Heart disease is the leading cause of death amongst adult Americans and has recently become a top killer worldwide. The direct costs of cardiovascular disease are projected to triple in the next 20 years, from $272.5 billion to $818.1 billion (Heidenreich et al. 2011). Although there has been a decreased incidence and prevalence of ischemic heart disease over the past several decades in the United States, heart failure remains a major cause of morbidity and mortality. In the United States, approximately (...) 500,000 to 700,000 new cases are identified each year (Lloyd-Jones et al. 2009). Heart failure is now the number one diagnosis leading to hospitalization. As such, it is an increasingly heavy economic burden on .. (shrink)

The recent war in Europe, the Ukraine–Russia war, has had a huge impact in the lives of millions of people in the European continent—in the lives of both those who have fled the conflict and of those who have welcomed them with open arms. In this paper, we conduct a philosophical investigation into the issue of hospitality to others, to strangers, to foreigners trying to understand this phenomenon taking place in Europe, and elsewhere. First, we investigate the Jewish Mitzvah of (...) Hospitality by referring to two passages in the Torah that exemplify hospitality and one that instantiates its opposite, hostility to the other, to strangers and foreigners. Following from this, we provide a discussion on Jewish ethics and its deontological and virtue ethics connections. In the last section, we engage with a discussion connecting the field of education and the matter of hospitality. (shrink)

ArgumentIn this article we examine how a leading Israeli hospital gradually became a large biomedical research facility, resembling a huge laboratory. For Chaim Sheba (1908-1971), the founder and first director of Tel-Hashomer Hospital, the massive immigration to Israel in the 1950s was a unique opportunity for research of diverse human populations, especially Jews who had arrived to Israel from Asia and Africa. The paper focuses on the way research and medical practices were integrated and their boundaries blurred, and (...) studies the conditions under which an entire hospital became a research field. Using the case of one of Israel’s prominent medical institutes, we explore and expand upon the idea of “the hospital as a laboratory,” arguing that, for Sheba, it was not only the hospital but the entire country that functioned as a great research site—a vast laboratory that “had no walls.”. (shrink)

Negotiating clinical knowledge: a field study of psychiatric nurses’ everyday communication Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses’ production of clinical knowledge was influenced by the particular social relations on hospital wards. Empirical data stemming from an extended fieldwork at two Danish psychiatric hospital wards were interpreted using interactionistic theory (...) and the metaphor: ‘the game of clinical knowledge’. The results indicated that the nurses’ production of clinical knowledge was highly dependent on the individual nurses’ practical ability to participate in the game. Furthermore, the nurses colluded in their mutual communication to enable the collective display and sense of knowing that protected them against explicit signs of uncertainty about the clinic. The game of clinical knowledge influenced processes of clinical decision‐making among the nurses as the game added to a distorted widening of a ‘fictional distance’ between patients and the representations produced by the nurses. (shrink)

Hospital ethics committees were created in the United States of America in the 1970s. Their aims were the education of the hospital personnel in the field of ethics, the development of policies and the publication of guidelines concerning ethical issues, as well as consultations and case reviews of hospitalized patients when an ethical concern was present. During the last thirty years, these committees disseminated, particularly in Western Europe. In this manuscript, we describe the benefit, but also some (...) difficulties with these committees, and we propose some solutions. The characteristics of these committees are discussed (i.e. typology of members, functioning and legitimacy). Finally, we carefully describe our local hospital clinical ethics committee in Geneva (Switzerland), which was founded in 1994 and it still very active. After fifteen years of experience, we remain strongly in favour of the implementation of such committees in any modern hospital. (shrink)

