Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Although Western biomedical ethics emphasizes respect for autonomy, the medical decision-making of Muslim patients interacting with Western healthcare systems is more likely to be motivated by relational ethical and religious commitments that reflect the ideals of equity, reciprocity, and justice. Based on an in-depth cross-cultural comparison of Islamic and Western systems of biomedical ethics and an assessment of conceptual alignments and differences, we argue that, when working with Muslim patients, an ethics of respect extends to facilitating decision-making grounded in the (...) patient’s justice-related customs, beliefs, and obligations. We offer an overview of the philosophical contestations of autonomy-enhancing practices from the Islamic tradition of biomedical ethics, and examples that demonstrate a recommended shift of emphasis from an autonomy-centered to a justice-focused approach to culturally competent agency-promotion. (shrink)

I argue that the use of the separateness of persons in the debate between the priority view and the competing claims view is deeply flawed. In making the case, I argue for three points. First, that...

In this chapter, I explore moral competence as a central condition on moral responsibility. I distinguish two main conceptions. On the first, a morally competent agent is someone who knows right from wrong. On the second, a morally competent agent is someone who responds aptly to reasons. These two conceptions merit separate treatment as they offer different insights on how and why moral competence might be compromised. This distinction is of particular relevance since the chapter critically examines a (...) standard assumption stating that whenever a mental disorder impacts moral competence, it decreases its scope (on the first conception) or precision (on the second). In close conversation with the memoir literatures on bipolar disorder, autism and schizophrenia, I argue that moral competence may also be affected by what looks like increases in scope or precision; moreover, neither impact – decrease or increase – necessarily undermines moral competence in and of itself; oftentimes, either could enhance it in a reliable way. Finally, by critically revisiting the ecological or scaffolding approach to moral responsibility, I show that moral competence is best understood as a practical way of knowing right from wrong embedded in daily routines and habits, and irreducible to propositional understanding or intellectual skills. (shrink)

Noting the pervasiveness of the adoption of "responsibility" as a core ideal of neoliberal governance, the contributors to Competing Responsibilities challenge contemporary understandings and critiques of that concept in political, social, and ethical life. They reveal that neoliberalism's reification of the responsible subject masks the myriad forms of individual and collective responsibility that people engage with in their everyday lives, from accountability, self-sufficiency, and prudence to care, obligation, and culpability. The essays—which combine social theory with ethnographic research from Europe, North (...) America, Africa, and New Zealand—address a wide range of topics, including critiques of corporate social responsibility practices; the relationships between public and private responsibilities in the context of state violence; the tension between calls on individuals and imperatives to groups to prevent the transmission of HIV; audit culture; and how health is cast as a citizenship issue. Competing Responsibilities allows for the examination of modes of responsibility that extend, challenge, or coexist with the neoliberal focus on the individual cultivation of the self. Contributors Barry D. Adam, Elizabeth Anne Davis, Filippa Lentzos, Jessica Robbins-Ruszkowski, Nikolas Rose, Rosalind Shaw, Cris Shore, Jessica M. Smith, Susanna Trnka, Catherine Trundle, Jarrett Zigon. (shrink)

This book is an essential guide for veterinarians, veterinary faculty and policymakers for understanding the core competencies of a fresh veterinarian. The book briefly covers competencies in preclinical, paraclinical, and clinical subjects including anatomy, physiology, biochemistry, veterinary jurisprudence, animal management & welfare including nutrition and breeding, infectious and non-infectious diseases, disease epidemiology, diagnosis, and treatment, prevention, control and zoonoses, surgical and other clinical interventions. The book further includes other competencies, including biologicals, anti-mortem, and post-mortem inspection, certifications, applied one health aspects, (...) review and analysis of scientific evidence, international trade and regulations, and organization of veterinary services. It also highlights the importance of effective communication, interpersonal skills, record keeping and management of a small veterinary hospital, health informatics, etc. The book breakdowns the must-have competencies of a global veterinarian into different topics and subtopics for easy comprehension and further learning. It enables the professional standard-setting & regulatory bodies and academicians in improved curricula designing and implementation and more importantly tries to bring uniformity in day one veterinary graduates’ competencies globally, enhancing the movement and employability of veterinarians across the world. (shrink)

