Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms. Here's what the experts had to say: Professor Zaner has provided us with a remarkably (...) lucid and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. Dokecki Richard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee (1985), he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore (...) what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

Recently two distinct forms of rule-utilitarianism have been introduced that differ on how to measure the consequences of rules. Brad Hooker advocates fixed-rate rule-utilitarianism, while Michael Ridge advocates variable-rate rule-utilitarianism. I argue that both of these are inferior to a new proposal, optimum-rate rule-utilitarianism. According to optimum-rate rule-utilitarianism, an ideal code is the code whose optimum acceptance level is no lower than that of any alternative code. I then argue that all three forms of rule-utilitarianism fall prey to two fatal (...) problems that leave us without any viable form of rule-utilitarianism. (shrink)

With disparate rates of morbidity and mortality among minoritized communities, COVID-19 illuminated the need for equity-informed practices in public health. Pacia et al posit FQHCs as entities that addressed inequity when others failed. This commentary further situates how FQHCs address the public health crisis of institutional racism and related health inequities every day and presents a FQHC-led Ethics and Equity Framework and Workflow Checklist to guide ethical and equitable engagement with FQHCs.

Despite its uniform appearance, the cerebellar cortex is highly heterogeneous in terms of structure, genetics and physiology. Purkinje cells (PCs), the principal and sole output neurons of the cerebellar cortex, can be categorized into multiple populations that differentially express molecular markers and display distinctive physiological features. Such features include action potential rate, but also their propensity for synaptic and intrinsic plasticity. However, the precise molecular and genetic factors that correlate with the differential physiological properties of PCs remain elusive. In this (...) article, we provide a detailed overview of the cellular mechanisms that regulate PC activity and plasticity. We further perform a pathway analysis to highlight how molecular characteristics of specific PC populations may influence their physiology and plasticity mechanisms. (shrink)

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

It has been argued that organizational structures (the way tasks are defined, allocated, and coordinated) can influence moral agency in organizations. In particular, low values on different structural parameters (functional concentration, specialization, separation, and formalization) are said to foster an organizational context (allowing for relating to the goals and output of the organization, moral deliberation, and social connectedness) that is conducive to moral agency. In this paper, we investigate the relation between the organizational structure and moral agency in the case (...) of a.s.r. (a large Dutch insurance company). While our empirical results fit the thesis that low values on structural parameters positively relate to moral agency, they also refine our understanding of the influence of structural parameters. In particular, our data suggest that the influence of functional concentration not only depends on whether it is low, but also on the type of criterion used for identifying business units; they suggest that the specific organizational context may put a limit to lowering design parameters and points at several non-structural factors that have an influence on the relation between structure and moral agency. In all, the paper contributes to a more detailed understanding of the conditions conducive to moral agency in organizations. (shrink)

Introduction By the late fifth century BCE Panini had composed the Astadhyayi, consisting of nearly 4000 rules giving a precise and fairly complete ...

Peace is a hallmark of human societies. However, certain ant species engage in long-term intergroup resource sharing, which is remarkably similar to peace among human groups. We discuss how individual and group payoff distributions are affected by kinship, dispersal, and age structure; the challenges of diagnosing peace; and the benefits of comparing convergent complex behaviours in disparate taxa.

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

Even though the measurement of fear of crime in criminological research commenced a few decades ago, specific populations, such as social activists, remain undocumented. This article is an attempt to address this gap. A study was conducted among 153 social activists involved in exposing corruption and irregularities that take place in the government system in India. This article explores the gap between the fear of crime and actual victimization among the specific social activists in India. The results indicate activists expressed (...) moderate fear of any one form of victimization including verbal and emotional, physical, and sexual victimization. It was also found that one-third of them have reported facing some form of abuse. The research implications are discussed. (shrink)

The perception of meaningful patterns in random arrangements and unrelated events takes place in our everyday lives, coined apophenia, synchronicity, or the experience of meaningful coincidences. However, we do not know yet what predicts this phenomenon. To investigate this, we re-analyzed a combined data set of two daily diary studies with a total of N = 169 participants (mean age 29.95 years; 54 men). We investigated if positive or negative affect (PA, NA) predicts the number of meaningful coincidences on the (...) following day (or vice versa). By means of a cross-lagged multilevel modelling approach (Bayesian estimation) we evaluated with which of two theoretical assumptions the data are more in line. First, if meaningful coincidences are facilitated by a broader and more flexible thinking style, PA should positively predict meaningful coincidences at the following day. However, if the experience of meaningful coincidences signifies a strategy to cope with negative feeling states, NA should predict the experience of meaningful coincidences during the following day. In favour of a more flexible thinking style, we found that PA predicted the number of perceived coincidences the following day. We did not find any effect for NA, and therefore, no evidence arguing for the coping mechanism hypothesis of meaningful coincidences. (shrink)