How to hospitably welcome refugees and migrants presents urgent questions for social and political thought. Current debates can be attributed to three discursive fields. Liberal versions hold that there are good reasons for political and legal limits of hospitality, critical perspectives advocate a renewed cosmopolitanism and, finally, deconstructive perspectives focus on the demand of unconditional hospitality as an absolute ethical requirement. These concepts trouble the conventional congruence of citizenship and bounded territory that make up modern nation states, on the one (...) hand. On the other hand, they affirm the rights of political communities to decide on the contents and the extent of the universal duty to host those endangered. Taking the Mediterranean and the local arena (Lampedusa) as the example, the article, which is based on extensive, multi-sited anthropological field research, engages with the tensions and limits inherent in current notions of hospitality. (shrink)

Hospital ehtics committees are often consulted when cmopeting patient interests blur an otherwise clear course of medical treatment. Nowhere is the potential for competing interests greater than in the field of abosterics, wherer obstetricians have traditionally viewed themselves as having two patients: the pregnant woman and the fetus.

Purpose. Considers the possibility of establishing the Hospitality Philosophy as an independent field of philosophical knowledge. Theoretical basis. Theoretical basis for this issue is the numerous philosophical researches on the topic of hospitality (anthropological, phenomenological, ethical, social-philosophical etc.) and the analysis of its essence and paradigmatic antinomy in the historicalphilosophical way. Scientific novelty. The article attempts to revitalise the notion of philotechnics (φιλοτεχνία) as 'the art of taking care of the guest's welfare' as a possible basic concept of contemporary (...) philosophy of hospitality, which is able to reflect its nature most concisely, including its utilitarian and extra-utilitarian functions – not only a high service level, but also a “humane” attitude towards the guest. Findings. It has been summarized that modern hospitality as a specific human activity needs its own philosophy, which would comprehensively analyze the concept, study the facets and forms of its manifestations, define the worldview paradigm, form a methodology and be able to lead to an understanding of the goals of hospitality, to orient modern hospitality models to achieve certain and clear quality indicators while respecting historically verified value constants. (shrink)

In this essay I discuss my early career as a failed philosophical practitioner when the field of philosophical counseling was still in its infancy. I describe setting up a private practice and discuss various details from my field notes with regards to some of the earliest clients I received. I further depict experimenting with philosophical group therapy in an inpatient psychiatric unit of a general hospital, which by all objective standards turned out to be a disaster. Musings (...) on how philosophy may be successfully applied in the consulting room is considered through a phenomenological-existential approach to therapy. (shrink)

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta‐level and (...) to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research. (shrink)

BackgroundThe theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, (...) ensure that this practice is in line with the overarching goals of this approach and support the development of standards.MethodsWe analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why—and under what circumstances—some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ2 difference tests and Welch’s t-test.ResultsA total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation.ConclusionFrom the client’s point of view, there does not seem to be only one “right” way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations. (shrink)

Nurses who attend patients with psychiatric disorders often encounter ethical dilemmas and experience difficulties in making the right decision. The present study aimed to evaluate the decisions of psychiatric nurses regarding their duty to warn third parties about the dangerousness of the patient, the need for compulsory hospitalization, and the competence of patients. In total, 111 nurses working in the field of psychiatry in Turkey completed a questionnaire form consisting of 33 questions. The nurses generally assessed the decision-making competency (...) of the patient correctly. However, their decisions regarding whether the patient should be compulsorily hospitalized and their understanding of their duty to warn/protect were less consistent. A significant relationship was found between the decisions of the psychiatric nurses and their work experience, them having children, and them having postgraduate education in psychiatric nursing. The nurses stated their desire to be part of the team that decided on ethical problems in psychiatry. (shrink)

Nurses who attend patients with psychiatric disorders often encounter ethical dilemmas and experience difficulties in making the right decision. The present study aimed to evaluate the decisions of psychiatric nurses regarding their duty to warn third parties about the dangerousness of the patient, the need for compulsory hospitalization, and the competence of patients. In total, 111 nurses working in the field of psychiatry in Turkey completed a questionnaire form consisting of 33 questions. The nurses generally assessed the decision-making competency (...) of the patient correctly. However, their decisions regarding whether the patient should be compulsorily hospitalized and their understanding of their duty to warn/protect were less consistent. A significant relationship was found between the decisions of the psychiatric nurses and their work experience, them having children, and them having postgraduate education in psychiatric nursing. The nurses stated their desire to be part of the team that decided on ethical problems in psychiatry. (shrink)

