During the 1970s and 1980s, legal precedent, governmental recommendations, and professional society guidelines drove the formation of hospital ethics committees (HECs). The Joint Commission on Accreditation of Health Care Organization’s requirements in the early 1990s solidified the role of HECs as the primary mechanism to address ethical issues in patient care. Because external factors drove the rapid growth of HECs on an institution-byinstitution basis, however, no initial consensus formed around the structure and function of these committees. There are now almost (...) 40 years of empirical studies on the composition, administration, and activities of HECs in the United States. We conducted a systematic review of the available empirical literature on HECs to describe their evolution. As HECs changed over time, they increased their total number of members and percentage of members from nursing and the community. Although physicians increasingly chaired these committees, their presence as a percentage of overall members declined. The percentage of administrative members remained steady, although committees became increasingly likely to have at least one administrative member. HECs were also increasingly likely to report to an administrative body or to the board of trustees or directors rather than to the medical staff. Finally, consultation volume increased steadily over time. There has not, however, been a national survey of the composition of ethics committees, their administration, or volume of consultation in more than 10 years, despite increasing calls for professional standards and quality improvement assessments among HECs. (shrink)

The debate about health insurance coverage and the related issue of unequal access to health care turn on fundamental questions of justice, but for an individual patient like DM, the abstract question about who is deserving of health insurance becomes a very concrete problem that has a profound impact on care and livelihood. DM's circumstances left him stuck in the hospital. A satisfactory discharge plan remained elusive; his insurance coverage severely limited the number and type of facilities that would accept (...) him; and his inadequate engagement in his own rehabilitation process limited discharge options even further. Despite extensive involvement with the psychiatry, social work, physical therapy, and occupational therapy teams, DM consistently made “bad” decisions. He repeatedly refused antibiotics and did not consistently work with rehab services to improve his strength and mobility. Although the clinicians wanted to provide him with the best care possible, he often seemed unwilling to do the things necessary to achieve this care—or perhaps his depression rendered him unable to do so. He also tended to take out his frustration on staff members caring for him. All of this was, in turn, very frustrating for the staff. It may be easy, however, to make too much of DM's role, to see his choices as more important than his circumstances. A major goal of the ethics consultants was to reframe DM's predicament for the staff members involved in his care. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 45-47, October 2012.

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Growing evidence suggests that nurses and other clinicians often feel insufficiently equipped to manage ethical issues that arise in their practice (Truog et al. 2015; Woods 2005; Darmon et al. 201...

Who are you? What is truly real? Is there such a thing as free will? If you have ever considered questions like these, that’s philosophy. The Philosophy Book for Beginners breaks down the core concepts of both Eastern and Western philosophy in clear language that explains the most important people and ideas. You’ll develop an understanding of the basic ideas and see your understanding of the world expand―no dense, academic texts required. -/- The major branches―Explore the central questions of metaphysics, (...) epistemology, logic, and axiology as you see how they changed over time. A wide range of thinkers―Discover the diverse perspectives of philosophers, from Socrates in the fifth century BCE to modern-day thinkers like Martha Nussbaum. Thought experiments―Each chapter focuses on a topic, like existentialism, stoicism, or radical faith, and ends with a related thought experiment for you to ponder. Gain a solid understanding of philosophy, with a book that makes it easy to grasp and relevant to the world today. (shrink)

From one of the world's most celebrated moral philosophers comes a thorough examination of the current American political crisis and recommendations for how to mend a divided country.

