to reflect the significant developments achieved in sexual consent jurisprudence since enactment of the provision in 1992; and -/- (b) that, in the interim, the judiciary act with resolve to make full and proper use of the statutory and common law tools that are presently available to determine whether the accused acted with mens rea in relation to the absence of sexual consent. (shrink)

In the United States, there is a long history of racial disparities in maternal health, with Black women disproportionately representing poor maternal health outcomes. Black women are three to four times more likely to die from a pregnancy‐related complication and twice as likely to experience severe maternal morbidity when compared to white women. Where are nurses in the development of knowledge to improve maternal health outcomes among Black birthing people? This dialogue discusses how decolonizing nursing can occur by examining the (...) history of Black maternal health in the United States and using the works of nursing scholars of color to inform nursing education, research, and clinical practice. (shrink)

The availability of the defence of belief in consent under section 265(4) is a question of law, subject to review on appeal. The statutory provision is based on the common law rule that applies to all defences. Consideration of the defence when it is unavailable in law and failure to consider it when it is available are both incorrect. A judge is most likely to avoid error when ruling on availability of the defence if the ruling: (1) is grounded on (...) sound analysis of the substantive basis for the defence and its relationship to the principles of criminal responsibility; and (2) uses precise legal criteria to govern practical application of section 265(4) to the evidence in specific cases. The guidelines proposed in Part I are based on analyses of the substantive defence and culpable awareness and were developed to ensure that appropriate criteria are properly used when section 265(4) is applied. When a trial judge rules that the defence is available in law, the trier of fact must determine whether the defence is available on the facts as found, based on the evidence in the case. The model jury instructions proposed in Part II are designed to ensure that deliberations by the trier of fact are also guided and shaped by appropriate legal criteria. At both stages, the objective is to ground the deliberation process on fact, not fiction, and to regulate the exculpatory effect of the defence by using legal norms to exclude excuses based on extra-legal considerations such as sexual/racial fantasy, stereotype and myth, or community attitudes and custom. (shrink)

In early visits to Lothlorien—which is a loosely Pagan community of environmentalists in Indiana—I was confounded by attempts to categorize either the place or the people. As one of the founders said, “I tend to run from labels so I don't know what I am. It's safer that way.” In this paper I explore four members’ narratives about the emotional high points in their lives, where they often cross the usual boundaries of self and other. At the same time the (...) subjectivity at the core of these experiences is something that is felt and that cannot be dismissed as a discursive construct. Through these narratives I attempt to understand selfhood as a process—experientially inescapable but essentially in flux. I see a strong case for anthropologists moving beyond an overly neat, overly dichotomized view of “Western” and “non-Western” senses of self. (shrink)

Jacob Böhme (1575–1624) has been recognized as one of the internationally most influential German authors of the Early Modern period. Even today, his writings continue to impact fields as diverse as literature, philosophy, religion and art. Yet Böhme and his reception remain understudied. As a lay author, his works were often suppressed and circulated underground. Borrowing Böhme’s idea of “three worlds” or planes of existence, this volume traces the transmission of his thought through three stations: from his first underground readers (...) in Central and Eastern Europe, to the Netherlands, where most of his writings were first published, to Britain, where early translations made him a popular author for generations to come. Drawing on the work of both established and younger researchers from around the world, this volume charts new territory. It fills many lacunae and reveals a number of exciting discoveries, especially regarding the production and diffusion of manuscripts and previously overlooked sites of engagement. This book will be of interest to a wide range of scholars interested in the development of philosophical, religious, literary and artistic thought from the 17th century to the present day. (shrink)

This book is designed to provide an introduction to the history of American thought. It does not attempt to be encyclopedia in its coverage of the subject; many familiar names of names of men and books are absent.