The series friends, rivals, enemies is a seemingly ‘natural’ classification for the relations of states, while the parallel series kin, neighbors, strangers functions as an informal classification system for social relations in general. That we may owe foreigners the hospitality due to strangers has become a matter of discussion among normative theorists, thanks to Kant's Perpetual Peace. Thus the conjunction of friendship and hospitality calls for a conceptual assessment. This assessment uses Aristotle's treatment of friendship (and Derrida's treatment of Aristotle's (...) ‘familial schema’) to establish three primary models of social relations (father to sons, husband to wife, brother to brother). Only ‘brothers’ (agents modeled as brothers) can be friends, rivals, or enemies. Only ‘fathers’ can be hosts who offer strangers the hospitality of the household. By the same token, only ‘fathers’ can be guests or take hostages. Such an assessment brings the conceptual concerns of two fields — international relations and political theory — closer together. In so doing, it rejects anarchy's conceptual hegemony in the field of international relations. (shrink)

In 1987, the School of Hotel Administration and the Department of Human Service Studies at Cornell University joined efforts to design and implement a new course entitled Housing and Feeding the Homeless. This course has allowed students to use their skills and expertise in hospitality management and human service administration to respond to hungry and homeless individuals in the community. This article outlines the origin of the course and objectives, structure, content, and field placement design. It also describes students' (...) reaction to the course and highlights issues of concern for anyone interested in offering a similar course. (shrink)

When a child is hospitalized, the parents find themselves in an unfamiliar environment and their parental role changes. They are in a stressful and often anxiety-filled situation and it may be difficult for them to participate in decisions. The purpose of this study was to examine the extent to which parents participate in decisions during the course of events when their child is hospitalized. Thirty-five parents of 24 children (aged 5 months to 18 years) were followed by mobile observation during (...) their child’s hospitalization in a paediatric department in Sweden. Three researchers analysed field notes in three steps, using manifest and latent coding. In step 1, 119 situations that included a decision process were identified. In step 2, the situations were assessed according to a five-level scale concerning how the parents’ wishes, desires or values had been respected. In step 3, each situation was scrutinized with respect to factors influencing the extent of the parents’ participation. The results showed that parents have varying ability to be involved in decision making. Professionals need to communicate more openly with them in order to identify and satisfy their needs because some parents are unwilling or incapable of expressing them. (shrink)

The immigrant problem, one of the most striking socio-pathological events of our day, is more often raised in the context of political issues. While these debates are driven by local and political interests, what is hidden behind political calculations is the tragic position of the migrant. The migrant, who comes to the agenda with political debates, takes on an extremely negative image in terms of social relations. The problem with the sameness of "We" is that the "Other" or the immigrant, (...) as the expression of an element that is incompatible with the local culture, is pushed from the field of "I" into otherness, and is evaluated as an element of conflict that does not force the transformation of publicity on the social level. Although the interest-based determining power of politics has negative effects on the formation of sufficient human common sense regarding the problem, there is an intense debate in the philosophical literature on the basis of Immanuel Kant, Hannah Arendt, Emmanuel Lévinas. Most of the studies put forward in the context of associating the ideas put forward by the thinkers in question with immigration have kept the research deep but limited in scope. In our study, the subject was not deemed necessary in depth, it was sufficient to discuss the basic thinkers, views and the basic dynamics of the relevant views on the subject, and care was taken to outline the relevant literature. Levinas, who stands out as one of the dynamics of the basic literature on immigration and the emphasis on "Otherness", pointed to Western thought that did not prioritize ethical relations as the cause of the political crises of his time. Levinas tries to handle the problem of Otherness, which emerges as a political, ethical and legal problem of the tension that the "I"-centered way of thinking, which brings about sameness, will experience against the "Other", in a different way from the tradition of thought that prioritizes ontology. In the thought of Levinas, who considers the “Other” as an alternative field of sameness, the transcendence dimension of Otherness has the function of removing the Self from narcissism through the discovery or tension of the alterity in the "Other" rather than the sameness of the position of the "I" against the "Others". There is a belief that the "Other", embodied in transcendent Otherness, will lead to an act of unconditional hospitality in the "I". It can be seen that Arendt also discusses the problems that Levinas puts on the agenda. In the context of "Otherness", Arendt's criticisms of the concept of right, which manifests itself with a political ontological understanding rather than an ethical relationship as expressed in Levinas, are in question. Thus, while it becomes possible to question the legal structure that does not include the “Other” in the political sphere, the importance of the "Other" for political discourse is also revealed. At this point, conditional hospitality comes to the fore in the context of foreigner's right, which we encounter in Kant. However, Derrida, who would state that Levinas's unconditional hospitality had practical problems, also found Kant's conditional hospitality problematic. The immigrant, as the “Other” of our time, which is hoped to gain an ethical-political basis of thought in the context of the idea of hospitality, aims to re-discuss the idea of hospitality developed in the existing literature, while also being a call to produce thoughts on the philosophical understanding of the immigrant and the importance of creating a philosophy of immigration. (shrink)

