We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical and (...) moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finitegoal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases. (shrink)

Interest in German Romanticism has been revitalized in recent years by new post-structural, interdisciplinary, and intertextual perspectives. However until now this renewed interest has not led to a re-examination of Jakob Böhme's formative influence on.

This paper proposes that there is a kind of moral luck that hasn’t been recognized in the philosophical literature: luck in the ‘wide’ contents of one’s concepts. We will treat moral luck as occurring when an agent is morally responsible for X—when X is a matter of luck for that agent. If moral luck is possible and content externalism is true, then there is a heretofore unrecognized kind of moral luck. We call it “conceptual moral luck.” This new kind of (...) moral luck poses significant problems for two major theories of morally responsible agency, Agent-Causal Libertarianism and the Real Self View. (shrink)

Effective documentation is considered a core competency for clinical ethics consultation. Ethics consultants within the Cleveland Clinic in Cleveland, Ohio, observed variation in the formatting of ethics chart notes across consultants and realized that this formatting was based on their own views of effectiveness. To minimize variation and optimize the readability and understandability of ethics chart notes for end users, a team undertook a quality improvement project to assess the formatting preferences of healthcare professionals who rely on ethics consultation notes. (...) The team developed three sample templates and conducted interviews with stakeholders to understand their preferences. A single standardized template was developed based on the preferences that emerged, which all consultants on the ethics consultation service then utilized. In the first five months of implementation, the percentage of end user respondents marking the highest Likert scale option on a post-consultation survey regarding whether the ethics consultation service provided helpful documentation increased from 60 percent to 72 percent compared to the same five-month period in the year prior. (shrink)

Enlightenment - both the phenomenon specific to the eighteenth century and the continuing trend in Western thought - is an attempt to dispel ignorance, achieve mastery of a potentially hostile environment, and contain fear of the unknown by promoting science and rationality. Enlightenment is often accompanied and challenged by countercultures such as German Romanticism, which explored the nature of fear and deployed it as a corrective to the excesses of rationalism. The Aesthetics of Fear in German Romanticism uncovers the formative (...) role this movement played in the development of dark or negative aesthetics. Recovering a missing chapter in the history of the aesthetics of fear, Paola Mayer illustrates that Romanticism was a crucial transitional phase between the eighteenth-century sublime and the early twentieth-century uncanny. Mayer puts literature and philosophy in dialogue, examining how German Romantic literature employed narratives of fear to radicalize and then subvert the status quo in society, culture, and science. She traces the development of this aesthetic from its inception with pre-Romantics such as Jean Paul Richter to its end in Joseph von Eichendorff's critical retrospective, and juxtaposes canonical authors such as E.T.A. Hoffmann - the father of the modern fantastic - with writers who have previously been ignored. Today, when the dark side of science looms in the foreground, The Aesthetics of Fear in German Romanticism points to the power of a literary movement to construct competing currents of thought. (shrink)