I outline some of my work and results on my matter-gravity entanglement hypothesis, according to which the entropy of a closed quantum gravitational system is equal to the system’s matter-gravity entanglement entropy. The main arguments presented are: that this hypothesis is capable of resolving what I call the second-law puzzle, i.e. the puzzle as to how the entropy increase of a closed system can be reconciled with the asssumption of unitary time-evolution; that the black hole information loss puzzle may be (...) regarded as a special case of this second law puzzle and that therefore the same resolution applies to it; that the black hole thermal atmosphere puzzle can be resolved by adopting a radically different-from-usual description of quantum black hole equilibrium states, according to which they are total pure states, entangled between matter and gravity in such a way that the partial states of matter and gravity are each approximately thermal equilibrium states ; that the Susskind–Horowitz–Polchinski string-theoretic understanding of black hole entropy as the logarithm of the degeneracy of a long string cannot be quite correct but should be replaced by a modified understanding according to which it is the entanglement entropy between a long string and its stringy atmosphere, when in a total pure equilibrium state in a suitable box, which ) goes over, at strong-coupling, to a black hole in equilibrium with its thermal atmosphere. The modified understanding in is based on a general result, which I also describe, which concerns the likely state of a quantum system when it is weakly coupled to an energy-bath and the total state is a random pure state with a given energy. This result generalizes Goldstein et al.’s ‘canonical typicality’ result to systems which are not necessarily small. (shrink)

This publication is an appreciation of the natural philosophy and epistemology of the philosopher Grete (Henry-)Hermann. A student of the mathematician Emmy Noether and the philosopher Leonard Nelson, she was one of the early interpreters of quantum mechanics. Werner Heisenberg memorialized her in his book "The Part and the Whole". For the first time, her writings on natural philosophy and epistemology are collected in one volume. An extensive introduction by various authors introduces the work of Grete Henry-Hermann. This edition is (...) supplemented by excerpts from correspondence on natural philosophical and epistemological topics, including correspondence with Carl Friedrich von Weizsäcker, Werner Heisenberg, and Gustav Heckmann. Contents ● Grete Henry-Hermann's contribution to the interpretation of quantum mechanics ● Grete Henry-Hermann's work on the relationship between modern physics and transcendental philosophy ● Grete Hermann's dissertation: The Question of the Finitely Many Steps in the Theory of Polynomial Ideals (1925) ● Discussions on the question of free will and the significance of behavioral research for the critique of reason ● Excerpts from correspondence from 1925 to 1982. (shrink)

Prior to European influence, predation by Native Americans was the major factor limiting the numbers and distribution of ungulates in the Intermountain West. This hypothesis is based on analyses of (1) the efficiency of Native American predation, including cooperative hunting, use of dogs, food storage, use of nonungulate foods, and hunting methods; (2) optimal-foraging studies; (3) tribal territory boundary zones as prey reservoirs; (4) species ratios, and sex and age of aboriginal ungulate kills; (5) impact of European diseases on aboriginal (...) populations; and (6) synergism between aboriginal and carnivore predation. Native Americans had no effective conservation practices, and the manner in which they harvested ungulates was the exact opposite of any predicted conservation strategy. Native Americans acted in ways that maximized their individual fitness regardless of the impact on the environment. For humans, conservation is seldom an evolutionarily stable strategy. By limiting ungulate numbers and purposefully modifying the vegetation with fire, Native Americans structured entire plant and animal communities. Because ecosystems with native peoples are entirely different than those lacking aboriginal populations, a “hands-off” or “natural regulation” approach by today’s land managers will not duplicate the ecological conditions under which those ecosystems developed. The modern concept of wilderness as areas without human influence is a myth. North America was not a “wilderness” waiting to be discovered, instead it was home to tens of millions of aboriginal peoples before European-introduced diseases decimated their numbers. (shrink)

PURPLE (RED-and-BLUE) is the most frequently occurring derived (binary) basic color term (BCT), but there is never a named composite BCT meaning RED-or-BLUE. GREEN-or-BLUE is the most frequently named composite color category, but there is never a BCT for the corresponding derived (binary) category CYAN (BLUE-and-GREEN). Why?