Re-reading Derrida: Perspectives on Mourning and its Hospitalities, edited by Tony Thwaites and Judith Seaboyer, is a uniquely collaborative exploration of the legacies of Jacques Derrida. Scholars from a wide variety of fields respond to his work by addressing such issues as the politics of the memorial, poetry, trauma, film, neoliberalism, the novel, and psychoanalysis--and then, in the processes of revision, they respond to each other.

Hotel architectural design plays a critical role in the hospitality experiences of consumers, and it is important to consider that people may have different aesthetic cognitions toward the sensory properties of nature, such as its color and texture, as well as the landscape. While neuroaesthetics has emerged as a nascent field in hospitality research, few studies have investigated how nature reflects aesthetic experiences in the human brain. Moreover, the neuroaesthetic interpretation of architecture through the aesthetic triad is a novel (...) interdisciplinary field. A field survey conducted at Amanfayun, a hotel in Hangzhou, China, in support of our propositions proves that sensory-motor, knowledge-meaning, and emotion valuation systems play key roles in appreciating architectural aesthetics. This study demonstrates that the evaluation of fluency, complexity, and naturalistic patterns of an architectural masterpiece is achieved through the sensory-motor systems. Our results also prove that familiarity, expectations, context, and cultural background directly affect the aesthetic knowledge of an individual and the meaning of architecture. Moreover, the interaction of sensory-motor and knowledge elements is uniformly moderated by the emotion valuation systems, resulting in a balanced appreciation of aesthetic architecture. Finally, the study reveals the central roles of culture and nature in cognitive rejuvenation. (shrink)

The multidisciplinary nature of bioethics can result in narrow sub-specialists within the field, whose work reflects the issues and concerns most relevant to their home discipline. This can result in work which is insensitive to the important ways in which particular areas of bioethics are interrelated, and which (while viable in the context of the sub-specialty) is not viable in a broader context. The narrow focus of many healthcare ethics committees on issues directly related to clinical patient care can (...) exacerbate this problem. Increasingly, issues in the clinical care of patients cannot be separated from issues in research, organizational ethics, and public policy. I argue that these problems call for a need to identify core areas for bioethics education. This is especially true for education of hospital ethics committees, which incresingly face complex cases involving concerns that fall outside traditional patient care issues. I then consider nine areas examined in detail in A Companion to Bioethics edited by Helga Kuhse and Peter Singer, as potential candidates for core areas of bioethics education. At the same time, I evaluate the range of issues examined in each area of the book, in the context of the books ability to provide an introduction to each area. (shrink)