The theory of evolution: The rise and impact of evolutionary ideas, by R. Scoon. Evolution in its relation to the philosophy of nature and the philosophy of culture, by F.S.C. Northrop. The genetic nature of differences among men, by T. Dobzhansky. Evolutionary thought in America: Evolution and American sociology by R.E.L. Faris. The impact of the idea of evolution on the American political and constitutional tradition, by E.S. Corwin. Evolutionism in American economics, 1800-1946, by J.J. Spengler. The influence of evolutionary (...) theory upon American psychological thought, by E.G. Boring. Naturalism in American literature, by M. Cowley. The idea of organic expression and American architecture, by D.D. Egbert. Evolution and moral theory in America, W.F. Quillian, Jr. Evolution and theology in America, by S. Persons. (shrink)

In 1987, apprehension that “unreasonable mistakes of fact” might negative mens rea in sexual assault cases led the Canadian Parliament to enact “reasonable steps” requirements for mistakes of fact with respect to the age of complainants. The role and operation of the “reasonable steps” provisions in ss. 150.1(4) and (5) and, to a lesser extent, s. 273.2 of the Criminal Code, must be reassessed. Mistakes of fact are now largely addressed at common law by jurisprudence that has re-invigorated judicial awareness (...) of the evidentiary requirements for the availability of defences at common law and explicitly defines “honest belief” as a belief that is neither reckless nor willfully blind. As a consequence of these common law developments, the defence of mistake of fact with respect to age is rarely available as a matter of law. Properly used, these common law analytic tools afford minors and under-age sex-workers better legal protection from sexual exploitation than has often been achieved in practice over the last 25 years with the “reasonable steps” requirement under ss. 150.1(4) and (5). -/- Socio-economic inequalities ensure that aboriginal children and youth are disproportionately affected by the non-enforcement, under-enforcement, and selective enforcement of laws enacted to protect minors against sexual assault and participation in sex work. Continued reliance by prosecutors and judges on out-moded jurisprudence in the screening, prosecution, and disposition of these cases in the criminal justice system reinforces existing patterns of inequality and disadvantage and violates basic principles of human rights. (shrink)

Two experiments were conducted to examine adult learners' ability to extract multiple statistics in simultaneously presented visual and auditory input. Experiment 1 used a cross‐situational learning paradigm to test whether English speakers were able to use co‐occurrences to learn word‐to‐object mappings and concurrently form object categories based on the commonalities across training stimuli. Experiment 2 replicated the first experiment and further examined whether speakers of Mandarin, a language in which final syllables of object names are more predictive of category membership (...) than English, were able to learn words and form object categories when trained with the same type of structures. The results indicate that both groups of learners successfully extracted multiple levels of co‐occurrence and used them to learn words and object categories simultaneously. However, marked individual differences in performance were also found, suggesting possible interference and competition in processing the two concurrent streams of regularities. (shrink)

In this ground-breaking article submitted for publication in mid-1986, Lucinda Vandervort creates a radically new and comprehensive theory of sexual consent as the unequivocal affirmative communication of voluntary agreement. She argues that consent is a social act of communication with normative effects. To consent is to waive a personal legal right to bodily integrity and relieve another person of a correlative legal duty. If the criminal law is to protect the individual’s right of sexual self-determination and physical autonomy, rather (...) than simply to regulate the type and degree of force that may be used to obtain compliance from a victim, the point of reference must be the individual complainant, as a person who makes choices, not social norms or objective tests based on the ordinary person. To determine whether consent is voluntary, attention must be directed to the presence or absence of factors that had a coercive impact on the individual complainant, a specific person with a collection of social, cultural, and psychological experiences, needs, fears, values, and priorities. Individuals have the right to exercise self-determination in accordance with their own values and perceptions, not those of a mythical victim. Accordingly, Vandervort argues that the prosecution may show either refusal, the absence of affirmative voluntary agreement (including passivity or the absence of consent due to unconsciousness), or circumstances that invalidate any apparent consent. Any of these prove the absence of consent for the purposes of establishing the actus reus of sexual assault. -/- The definition of consent as the affirmative communication of voluntary agreement is also shown to have a variety of implications for the interpretation and application of the law of sexual assault and the handling of evidentiary issues at trial in sexual assault cases. Key among these is the pivotal significance of the legal definition of consent as a tool to bar availability of the defence of “mistaken belief in consent.” Vandervort argues that in many cases the defence of “mistaken belief in consent” is based on ignorance of the law of consent, mistake about the legal definition of consent, or a failure to appreciate the legal significance of facts that are well-known, and not on a mistaken belief in an erroneous set of facts. The broad proposition asserted here is that a statutory criminal law is enforceable only if all defences based directly or indirectly on belief in the validity of extra-legal norms that authorize infringement of rights protected by the criminal law are barred. This proposition and the characterization of some mistakes about consent as legal, not factual, are also shown to be useful to exclude rape-myths and stereotypical assumptions---the stuff of which “social” definitions of consent have long been constructed---from the decision-making process at trial. -/- . (shrink)