Prior to European influence, predation by Native Americans was the major factor limiting the numbers and distribution of ungulates in the Intermountain West. This hypothesis is based on analyses of (1) the efficiency of Native American predation, including cooperative hunting, use of dogs, food storage, use of nonungulate foods, and hunting methods; (2) optimal-foraging studies; (3) tribal territory boundary zones as prey reservoirs; (4) species ratios, and sex and age of aboriginal ungulate kills; (5) impact of European diseases on aboriginal (...) populations; and (6) synergism between aboriginal and carnivore predation. Native Americans had no effective conservation practices, and the manner in which they harvested ungulates was the exact opposite of any predicted conservation strategy. Native Americans acted in ways that maximized their individual fitness regardless of the impact on the environment. For humans, conservation is seldom an evolutionarily stable strategy. By limiting ungulate numbers and purposefully modifying the vegetation with fire, Native Americans structured entire plant and animal communities. Because ecosystems with native peoples are entirely different than those lacking aboriginal populations, a “hands-off” or “natural regulation” approach by today’s land managers will not duplicate the ecological conditions under which those ecosystems developed. The modern concept of wilderness as areas without human influence is a myth. North America was not a “wilderness” waiting to be discovered, instead it was home to tens of millions of aboriginal peoples before European-introduced diseases decimated their numbers. (shrink)

The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient (...) ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood – of residents and staff – are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued. (shrink)

In order to gain greater insight into the nature of corporate social responsibility (CSR) during a time of crisis, the study examines the commitment of firms to continue to engage in CSR activity despite financial pressures to divert their slack resources elsewhere. The setting of the study is CSR activity during the perhaps unprecedented global crisis associated with the COVID-19 pandemic. Based on a qualitative research method approach, both a variety of media sources and the relevant academic literature are reviewed (...) in order to identify examples of CSR activity related specifically to COVID-19. The examples are then categorized and situated according to Professor Archie Carroll’s well-known CSR Pyramid framework describing the economic, legal, ethical, and philanthropic domains of CSR. As such, this study is the first to extend the rich literature stream utilizing Carroll’s CSR Pyramid within the unique context of a global pandemic. (shrink)

Political action requires a concept of humanity grounded in an explicit notion of human nature. Feminists apprehensive about poststructuralism's implications for a feminist politics need methods and discourses that allow feminist politics to proceed toward a vision of human well-being. Recent work by Chris Weedon and Erica Sherover-Marcuse highlights the need for hypotheses that can guide efforts to dismantle oppressed habits of being and help women evaluate and develop political strategies for universal solidarity.

The ArgumentThis paper focuses on the opening of a discursive space: the emergence of informational and scriptural representations of life and their self-negating consequences for the construction of biological meaning. It probes the notion of writing and the book of life and shows how molecular biology's claims to a status of language and texuality undermines its own objective of control. These textual significations were historically contingent. The informational representations of heredity and life were not an outcome of the internal cognitive (...) momentum of molecular biology; they were not a logical necessity of the unravelling of the base-pairing of the DNA double-helix. They were transported into molecular biology still within the protein paradigm of the gene in the 1940s and permeated nearly every discipline in the life and social sciences. These information-based models, metaphors, linguistic, and semiotic tools which were central to the formulation of the genetic code were transported into molecular biology from cybernetics, information theory, electronic computing, and control and communication systems — technosciences that were deeply embedded with the military experiences of world war II and the Cold War. The information discourse thus became fixed in molecular biology not because it worked in the narrow epistemic sense (it did not), but because it positioned molecular biology within postwar discourse and culture, perhaps within the transition to a post-modern information-based society. (shrink)

A narrow conception of who counts among the marginalized can blind ethicists to the precarious position of groups who function as middle agents between elites and the lower class. The imposition of middle agency on such groups is a form of oppression that leaves them vulnerable to abandonment and attack. In Rwanda, discourses emanating from colonialism, classism, and racism obscured the Tutsi as middle agents, despite white Catholics' dedication to the poor. By neglecting to recognize middle agency as a type (...) of marginalization, missionaries contributed negatively to the genocide. Liberatory practices are recommended so that ethicists can expose and challenge the dynamics of middle agency and include all the marginalized in liberation strategies. (shrink)