Natural disasters in populated areas may result in massive casualties and extensive destruction of infrastructure. Humanitarian aid delegations may have to cope with the complicated issue of patient prioritization under conditions of severe resource scarcity. A triage model, consisting of five principles, is proposed for the prioritization of patients, and it is argued that rational and reasonable agents would agree upon them. The Israel Defense Force's humanitarian mission to Haiti following the 2010 earthquake serves as a case study for the (...) various considerations taken into account when designing the ethical-clinical policy of field hospitals. The discussion focuses on three applications: the decision to include an intensive care unit, the decision to include obstetrics and neonatal units, and the treatment policy for compound fractures. (shrink)

In the hyper-mobile world of today, the industry of tourism and cultural entertainment, witnesses the multiplication of opportunities to travel. According to John Urry, we inhabit mobile cultures where being kind to strangers is a positive cultural value. This reality archives the bloody past of hospitality, which from the ideological fields facilitated, for instance, the conquest of the Americas. In the present discussion, I delve into the world of literature and explore Viaje a caballo por las provincias Argentinas [Journey on (...) horseback across the provinces of Argentine] a work originally written by William Mac Cann, a British businessman who visited the country between 1947 and 1948. His observations not only reveal the collective patterns of behaviour that have remained part of daily life up to date. The volume describes the attempts of an elite interested in creating a united, but subordinated, image of society, and illuminates the diverse mechanisms of imperial expansion. Hospitality plays a crucial role in the hierarchy of travellers presented in the book, with some belonging to the higher classes of society and others unnamed. (shrink)

The philosophy of family‐centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision‐making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents (...) must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. (shrink)

This article reports on a researcher's experience of being invited to improve upon an organisational situation in a hospital in Denmark. Being engaged with different networks of participants in the organisational situation, the researcher found himself wrapped up in various agendas, with different sections of the staff trying to persuade him to support their own respective interests. The article theorises these persuasions as "seductions." Consequently, the task of the researcher involves selecting, prioritising, and working upon his connections with various (...) networks, while each continues to represent a different set of values, expectations, interests, and experiences. Based on this conceptualisation, the article interrogates the notion of interventionist research. Intervention is not limited only to a simple one-way causation where the interventionist does something useful in a studied field; it also involves engagement with multiple networks present in the field, each of which tries to seduce the researcher in order to befriend this potentially powerful collaborator. Using the term "interference," rather than intervention, to represent the researcher’s action, the article suggests that the researcher is often not able to control the effect of his or her action unilaterally. Neither is the researcher able to establish an overarching perspective which can be used to evaluate the final outcome. The article calls for fresh thinking on how a researcher may be engaged usefully in an organisational situation, working within the boundaries defined by the institutional logic, confronting the seductions from multiple sources, and still seeking to maintain a ground that justifies one's identity as a researcher. (shrink)

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical (...) and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families. (shrink)

Objective: To explore the ways in which health care practitioners working within the morally contested area of prenatal screening balance their professional and private moral values.Design: Qualitative study incorporating semistructured interviews with health practitioners followed by multidisciplinary discussion groups led by a health care ethicist.Setting: Inner city teaching hospital and district general hospital situated in South East England.Participants: Seventy practitioners whose work relates directly or indirectly to perinatal care.Results: Practitioners managed the interface between their professional and private moral (...) values in a variety of ways. Two key categories emerged: “tolerators”, and “facilitators”. The majority of practitioners fell into the “facilitator” category. Many “facilitators” felt comfortable with the prevailing ethos within their unit, and appeared unlikely to feel challenged unless the ethos was radically challenged. For others, the separation of personal and professional moral values was a daily struggle. In the “tolerator” group, some practitioners sought to influence the service offered directly, whereas others placed limits on how they themselves would contribute to practices they considered immoral.Conclusions: The “official” commitment to non-directiveness does not encourage open debate between professionals working in morally contested fields. It is important that practical means can be found to support practitioners and encourage debate. Otherwise, it is argued, these fields may come to be staffed by people with homogeneous moral views. This lack of diversity could lead to a lack of critical analysis and debate among staff about the ethos and standards of care within their unit. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, (...) two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