I have two main goals in this paper. My first goal is to sketch a new view of color perception. The core of the view can be expressed in the following two theses: (i) the overarching function of color vision is to enable and enhance the manifestation of relevant (species-specific) competences and (ii) color experiences are correct when they result from processing that directly and non-accidentally subserves the manifestation of such competences. My second goal is to show that the view (...) can accommodate and account for a wide variety of color perceptual phenomena, including many problem cases. Importantly, the framework allows us to differentiate between two kinds of good cases of color perception: ideal cases where the demands of the relevant competences converge and non-ideal cases where the demands of the relevant competences diverge and clash. (shrink)

Designed specifically for the educational needs of RN to BSN students This is a unique, innovative professional nursing ethics textbook designed specifically for the educational needs of RN to BSN students. Written by experts in the field, it discusses ethical concepts geared to the licensed nurse who has spent several years in practice but is learning high-level concepts and applications. The text addresses different areas of professional practice and is rich with case studies illustrating clinical scenarios involving ethical awareness and (...) decision-making. The book fulfills the necessary criteria for the AACN Essentials for Baccalaureate Education and the QSEN and ISOM competencies. Clear and concise, the text relates content to the nurse’s current practice and professional development without extraneous information typically included in other texts. Progressing from simple to complex, chapters build on previous practice experience to focus on ethical decision-making in a variety of practice environments. The book incorporates a “four boxes” decision-making model and addresses essential communication skills, how to recognize and resolve moral distress, and the role of an ethics committee. It discusses common ethical issues likely to be encountered and ethical practice as it relates to quality and safety. Case Study Dilemmas that include evidence-based research provide the opportunity to apply ethical decision-making principles. QSEN application principles are also featured in each chapter, and interactive exercises and questions and PowerPoints provide further opportunity for critical thinking. Key Features: Addresses the specific needs of students in the RN to BSN course Fulfills AACN Essentials, IOM Competencies, and QSEN KSAs Builds upon previous practice experience of RN to BSN students Discusses ethical decision-making in a variety of practice environments Includes Case Study Dilemmas to apply ethical decision-making principles. (shrink)

The main objective of this study is to identify the socioemotional competencies of adolescents in secondary education who are currently in the first grade of secondary school (school year 2022-2023), which contribute to a better interaction with their peers and environment, in addition to preventing possible risk behaviors. It will be approached from a quantitative approach, with a descriptive scope. The sample consists of 19 students from a private institution, located in the municipality of Guadalupe, Zac. A questionnaire called emociogram (...) was applied through the Habilmind platform, to identify the main characteristics regarding the emotional scale, which in turn is composed of five subscales such as: empathy, assertiveness, interpersonal emotional regulation, teamwork and conflict resolution. The results show us some areas of opportunity that should be emphasized in order to improve the results and thus improve the socioemotional competencies of adolescents. (shrink)

I argue against traditional virtue epistemology on which knowledge is a success due to a competence to believe truly, by revealing an in-principle problem with the traditional virtue epistemologist’s explanation of Gettier cases. The argument eliminates one of the last plausible explanation of Gettier cases, and so of knowledge, in terms of non-factive mental states and non-mental conditions. I then I develop and defend a different kind of virtue epistemology, on which knowledge is an exercise of a competence (...) to know. I show how the account, while circular, is not viciously so. It explains both how knowledge is a mental state, as well as the relationship between knowledge and justification, including justified false beliefs and Gettier cases. Moreover, although direct virtue epistemology is compatible with many views on the nature of belief, it can explain how knowledge might be metaphysically more fundamental than belief as well. (shrink)