From the early modern period to well into the eighteenth century, cattle plagues, murrains, or what were called “great cattle mortalities” were often analogized to bubonic plague; felling animals in devastating numbers, these catastrophes likewise afflicted living creatures on a grand scale. Three Enlightenment cattle pandemics (1709–1720, 1742–1760, and 1768–1786) propelled governments across Europe to enact harsh regulatory measures, including widespread slaughters, quarantines, and major disruptions of trade. This article examines works by Theophilus Lobb, Richard Bradley, Nathaniel Hodges, and Daniel (...) Defoe, among other writers and physicians, who responded differently to the ways in which human and animal health were biophysically and imaginatively linked. (shrink)

From the early modern period to well into the eighteenth century, cattle plagues, murrains, or what were called “great cattle mortalities” were often analogized to bubonic plague; felling animals in devastating numbers, these catastrophes likewise afflicted living creatures on a grand scale. Three Enlightenment cattle pandemics (1709–1720, 1742–1760, and 1768–1786) propelled governments across Europe to enact harsh regulatory measures, including widespread slaughters, quarantines, and major disruptions of trade. This article examines works by Theophilus Lobb, Richard Bradley, Nathaniel Hodges, and Daniel (...) Defoe, among other writers and physicians, who responded differently to the ways in which human and animal health were biophysically and imaginatively linked. (shrink)

Only rarely have feminist theorists addressed the adequacy of just -war theory, a set of principles developed over hundreds of years to assess the justice of going to war and the morality of conduct in war. Recently, a few feminist scholars have found just -war theory inadequate, yet their own counterproposals are also deficient. I assess feminist contributions to just -war theorizing and suggest ways of strengthening, rather than abandoning, this moral approach to war.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 28.1 (2004) 220-223 [Access article in PDF] Doing Our Own Thing. The Degradation of Language and Music and Why We Should, Like Care, by John McWhorter; xiv & 279 pp. New York: Gotham Books, 2003, $26.00. In 2002, the first anniversary of the September 11th attacks was marked in New York City by the reading of the Gettysburg Address. It was, as many commentators noted, an (...) odd choice of eulogy, comparing as it did the unwitting and innocent victims of a terrorist attack to the willing and active [End Page 220] participants in a bloody civil war. In Doing Our Own Thing, the Berkeley linguist John McWhorter asserts that this strange choice was the result of a decline in American public discourse. A "particular kind of artful English, formerly taken for granted as crucial to legitimate expression on the civic stage has" he argues, "virtually disappeared" (p. xiv). For McWhorter, this lack of contemporary public oratory is merely part of a broader linguistic decline that has affected all aspects of American life and culture.There has, he suggests, been a dumbing-down of the language. Whereas Americans once took care to craft their language, public and private, McWhorter argues, there is now a casualness to their speech and writing which affects all aspects of their existence. The nature of this decline is best captured by McWhorter's anecdote about his research into Gullah, an obscure Creole dialect. In response to his inquiries about local speech patterns, an elderly black woman in Greenwood, Mississippi responded: "Well, seems like most folks, they speak pretty good English, but some people, it seems like they just talk" (p. 2). Whereas Americans once spoke pretty good English, McWhorter believes, now, for the most part, they just talk. In Doing Our Own Thing, he seeks to identify not only evidence for his thesis, but also the causes and consequences of this decline.Evidence of linguistic decline is, McWhorter believes, to be found in our public discourse (as evidenced by the contemporary use of the Gettysburg Address), and in the rise of rap music and popular lyrics at the expense of poetry—he notes that as late as the 1960s, the poet Marianne Moore was a guest on The Tonight Show twice. Less intuitively perhaps, he identifies the same decline in the decreased popularity of piano bars, and the rising popularity of cell-phones. What all these examples of have in common, McWhorter suggests, is a turn towards an oral as opposed to a written culture. Speech has, he says, become something of a "dress-down affair" (p. 49), and this has infected both our written word and public oratory. The "modern American speech writer" he notes, "tends strongly to operate under a guiding imperative not to sound too high a note" (p. 47). McWhorter contrasts this with examples from the nineteenth-century—with letters from ordinary soldiers to their sweethearts, and with Edward Everett's two-hour plus address at Gettysburg—which show that "we live in an America with a distinctly different relationship to the English language than an America still within living memory" (p. 167).For McWhorter, the causes of this decline are clear. The 1960s counterculture, in its efforts to "Speak Truth to Power, abandoned the formal conventions of previous generations' speech, and adopted its own more casual approach to public discourse. Indeed, McWhorter feels confident enough to identify "a single year when America lost its love for its language": 1965 (p. 183). The consequences of this decline are, for McWhorter, similarly obvious. Among them, the shift to an oral culture is held to be responsible for: the election of George W. Bush—Al Gore's "studied articulateness is certainly one of the major [End Page 221] factors that blocked him from winning the presidency" (p. xxi); the decline of contemporary political debate—more formal written language is, says McWhorter, "a better vehicle for objective argument than speech" (p. 35); and the increasingly obtuse nature of academic language. Indeed, McWhorter asserts that Judith Butler... (shrink)