RESUMEN: El presente artículo tiene por objetivo analizar la jurisprudencia de la Corte Interamericana de Derechos Humanos en materia de movilidad humana bajo la óptica de la doctrina filosófica del cosmopolitismo. A partir del desarrollo de las principales características de esta doctrina en relación a la migración (tensión entre nacionalidad, ciudadanía y derechos, así como las perspectivas actuales de solidaridad global), se sostendrá que la jurisprudencia interamericana tiende hacia al cosmopolitismo.ABSTRACT: The purpose of this article is to analyze the jurisprudence (...) of the Inter - American Court of Human Rights in the field of human mobility from the perspective of the philosophical doctrine of cosmopolitanism. From the development of the main characteristics of this doctrine in relation to migration (conflict between nationality, citizenship and rights, as well as current perspectives of global solidarity), it will be argued that inter-American jurisprudence tends toward cosmopolitanism.PALABRAS CLAVE: cosmopolitismo, ciudadanía, migración, Corte Interamericana de Derechos Humanos.KEYWORDS: cosmopolitanism, citizenship, migration, Inter-American Court of Human Rights. (shrink)

The meeting of rationalities is the core of the psychoanalytic treatment of madness. We see madness as a field of research in the area of historical, political and natural disasters where the social bond disintegrates, language slips away, the unimaginable happens and tried and tested rationalities fail. Faced with the irrationality of a behaviour or delusional episode, we need to find the ‘reason for this unreason’. The patient is a searcher in a disaster area, looking for someone to share (...) the craziness of what is discovered. An analysis of madness more often than not consists of discovering excised – not repressed – truths that are revealed during a heuristic journey taking place over often turbulent sessions. It is the end result of a continually surprising encounter with the rationalities carried by the analyst emerging from similar areas of disturbance, bringing to light common points of view, or transcultural invariants. Based on a brief clinical exchange with an African patient, in which the man who discovered the equations of quantum mechanics had a role, the author draws on the work of Schrödinger with its warnings not to give in to objectivization when we are struggling for meaning. (shrink)

How can one be trained to enter the evolving field of clinical ethics consultation? The classroom is not the proper place to teach clinical ethics consultation; it is best done in a clinical setting. The author maps the elements that might be included in an apprenticeship, and sets out propositions for debate regarding the training needed for clinical ethics consultants and directors of clinical ethics consultation services.