A competence model describes the abstract structure of a solution to some problem. or class of problems, facing the would-be intelligent system. Competence models can be quite derailed, specifying far more than merely the function to be computed. But for all that, they are pitched at some level of abstraction from the details of any particular algorithm or processing strategy which may be said to realize the competence. Indeed, it is the point and virtue of such models (...) to specify some equivalence class of algorithms/processing strategies so that the common properties highlighted by the chosen class may feature in psychologically interesting accounts. A question arises concerning the type of relation a theorist might expect to hold between such a competence model and a psychologically real processing strategy. Classical work in cognitive science expects the actual processing to depend on explicit or tacit knowledge of the competence theory. Connectionist work, for reasons to be explained, represents a departure from this norm. But the precise way in which a connectionist approach may disturb the satisfying classical symmetry of competence and processing has yet to be properly specified. A standard ?Newtonian? connectionist account, due to Paul Smolensky, is discussed and contrasted with a somewhat different ?rogue? account. A standard connectionist understanding has it that a classical competence theory describes an idealized subset of a network's behaviour. But the network's behaviour is not to be explained by its embodying explicit or tacit knowledge of the information laid out in the competence theory. A rogue model, by contrast, posits either two systems, or two aspects of a single system, such that one system does indeed embody the knowledge laid out in the competence theory. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how-to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

I argue that wrongdoers may be open to moral blame even if they lacked the capacity to respond to the moral considerations that counted against their behavior. My initial argument turns on the suggestion that even an agent who cannot respond to specific moral considerations may still guide her behavior by her judgments about reasons. I argue that this explanation of a wrongdoer’s behavior can qualify her for blame even if her capacity for moral understanding is impaired. A second argument (...) is based on the observation that even when a blameworthy wrongdoer could have responded to moral considerations, this is often not relevant to her blameworthiness. Finally, I argue against the view that because blame communicates moral demands, only agents who can be reached by such communication are properly blamed. I contend that a person victimized by a wrongdoer with an impaired capacity for moral understanding may protest her victimization in a way that counts as a form of moral blame even though it does not primarily express a moral demand or attempt to initiate moral dialogue. (shrink)

Because corporate social responsibility can be beneficial to both companies and its stakeholders, interest in factors that support CSR performance has grown in recent years. A thorough integration of CSR in core business processes is particularly important for achieving effective long-term CSR practices. Here, we explored the individual CSR-related competencies that support CSR implementation in a corporate context. First, a systematic literature review was performed in which relevant scientific articles were identified and analyzed. Next, 28 CSR directors and managers were (...) interviewed. The literature review complemented with interview data resulted in the following eight distinct CSR-related competencies: Anticipating CSR challenges; Understanding CSR-relevant systems and subsystems; Understanding CSR-relevant standards; CSR management competencies, including Leading CSR programs, Managing CSR programs, and Identifying and realizing CSR-related business opportunities; Realizing CSR-supportive interpersonal processes; Employing CSR-supportive personal characteristics and attitudes; Personal value-driven competencies, including Ethical normative competencies, Balancing personal ethical values and business objectives, and Realizing self-regulated CSR-related behaviors and active involvement; and Reflecting on personal CSR views and experiences. Based on these results, implications for further research on this topic, as well as implications for practitioners, are discussed. (shrink)

According to the principle of patient autonomy, patients have the right to be self-determining in decisions about their own medical care, which includes the right to refuse treatment. However, a treatment refusal may legitimately be overridden in cases where the decision is judged to be incompetent. It has recently been proposed that in assessments of competence, attention should be paid to the evaluative judgments that guide patients' treatment decisions.In this paper I examine this claim in light of theories of (...) practical rationality, focusing on the difficult case of an anorexic person who is judged to be competent and refuses treatment, thereby putting themselves at risk of serious harm. I argue that the standard criteria for competence assess whether a treatment decision satisfies the goals of practical decision-making, and that this same criterion can be applied to a patient's decision-guiding commitments. As a consequence I propose that a particular understanding of practical rationality offers a theoretical framework for justifying involuntary treatment in the anorexia case. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

In the study of cognitive processes, limitations on computational resources (computing time and memory space) are usually considered to be beyond the scope of a theory of competence, and to be exclusively relevant to the study of performance. Starting from considerations derived from the theory of computational complexity, in this paper I argue that there are good reasons for claiming that some aspects of resource limitations pertain to the domain of a theory of competence.

Whatever societies accept as "knowledge" is embedded in specific epistemological, political and economic power relations. How is knowledge produced and functionalized? What is the difference between knowledge and the sciences? Can there be science without universal truth claims? Questions like these, all of them highly relevant, are discussed in twelve essays from the perspective of Sociology, Law, Cultural Studies and the Humanities.

