As ethics committees and programs become integrated into the “usual business” of healthcare organizations, they are likely to face the predicament of responding to greater demands for service and higher expectations, without an influx of additional resources. This situation demands that ethics committees and programs allocate their scarce resources (including their time, skills and funds) strategically, rather than lurching from one ad hoc request to another; finding ways to maximize the effectiveness, efficiency, impact and quality of ethics services is essential (...) in today’s competitive environment. How can Hospital Ethics Committees (HECs) begin the process of strategic priority-setting to ensure they are delivering services where and how they are most needed? This paper describes the creation of the Clinical Ethics Needs Assessment Survey (CENAS) as a tool to understand interprofessional staff perceptions of the organization’s ethical climate, challenging ethical issues and educational priorities. The CENAS was designed to support informed resource allocation and advocacy by HECs. By sharing our process of developing and validating this ethics needs assessment survey we hope to enable strategic priority-setting in other resource-strapped ethics programs, and to empower HECs to shift their focus to more proactive, quality-focused initiatives. (shrink)
I address an argument in value theory which threatens to render nonsensical many debates in modern ethics. Almotahari and Hosein’s :1485–1508, 2015) argument against the property of goodness simpliciter is presented. I criticise the linguistic tests they use in their argument, suggesting they do not provide much support for their conclusion. I draw a weaker conclusion from their argument, and argue that defenders of goodness simpliciter have not responded adequately to this milder conclusion. I go on to argue that moral (...) philosophers ought to abandon the property of goodness simpliciter and focus their attention on the property of being a good state of affairs. I defend this property against Almotahari and Hosein’s criticism, and give reasons to think it is at the heart of moral theory. (shrink)
This paper details the implementation of the Clinical Ethics Needs Assessment Survey (CENAS) through a pilot study in five units within Hamilton Health Sciences. We describe how these pilot sites were selected, how we implemented the survey, the significant results and our interpretation of the findings. The primary goal of this paper is to share our experiences using this tool, specifically the challenges we encountered conducting a staff ethics needs assessment across different units in a large teaching hospital, and the (...) facilitators to our success. We conclude with a discussion of the limitations of this study, our plans for using the results to develop a proactive ethics education strategy, and suggestions for other organizations wishing to adapt the CENAS to assess their staff ethics needs. Our secondary goal is to advance the “quality agenda” for ethics programs by demonstrating how a tool like the CENAS can be used to design more effective educational interventions, and to support strategic planning and proactive priority-setting for ethics programs. (shrink)
It is 2 a.m. I am very sick. I am not sure how long I have been hospitalized. The last two or three days have been a blur, a parade of procedures and people. I had a bloody debridement for a severe, large, and grossly infected stage four wound‐the first wound I have had since I was paralyzed in 1978. I know the next six months or longer are going to be exceedingly difficult. I will be bedbound for months, dependent (...) upon others for the first time in my adult life. As these thoughts are coursing through my mind, a physician I have never met and the registered nurse on duty appear at my door. As they put on their gowns I am weary but hopeful. Surely there is something that can be done to stop the vomiting. The physician examines me with the nurse's help. Like many other hospitalists that have examined me, he is coldly efficient. At some point, he asks the nurse to get a new medication. What transpired after the nurse exited the room has haunted me. Paralyzed me with fear. The hospitalist asked me if I understood the gravity of my condition. He grimly told me I would be bedbound for at least six months and most likely a year or more. That there was a good chance the wound would never heal. If this happened, I would never sit in my wheelchair. I would never be able to work again. Not close to done, he told me I was looking at a life of complete and utter dependence. He went on to tell me I was on powerful antibiotics that could cause significant organ damage. He informed me I had the right to forego any medication, including the lifesaving antibiotics. If I chose not to continue with the current therapy, I could be made very comfortable. I would feel no pain or discomfort at all. Although not explicitly stated, the message was loud and clear. I can help you die peacefully. (shrink)
Consequentialists claim that their theory is simply that the right action is whichever one will lead to the best state of affairs - and that this formulation provides a powerful intuitive ground for accepting consequentialism. Recent arguments in value theory threaten to show that this formulation lacks either coherent meaning, because states of affairs cannot be good simpliciter, or philosophical power, because their goodness provides no reason to bring them about. I respond to two such arguments - from Judith Jarvis (...) Thomson and Richard Kraut - contending that none can be made to work in a way which undercuts consequentialism's simple formulation. (shrink)
Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.
In an attempt to learn from COVID-19, this essay features six responses to the question: what did COVID-19 teach us, expose in us, or purge out of us when it comes to spiritual formation in Christ? Each response was written independently of the others by one of the coauthors. Diane J. Chandler focuses in on how COVID-19 exposed grievous inequities for ethnic groups in the American church and broader society. Kelly M. Kapic reminds us of the goodness of human finitude (...) and how COVID restrictions have forced many of us to embrace our limitations. Siang-Yang Tan reflects on eight lessons he has learned during this pandemic year in his role shepherding a local church. James C. Wilhoit calls us to consider the structures that are needed for local church leadership to make wise and godly decisions in times of crisis. Richard Peace draws our attention to what might be learned from the forced monasticism brought about by COVID-19 quarantines. Finally, Ruth Haley Barton pauses to consider the interdependence of human life that has been dramatically illustrated by this pandemic. While these six responses certainly do not exhaust all there is for the church to learn from COVID, we present them in the spirit of “O Lord, teach us what we do not see” and hope they will inspire your own reflections. (shrink)