Next SectionEvidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically (...) unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bombs and Roses: The Writing of Anxiety in Henry Green’s CaughtLyndsey Stonebridge (bio)(The firemen saw each other’s faces. They saw the water below a dirty yellow towards the fire; the wharves on that far side low and black, those on the bank they were leaving a pretty rose.... They sat very still, beneath the immensity. For, against it, warehouses, small towers, puny steeples seemed alive with sparks from the (...) mile high pandemonium of flame reflected in the quaking sky. This fan, a roaring red gold, pulsed rose at the outside edge, the perimeter round which the heavens, set with stars before fading into utter blackness, were for a space a trembling green.)—Henry Green, CaughtWar, she thought, is sex.—Henry Green, CaughtRoses are not generally thought to be objects of anxiety. They are objects of desire, or better, objects that arrest desire by their invitation to aesthetic contemplation, but only for the phobic could a rose be said to be an occasion for dread. Writing during World War II, the British writer Henry Green (“a trembling green”) suggests otherwise. In this description of the London Blitz from his 1943 novel, Caught, everything comes up roses. 1 First among literary clichés, roses lend themselves to this kind of figurative estrangement (by virtue of which, in literature, a rose is in fact only very rarely a rose), and Green is by no means the only British writer in World War II to note that the fire and the rose are one. 2 In Caught, however, Green’s roses wreath desire and dread together so tightly that the psychoanalytic cliché—war is sex—snaps back into the tautology that Freud perhaps always intended.The idea that war could be sex was, of course, the scandal of Freud’s theory of the traumatic neurosis during World War I. As is well known, only a desexualized version of psychoanalysis was admitted into the field hospitals and the officer’s convalescent homes that sprang up in upper-class houses all over Britain. One of these was Green’s childhood home, which, he later said, like many of the overprivileged, opened up its doors to the wounded and traumatized in a calculated act of class preservation. 3 One does not have to [End Page 25] think too hard to appreciate why, for some at least, it was preferable to see these torn and shocked bodies as seized by a dreadful—but after all perfectly understandable—fear in the face of war, rather than gripped with a less comprehensible anxiety that carried with it a dangerous and potentially lethal sexual charge.The temptation to unsex trauma theory is still with us today. It is not quite that something has been occluded in contemporary debate and that this something is sexuality. It is more accurate to say that, from a psychoanalytic perspective, the agon of sexuality—and particularly of the drives—is right at the heart of trauma, and that this, especially in the recent alliance of psychoanalysis and history, causes a certain awkwardness. One of the strengths of contemporary trauma theory lies in its articulation of a nuanced and subtle historicity, read through both psychoanalysis and literature, which allows the humanities to reconnect with historical violence, without (supposedly) falling into the pitfalls of a naive historicism [see Caruth]. The awkwardness comes because sexual antagonism is both clearly historical (the violence is well documented) and structurally necessary to psychoanalytic theories of trauma. The two, the historical and the psychic, are clearly not analogues, but they remain stubbornly and infuriatingly intertwined. 4Faced with this theoretical tangle, two options present themselves. The first is to privilege historical trauma over sexual trauma. Psychoanalysis, hence, provides an account of the multiple difficulties of historical representation while escaping the age-old accusation of sexual determination. War, thus, is not (only) sex. For all its hermeneutic power, this new historiography runs the risk of producing a trauma theory without, paradoxically, a psychoanalysis (an Orphics without Eurydice). The second is to insist on the structural necessity of sexuality and, in particular, of sexual difference, not as the ahistorical referent that lurks beyond representation but, as Slavoj Zizek has... (shrink)

What does it mean to live and build up the Kingdom of God? In this book, professor and priest Alberto de Mingo Kaminouchi introduces the contemporary reader to Christian ethics by examining the New Testament through the three key concepts of Aristotle’s ethics: happiness, virtue, and love. In turn, the three affirmations orient this reflection through the Gospel. First, when the triune God appears on the horizon, it becomes easier to understand that existence has a purpose: namely, participating with the (...) entire human family in this project of happiness called the Kingdom of God. Second, happiness is not something outside of us; it consists in the practice of the virtues that bring about a personal transformation. Third, the project of the Kingdom leads us to live in love with others. De Mingo Kaminouchi shows the reader a real model of this in the community we call the church, the “field hospital” for all those in need of hope. This book is accessibly written for readers not already well-versed in Christian ethics. (shrink)

An exceptional collection of letters, postcards, original writings, and photographs The First World War witnessed an unprecedented mobilization of philosophers and their families: as soldiers at the front; as public figures on the home front; as nurses in field hospitals; as mothers and wives; as sons and fathers. In Germany, the war irrupted in the midst of the rapid growth of Edmund Husserl's phenomenological movement – widely considered one of the most significant philosophical movements in twentieth century thought. Philosophers (...) at the Frontoffers a documentary history of phenomenology in the First World War. Through an exceptional collection of primary source materials (letters, postcards, original writings, photographs) from the Husserl Archives in Leuven, the Bayerische Staatsbibliothek, and the Archives of the University of Göttingen, the complex narratives of how the war affected the lives and thought of central figures in the phenomenological movement are charted. Key figures such as Edmund Husserl, his sons Wolfgang and Gerhart, Max Scheler, Edith Stein, Adolf Reinach, Martin Heidegger, and others are included in this collection of materials. The volume includes reproductions of original material, as well as German transcription of all texts and their English translation. (shrink)