This book radically counters the optimism sparked by Competence Based Education and Training, an educational philosophy that has re-emerged in Schooling, Vocational and Higher Education in the last decade. CBET supposedly offers a new type of learning that will lead to skilled employment; here, Preston instead presents the competency movement as one which makes the concept of human learning redundant. Starting with its origins in Taylorism, the slaughterhouse and radical behaviourism, the book charts the history of competency education to (...) its position as a global phenomenon today, arguing that competency is opposed to ideas of process, causality and analog human movement that are fundamental to human learning. (shrink)

ABSTRACTAchievements are among the things that make a life good. Assessing the plausibility of this intuitive claim requires an account of the nature of achievements. One necessary condition for achievement appears to be that the achieving agent acted competently, i.e. was not just lucky. I begin by critically assessing existing accounts of anti-luck conditions for achievements in both the ethics and epistemology literature. My own proposal is that a goal is reached competently, only if the actions of the would-be-achiever make (...) success likely, and that this is the reason why she acts that way. (shrink)

Background Head nurses have duties in providing nursing care and ethical supervision to the nurses in the unit. Compliance with the ethical competence framework for head nurses is essential in fostering an ethical climate in the organization. Objective The objective of this research is to study the head nurses’ compliance with the ethical competence framework by the Thailand Nursing and Midwifery Council (TNMC). Methods The study is a qualitative research, using in-depth interviews conducted among 20 head nurses practicing (...) in a super tertiary hospital in Bangkok, Thailand. The sample was selected using a criterion sampling method. The head nurses’ ethical experience relating to work practice was analyzed by thematic analysis. Ethical considerations The ethical approval of this study was obtained from the Committee for Research Ethics (Social Sciences), Mahidol University, and from the Institutional Review Board of the hospital in which the study was conducted. Results From the thematic analysis of the ethical experience practiced by the head nurses, 8 themes and 16 sub-themes were categorized across 5 ethical competencies based on the ethical competence framework by the TNMC. It was found that all the identified themes and sub-themes conformed to the ethical competence framework, and demonstrated the head nurses’ compliance with the framework. Discussion Head nurses’ ethical experience in practice conforms to the ethical competence framework by the TNMC. The framework that is based on the Code of conduct and the nursing culture that places the importance of the seniority system may facilitate the compliance with the ethical competence framework. Conclusion Head nurses demonstrated compliance with the ethical competence framework by the TNMC. Nevertheless, improvements could be done to the framework by adding details such as more examples of ethical decision-making scenarios, personnel’s rights, and social media usage guidelines. (shrink)

Background The enhancement of nursing care quality is closely related to the clinical competence of nurses, making it a crucial component within health systems. Objective The present study investigated the relationship between nurses’ clinical competence, moral identity, and moral injury during the COVID-19 outbreak. Research design This cross-sectional study was carried out among frontline nurses, using the Moral Identity Questionnaire (MIQ), the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP), and the Competency Inventory for Registered Nurse (CIRN) as data (...) collection tools. Participants and research context: The research population for this study consisted of all frontline nurses ( n = 251) employed in a hospital in southern Iran. Sampling was conducted between May 1, 2021 and September 30, 2021, during the COVID-19 outbreak. Ethical considerations The present study received approval from the research ethics committee of Rafsanjan University of Medical Sciences, with project No. 99267 and code of ethics ID No. IR. RUMS.REC.1399.262, dated 15.02.2021. Results According to the study findings, 42.2% of the nurses demonstrated high clinical competence, while 51.4% exhibited moderate clinical competence. The results indicated a positive correlation between moral identity and clinical competence but a negative correlation between moral injury and clinical competence. Furthermore, the variables of moral identity and moral injury were found to predict 10% of the variance in clinical competence. Conclusion According to the results, moral identity and moral injury had an impact on the clinical competence of nurses. Therefore, implementing a program aimed at enhancing moral identity and providing training strategies to address moral injury during crises like the COVID-19 pandemic can lead to improvements in nurses’ clinical competence and the overall quality of care they provide. (shrink)

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, (...) compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand. (shrink)

Competing Explanations of Competing Explanations: Accounting for Conflict Between Scientific and Folk ExplanationsThis paper focuses on the level of people’s explanatory reasoning. It examines why laypeople prefer folk explanations of various physical or biological phenomena to alternative, well‐understood scientific explanations. Shtulman and Legare call this psychological phenomenon “explanatory co‐existence.” On the basis of new experimental data, they evaluate two possible accounts of explanatory co‐existence, a theory‐based and an associative account, and argue that a theory‐based account is the better supported.