What is the proper role for Theory in literary study? An aid to reading? Or source of insight into the world beyond the text? Half-heartedly apologizing for the political-theoretical excesses of the past two decades, Gayatri Chakravorty Spivak and Jean-Michel Rabaté offer up more of the same, with Spivak in particular recycling the ideas of others so as to revive literature as a source of political "Othering." Noting the ways in which Theory silences the sounds of "Others," I argue Valentine (...) Cunningham's placing of Theory permits both texts and others to speak, and in so doing, teaches us to listen. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.2 (2002) 459-461 [Access article in PDF] The Heart of What Matters. The Role for Literature in Moral Philosophy,by Anthony Cunningham; x & 296 pp. Berkeley: University of California Press, 2001, $60.00 cloth, $24.95 paper. Despite Socrates's rejection of the written word as a source of insight in the Phaedrus, a number of theorists have in recent years sought to find a role for literature in (...) critical thought. Anthony Cunningham's The Heart of What Matters joins a list of works that includes Richard Rorty's Contingency, irony and solidarity, Richard Posner's Law and Literature, and Martha Nussbaum's Poetic Justice. Whereas a number of these previous books have sought to articulate a public role for literature, Cunningham is more concerned with private philosophical reflection, specifically with the ways in which literature might help us reflect upon Socrates's dual questions "How should I live?" and "What sort of person should I be?" (p. 9). It is, nevertheless, appropriate to mention Cunningham's work in conjunction with these other texts because The Heart of What Matters faces a number of similar problems arising from what it means to read literature with an eye towards generating critical thought.The first part of the book consists of three chapters in which Cunningham sets out his conception of ethics, the role of a convincing ethical theory, and his account of what it means to "read for life." This last chapter is, by his own admission "fairly sketchy and theoretical" (p. 69), but he attempts to compensate for this in the second part where he offers—as a means, perhaps, of "showing by doing"—detailed, philosophically motivated readings of literary works by three authors: Kazuo Ishiguro, Toni Morrison, and Zora Neale Hurston. Like many of those who write about literature and ethics—including Wayne Booth and Martha Nussbaum—Cunningham's conception of ethics is "Aristotelian in spirit" (p. 5), as such it is no surprise to find that his "primary targets" in ethical theory are "Kant and Kantian ethics" (p. 4). Kant's theory of morality and indeed its various modern formulations—formulations Cunningham critques in some detail—are, he says, simply insufficient for capturing the nuances of our lived experience. Theories that focus on some underlying principle of morality are, he suggests, too abstract to help us answer Socrates's questions about the best way to live. By contrast, literature can, Cunningham argues, provide us with insight into the complexities of modern living. In a passage that is strongly reminiscent of Poetic Justice, Cunningham asserts that literature can "filter moral experience by heightening our attention to what should be morally salient and by directing us away from less crucial elements that can distract us from more important things" (p. 84). Similarly, in a passage that further echoes Nussbaum, Cunningham suggests that "literature can help us diagnose by taking us places that are difficult and even impossible to visit, much less understand in actual experience" (p. 85). Central to his overall argument is the suggestion, also common to Nussbaum and Rorty, that the [End Page 459] "right kind of novel" can "help us refine our moral vision by giving us a studied opportunity to practice seeing and appreciating diverse ethical lores" (pp. 84-85). It is, however, this suggestion that reading is some sort of moral exercise that proves problematic for almost all work on literature and philosophy.If literature is indeed a way for us to practice exercising our moral powers, then it is not clear why philosophers such as Cunningham, Nussbaum, and Rorty lavish so much attention on their own reading of texts. Reading about reading is not, I wish to suggest, the best way to exercise this moral capacity: it is rather like expecting to benefit from watching somebody else exercise. Instead of offering us a theory of reading which might allow us to engage in this exercise ourselves, Cunningham simply gives an account of his own experience. In this way, the subtitle of Cunningham's book, "The Role for Literature in... (shrink)