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable options (...) as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. (shrink)

Glowacki defines peace as harmonious relationships between groups maintained without the threat of violence, where groups can be anything from families to nation states. However, defining such contentious concepts like “peace” and “groups” is a difficult task, and we discuss the implications of Glowacki's definitions for understanding intergroup relationships and their evolutionary history.

M J Newby; Sensualism, Spirituality and Education: some reflections on the value of the individual and their significance for teaching, Journal of Philosophy of.

IntroductionEddy M. Zemach was born in Jerusalem in 1935. His mother, Helena, was a dentist as well as a poet, and his father, Shimon, was a dentist as well as a political figure. Eddy completed B.A. and M.A. degrees in both Hebrew literature and philosophy at the Hebrew university of Jerusalem. He studied for a doctoral degree in philosophy at Yale University. In 1965 he completed his dissertation on the boundaries of the aesthetic, supervised by Paul Weiss. Another of his (...) teachers at Yale was Wilfrid Sellars, who influenced his philosophical views on mind and language. Aesthetics, philosophy of mind, and philosophy of language formed the center of his philosophical interest, though this interest was extended to other philosophical areas, such as metaphysics and epistemology.Eddy published extensively in both philosophy and Hebrew literature, and also wrote many short stories . He wrote some two hundred papers, and twelve scholarly books .. (shrink)

David M. Zientek; Response to the Consensus Statement of the Working Group on Roman Catholic Approaches to Determining Appropriate Critical Care, Christian bioe.

Although the field of surgical ethics focuses primarily on informed consent, surgical decision‐making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment. The ethic of accompaniment is born (...) from a theological tradition that has motivated work to improve health outcomes in those at the margins through its emphasis on listening, solidarity against systemic drivers of disease, and proximity to individuals and communities. Through a review of surgical ethics and exploration of a central patient case, we argue for applying an ethic of accompaniment to the care of surgical patients and their communities. (shrink)

Socioeconomic inequality is perpetuated and exacerbated by an overlooked yet serious epidemic of time theft: the act of causing others to lose their time without adequate cause, compensation, or consent. We explain why time theft goes unnoticed, how it drives socioeconomic inequality, and what businesses and policymakers can do to address it.

Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed the (...) Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β = −.62) were significant and larger than those for the TV factor (average β = −.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component. (shrink)

"Critical Approaches to International Relations: Philosophical Foundations and Current Debates explores the achievements of a wide variety of critical approaches in International Relations theory, discusses the barrage of criticism and theoretical openings they levied against the IR orthodoxy and suggests future potential of critical IR scholarship to improve not only our explanatory possibilities, but also our ethical and practical horizons. In line with this broad objective, the book examines a number of influential approaches within critical IR scholarship, including core strands (...) of critical IR theory such as Marxism, post-structuralism, Feminism, post-colonialism and green politics as well as some sub-school approaches such as Marxist theories of imperialism, dependency perspective, uneven and combine development and non-western IR theory. Contributors are: M. Kürşad Özekin, Engin Sune, Çağdaş Özeniş, Gözde Turan, Mine Nur Küçük, Neslihan Dikmen Alsancak, Zeynep Arıöz, Pınar Akgül, and Altuğ Günar"--. (shrink)

In analogy with Planck’s construction of fundamental quantities in gravitation, we construct fundamental quantities associated with (1) theories of electrodynamics in which the electromagnetic field has a maximum value (e.g. Born-Infeld theory), and (2) the Fermi interaction. This gives us a maximum intensity of the electromagnetic field, and also reveals a close relationship between the fundamental lengths associated with the gravitational and weak interactions, supporting the connection between these two interactions.

Maternity careproviders often have strong views concerning a woman’s choice of where to give birth. These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should “count,” instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.

First published in 1994. Routledge is an imprint of Taylor & Francis, an informa company.

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond (...) its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials. (shrink)

We expect that consensus meetings, where researchers come together to discuss their theoretical viewpoints, prioritize the factors they agree are important to study, standardize their measures, and determine a smallest effect size of interest, will prove to be a more efficient solution to the lack of coordination and integration of claims in science than integrative experiments.