Inducement prizes have been long used to stimulate individuals and groups to accomplish diverse goals. Lately, governments have become more and more interested in these prizes and sought to include this kind of incentives within the set of policy tools available to promote science, technology, and innovation. To date, however, there has been little empirically-based scientific knowledge on how to design, manage, and evaluate innovation prizes. This note discusses aspects of the prize phenomenon and the opportunities and challenges related with (...) the use of innovation prizes as a government policy instrument. Compared to other incentive mechanisms, prizes are likely to present advantages to, for example, accelerate the development and commercialization of technologies that are held back for diverse reasons and help to leverage public money with external ideas, collaborative efforts, and the participation of diverse individuals and organizations. Still, despite these advantages and other interesting features of prizes, there are key questions that policy-makers and scholars must address to better understand this kind of incentives and further improve prize designs and implementations before governments move forward to a more widespread use of innovation prizes in science and technology policies. (shrink)

Policy makers and economists alike failed to predict the financial crisis of 2008. Their failure is due not only to the difficulties in predicting events in a complex world, but to the self-referential character of modern macroeconomics. Instead of seeking new empirical insights about economic behavior, macroeconomists have become creators of computer games—content to develop models that are internally consistent but have no necessary connection to the real world. Economic modeling aspires to be scientific in its deductive consistency and rigor. (...) However, even the natural sciences require a good dose of induction, which, in turn, entails varying one's method of study based on the phenomenon one is studying. (shrink)

Policy makers and economists alike failed to predict the financial crisis of 2008. Their failure is due not only to the difficulties in predicting events in a complex world, but to the self-referential character of modern macroeconomics. Instead of seeking new empirical insights about economic behavior, macroeconomists have become creators of computer games—content to develop models that are internally consistent but have no necessary connection to the real world. Economic modeling aspires to be scientific in its deductive consistency and rigor. (...) However, even the natural sciences require a good dose of induction, which, in turn, entails varying one's method of study based on the phenomenon one is studying. (shrink)

In this paper we trace the historical exclusion of women from the legal profession in Canada. We examine women’s efforts to gain entry to law practice and their progress through the last century. The battle to gain entry to this exclusive profession took place on many fronts: in the courts, government legislature, public debate and media, and behind the closed doors of the law societies. After formal barriers to entry were dismantled, women continued to confront formidable barriers through overt and (...) subtler forms of discrimination and exclusion. Today’s legal profession in Canada is a contested one. Women have succeeded with large enrolments in law schools and growing representation in the profession. However, women remain on the margins of power and privilege in law practice. Our analysis of contemporary official data on the Canadian legal profession demonstrates that women are under-represented in private practice, have reduced chances for promotion, and are excluded from higher echelons of authority, remuneration, and status in the profession. Yet, the contemporary picture of the legal profession also reveals that women are having an important impact on the profession of law in Canada by introducing policy reforms aimed at creating a more humane legal profession. (shrink)

This paper proposes an alternative view to the influential one of air or breath as inspiration that produces an imagined inner vision of the desired object. Instead, it outlines a poetics where air and inspiration connect with voice, language and music, thereby privileging sound over sight. A genealogy for this account is traced through Aristotle and various treatises connected to him, and an example of its operation is discussed in a song by the troubadour Bernart Marti. Voice is theorized as (...) a kind of sound, including non-human sound, made by striking air, which expresses the soul's passions and marks both the boundary and the connection between air and soul. Poetry and song form soundscapes whose implications exceed the acoustic. (shrink)

Every constitution defines and is defined by a period in time. Like all law the creation and application of constitutions require reference to the past and future respectively. Every instance of constitution‐making is an attempt to control behavior over an extended period of time. Therefore constitutions will be drafted, both in style and substance, to reflect that temporal ambition. The effectiveness of a constitution also requires that its interpretation makes reference to the understanding of its rules held by the constitution‐makers. (...) As a result, and notwithstanding the efforts to make it suitable over a long period by its creators, every constitution is bound to become unsuitable. Courts employ a number of devices to cope with the inevitable obsolescence of constitutions but, sooner or later, every constitution will have to be discarded and a new constitutional era begun. (shrink)

Chaotic itinerancy is useful for illustrating transitions in attractor dynamics seen in the olfactory system. Cantor coding is a good model for information processing, but so far it lacks perceptual proof. The theories presented provide a large step toward bridging the use of chaos as an interpretive tool and hard examination of chaotic neural activity during perception.