A teacher-student relationship (TSR) characterized by closeness promotes student engagement and positive emotional experiences among teachers. The present systematic review questions what the English-language literature reports on the effect of training dedicated to the development of teachers' emotional competences (EC) on these competences and on the TSR quality. 17 articles met the inclusion criteria. The findings suggest that brief EC trainings can sustainably develop teachers’ EC. The small number of articles that have also evaluated the TSR quality prevents to conclude (...) as to the effects of these training courses on this variab. (shrink)

In “Tracking, Competence, and Knowledge,” Ernest Sosa notes that in attempting to account for the conditions for knowledge, externalists have proposed that the justification condition be replaced or supplemented by the requirement that a certain modal relation be obtained between a fact and a subject's belief concerning that fact. While assessing attempts to identify such a relation, he focuses on an account labeled “Cartesian‐tracking”, which accounts for the relation in the form of two conditionals. If a person S believes (...) a proposition P → P P → S believes P. Sosa suggests that be abandoned as a requirement, and that, equipped with his modifications, can offer promising results in connection with skepticism. He argues that modified coupled with the requirement that S's belief be “virtuous” can illuminate the nature of propositional knowledge. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in (...) the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

In this paper I argue that reflection on competence and enfranchisement in relation to profound disability forces re-examination of the grounds of citizenship, with implications for theories of distributive justice in education. The primary purpose is less to point up that some people are disenfranchised without injustice; it is more to advance the view that, since enfranchisement is not an option for some profoundly disabled people, we require a conception of citizenship that is more sensitive to their distinctive needs (...) and interests. (shrink)

The controversy regarding the unit of selection is fundamentally a dispute about what is the correct causal structure of the process of evolution by natural selection and its ontological commitments. By characterizing the process as consisting of two essential steps--interaction and transmission--a singular answer to the unit question becomes ambiguous. With such an account on hand, two recent defenses of competing units of selection are considered. Richard Dawkins maintains that the gene is the appropriate unit of selection and Robert Brandon, (...) in response, argues that the individual organism is better suited to the role. This paper argues that by making explicit the underlying questions that each of these views addresses, the apparent conflict can be resolved. Furthermore, such a resolution allows for a more complete and realistic understanding of the process of evolution by natural selection. (shrink)

Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive to good reasoning about healthcare choices. (...) Vaccine denialists allocate epistemic authority more democratically than do mainstream medical professionals. They also sometimes make truth ascriptions for nonepistemic reasons, fail to recognize legitimate differences in expertiseand competence, and seek uncritical affirmation of their existing beliefs. By focusing on the different epistemic values and practices of vaccine denialists and mainstream medical professionals, I locate my discussion of vaccine denialism within broader debates about rationality. Furthermore, I argue that gender inequality and gendered conceptions of reason are important parts of the explanation of vaccine denialism. Accordingly, I draw upon feminist work—primarily feminist social epistemology—to help explain and evaluate this form of vaccine refusal. (shrink)

This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using (...) the MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from (...) the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine. (shrink)

Meaningful work is a key element of positive functioning of employees, but what makes work meaningful? Based on research on self-determination theory, basic psychological needs, and prosocial impact, we suggest that there are four psychological satisfactions that substantially influence work meaningfulness across cultures: autonomy (sense of volition), competence (sense of efficacy), relatedness (sense of caring relationships), and beneficence (sense of making a positive contribution). We test the relationships between these satisfactions and perceived meaningful work in Finland (n = 594, (...) employees of several organizations), India (n = 342, collected through Mturk), and the USA (n = 373, collected through Mturk). Regression analyses show that – except for competence in USA – all four satisfactions are significantly and independently associated with meaningful work. Moreover, structural equation modeling shows that they fully mediated the relationship between occupational position and work meaningfulness in India and in the USA. In sum, the results support the importance of these four satisfactions in explaining the psychological underpinnings of meaningful work. (shrink)