‘Shared’ decision-making is heralded as the gold standard of how medical decisions should be reached, yet how does one ‘share’ a decision when any attempt to do so will undermine _autonomous_ decision-making? And what exactly is being shared? While some authors have described parallels in literature, philosophical examination of shared agency remains largely uninvestigated as an explanation in bioethics. In the following, shared decision-making will be explained as occurring when a group, generally comprised of a patient and or their family, (...) and the medical team become a genuine intentional subject which acts as a collective agent. Collective agency can better explain how some medical decisions are reached, contrary to the traditional understanding and operationalization of ‘autonomy’ in bioethics. Paradoxically, this often occurs in the setting of high-stakes moral decision-making, where conventional wisdom would suggest individuals would _most_ want to exercise autonomous action according to their personally held values and beliefs. This explication of shared decision-making suggests a social ontology ought to inform or displace significant aspects of autonomy as construed in bioethics. It will be argued that joint commitments are a fundamental part of human life, informing and explaining much human behavior, and thus suggesting that autonomy - conceived of as discrete, individuated moral reasoning of a singular moral agent - is not an unalloyed ‘good.’. (shrink)

A two-year rounding program was initiated by the clinical ethics consult service (CECS) to improve ethics program integration and utilization at our 323-bed tertiary care pediatric hospital. Two critical variables were identified for improvement. One: identification of cases in which an ethics consult would have benefited clinical care but was not requested. Two: earlier detection of cases for which the medical team and/or family eventually sought ethics consultation but that worsened during the delay. Improvement relied on eliciting dialogue with the (...) CECS by the medical team and/or patients and families, when it had either not occurred before or had not occurred when it would have been most beneficial. The indirect nature of the improvements sought posed a specific challenge: how does one elicit such action from others? How does a small program with less than one full-time equivalent position that is dedicated to clinical ethics, and little funding, effect such a process change across an organization with more than 600 physicians, 2,000 nurses, 600 medical students, and thousands of other clinicians and staff? The following accounts such an effort and the accompanying two-year study undertaken to document the results. The data presented demonstrate improvement in both identified variables: increased overall utilization of the CECS and earlier detection of cases in which the CECS is typically engaged. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 4-7, January/February 2022.

The fidelity provided by rich, nuanced ethics consult narratives does not proscribe efforts to advance the profession by using data to assess performance and demonstrate value. While these two approaches have been described as in conflict with one another, the former sets the bar to which the latter should aim; to achieve this, consult data should, minimally, do two things: (1) tell the story of the case, as best as possible, in language easily accessible to both ethicists and non-ethicists alike; (...) and (2) do so in a way that elements of interest can be aggregated, disambiguated, and analyzed. Here we present a three-component system designed with that in mind.First, the Armstrong Clinical Ethics Coding System (ACECS) produces a set of six codes that tell a simplified story of the case. These six codes form a meta narrative, which, like meta data, can be aggregated, disambiguated, and analyzed. Second, we use a data model to uncover the stories those data tell. The results allow us to understand relationships, recognize patterns, and reveal insights that are otherwise not discoverable when using narratives alone. Third, due to tremendous heterogeneity among cases, we represent findings visually using techniques borrowed from data storytelling, a powerful means to demonstrate the value of a consult service to administrators and others. The ability to derive meta narratives from an aggregate of case narratives allows us to describe, in detail, the work of our consult service in a manner directly comparable to other services that use the system while we preserve unprecedented case-level nuance. If adopted broadly, this functionality suggests a means to undergird the legitimacy of the ethics consult practice itself in an evidence-based manner similar to that which undergirds other domains of healthcare. (shrink)