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)

This book is a study of ancient views about 'moral luck'. It examines the fundamental ethical problem that many of the valued constituents of a well-lived life are vulnerable to factors outside a person's control, and asks how this affects our appraisal of persons and their lives. The Greeks made a profound contribution to these questions, yet neither the problems nor the Greek views of them have received the attention they deserve. This book thus recovers a central dimension of Greek (...) thought and addresses major issues in contemporary ethical theory. One of its most original aspects is its interrelated treatment of both literary and philosophical texts. The Fragility of Goodness has proven to be important reading for philosophers and classicists, and its non-technical style makes it accessible to any educated person interested in the difficult problems it tackles. This new edition features an entirely new preface by Martha Nussbaum. (shrink)

The problem of synthetic judgments touches upon the question whether philosophy is in fact capable of making independent truth statements. According to Kant, synthetic judgments formulate the conditions for the possibility of objectively valid knowledge a priori. As far as empirical attempts at reinterpretation of the aprioristic fall short of this ambition, Kant’s a priori goes deeper. This is because modern science strives towards objective knowledge, although its statements are fundamentally fallible. The topic of synthetic a priori thus continues to (...) be relevant. -/- This paper will show that, in order to be viable at all, a modernized version of transcendental philosophy must ‘depart from’ the concepts of “independence from empirics” and/or the “purity” of the aprioristic. Kant’s reflections on non-pure synthetic a priori knowledge already contain attempts at this. Furthermore, the aprioristic validity of knowledge does not exclude the possibility, that it can be discovered empirically. Fries and, subsequently, Nelson proceeded with this separation (initially ascribed to Reichenbach) between the contexts of validity and discovery of knowledge, pointing out that the a priori can indeed be discovered empirically, yet never be proven. -/- Currently, there are still a number of valid reasons for arguing that concepts from transcendental philosophy continue to be of fundamental importance for the modern sciences. However, it must not be neglected that, even within a modernized framework of transcendental philosophy various unsolved problems remain and/or are created (such as the unfeasibility of the aprioristic claim to general validity and necessity, the problem of drawing a clear boundary between the noumenal and phenomenal worlds). Moreover, the “beautiful structure” of the Kantian system, which constitutes much of its persuasive strength, is lost. (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)

Shepherd propounds a theory of mind with a fair claim to be better than Hume’s at explaining the sources of commonly held human beliefs about causal necessity due largely to her relational theory of sense perception. In comparison with Hume’s account, it incorporates a more sophisticated treatment of mental representation, especially the role of relational structure and logical form. Most important, perhaps, Shepherd’s theory enforces the division, obscured by Hume, between the evidence of necessity and the metaphysical foundation of necessity.

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)

Introduction: Thinking, writing, and reading about the real -- Dialectic and the real : Lacan, Hegel, and the alchemy of après-coup -- 'Reality' and the real : culture as anamorphosis -- The real of sexual difference : imagining, thinking, being -- Ethics and the real : the ungodly virtues of psychoanalysis -- Politics, or, the art of the impossible.

The genetically-modified-organism (GMO) experience has been prominent in motivating science, industry, and regulatory communities to address the social and ethical dimensions of nanotechnology. However, there are some significant problems with the GMO-nanotech analogy. First, it overstates the likelihood of a GMO-like backlash against nanotechnology. Second, it invites misconceptions about the reasons for public engagement and social and ethical issues research as well as their appropriate roles in nanotech research, development, application, commercialization, and regulatory processes. After an explication of the standard (...) GMO-Nanotech analogy, these two problems are discussed in turn. (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 lack of resolution in the debate about the Bible’s environmental despotism or stewardship may be resolved by more literal and literary approaches. When the Bible is examined in its own terms, rather than in those of current environmentalism, the Bible’s own perspectives on nature and human ecology emerge. The Hebrew Bible’s principal environmental theme is of nature’s assistance in divine retribution. The Bible’s frequent deployment of contradiction as a literary device, however, tempers this perspective to present amoral, yet multi-sided (...) view of nature. (shrink)

Philosophical interest in forgiveness has seen a resurgence. This interest reflects, at least in part, a large body of new work in psychology, several newsworthy cases of institutional apology and forgiveness, and intense and increased attention to the practices surrounding responsibility, blame, and praise. In this book, some of the world's leading philosophers present twelve entirely new essays on forgiveness. Some contributors have been writing about forgiveness for decades. Others have taken the opportunity here to develop their thinking about forgiveness (...) they broached in other work. For some contributors, this is their first time writing on forgiveness. While all the contributions address core questions about the nature and norms of forgiveness, they also collectively break new ground by raising entirely new questions, offering original proposals and arguments, and making connections to the topics of free will, moral responsibility, collective wrongdoing, apology, religion, and our emotions. (shrink)

When covering traumatic events, novice journalists frequently face situations they are rarely prepared to resolve. This paper highlights ethical dilemmas faced by journalists who participated in a focus group exploring the news media's trauma coverage. Major themes included professional obligations versus ethical responsibilities, journalists' perceived status and roles, permissible harms, and inexperience. Instructional classroom simulations based on experiential learning theory can bridge the gap between the theory of ethical trauma reporting and realities journalists face when covering events that are often (...) chaotic and unpredictable by their very nature. A simulation outline that can be used by journalism instructors is provided. (shrink)

This paper takes as its starting point the thesis that one is responsible for one’s actions insofar as one has the ability to act for good reasons. Such a view faces a challenge: it is plausible that only beings with the ability to reflect are responsible agents, and yet it seems that not only is it possible to act for reasons without reflecting, it seems to happen quite frequently. Thus, advocates of the rational-ability view of responsibility must either reject as (...) a necessary condition that responsible agents must have the ability to reflect, or locate a plausible role for reflective ability. In this paper, I propose and assess a variety of ways to meet this challenge. (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)

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.

The problem for the CNS in any particular movement task is to coordinate the various frames of reference appropriate to the task. Control variables are determined by this coordination. The coordination problem varies greatly from task to task, and so no single set of control variables is likely to account for a broad range of movement tasks.

Jakob Friedrich Fries (1773–1843) zählt sicherlich zu den bedeutendsten Denkern der auf Kant folgenden Phase der deutschen Philosophie. Das wird in eindrucksvoller Weise durch die Beiträge dieses Bandes belegt, die aus Vorträgen auf dem Fries-Symposion hervorgingen, das im Oktober 1997 an der Friedrich-Schiller-Universität Jena stattfand. Die Autoren beleuchten die Lebensumstände von Fries, ordnen sein Werk philosophiegeschichtlich ein und setzen sich systematisch mit erkenntnistheoretischen, naturphilosophischen, wissenschaftstheoretischen und politischen Aspekten seiner Philosophie auseinander. Auch die Rezeption des Fries’schen Werkes bei Naturwissenschaftlern wie M. (...) J. Schleiden und Philosophen wie E. F. Fries und L. Nelson kommt zur Sprache. (shrink)

Jones's analysis of Seneca kinship semantics gets some of the facts about close relatives wrong, and his mechanism for extending the analysis to distant relatives does not work.