The director of Courage International talks about the work of the apostolate in addressing homosexuality according to the mind and heart of the Church, which he calls “one of the most demanding aspects of education, formation, and pastoral care today.” But it is also an opportunity to attend to the often acute and persistent wounds of those who need healing within what Pope Francis calls the “field hospital” of the Church. The author points out that the work of (...) Courage is not first about homosexuality but about what it means to be human. It is an invitation to consider the question of the fulfillment of the human heart according to God’s gracious plan. National Catholic Bioethics Quarterly 15.2 : 221–230. (shrink)

Catholic Relief Services , the international humanitarian agency of the U.S. Catholic community, has worked in Rwanda since 1963. The 1994 Rwandan genocide killed five of its staff, countless co-workers, friends and relatives; its offices were looted and operations destroyed. The genocide marked a turning point in the agency’s history. Since then CRS has made justice, peacebuilding, and solidarity agency priorities, and has committed itself to fully integrate them into all of its partnerships and programming. The focus of this study (...) is an innovative microfinance methodology, Savings and Internal Lending Communities , which CRS recently introduced in Rwanda. While the purpose of CRS’ SILC programming in Rwanda is to promote greater economic security, particularly for Orphans and other Vulnerable Children , and women’s empowerment, this essay explores its peacebuilding potential in the country. It raises the question of whether it is possible to conceive of Rwanda’s SILC groups as social spaces for peace where a culture of peace and peacebuilding skills may already be being generated. It suggests that if identified as such and developed more intentionally, CRS’ SILC programming in Rwanda could play a more significant and integral role in securing the peace Rwandans long for.In July 2008 five Villanova University faculty members and I traveled to Rwanda, spending a total of eight days in country.1 The purpose of the trip was to learn more about the 1994 genocide, the effort to rebuild the country, and in particular, the U.S. Catholic community’s contribution to that effort through Catholic Relief Services . In addition to visiting memorials to the victims of the genocide and meeting with representatives from the Rwandan Catholic Church, the University of Rwanda, and the Rwandan government, we had the opportunity to observe some of CRS’ programming and meet with CRS’ small U.S. staff and its much larger Rwandan staff working with its Rwandan partner agencies. We visited a field hospital where patients were being treated for HIV/AIDS; agricultural projects aimed at containing cassava blight and improving yield; projects to teach orphans and other vulnerable children and the blind trades to enable them to earn income to support themselves and their families; elementary school classrooms; a retreat center where diocesan justice and peace animators were being trained in grassroots peacebuilding skills; and a Savings and Internal Lending Community group. In this article, I would like to focus on CRS’ SILC programming, and in particular, what I believe to be its potential to contribute to peacebuilding in Rwanda. (shrink)

The peculiarities of speech etiquette in each language are determined by historical, cultural, social, cognitive, and religious factors. The study of greeting and farewell speech formulas in Turkish and Arabic is relevant for identifying key linguacultural meanings and concepts using conceptual modeling. The purpose is to analyze the linguistic and cultural conditioning of etiquette formulas in these languages. Linguacultural analysis of linguistic facts was used, along with elements of conceptual, communicative, comparative, and semantic analysis. The results show that the conceptual (...) structure of etiquette formulas consists of functional-semantic fields like temporality, religiosity, marking conversation beginnings/endings. In Turkish, temporal concepts like “day” and “morning” are most frequent, while in Arabic religious concepts like “Allah” and “peace” prevail. Similarities include polite treatment of interlocutors, adherence to religious traditions, and hospitality. Differences lie in the degree of metaphoricality, imagery, and extended responses. The conclusions form ideas about the interrelations between core and peripheral linguacultural concepts, linguistic diversity, and invariance of etiquette formulas, their cognitive representation and role in shaping linguistic personality. The study contributes to understanding national mentality through the analysis of speech formulas. (shrink)

In hospital rooms across the country, doctors, nurses, patients, and their families grapple with questions of life and death. Recently, they have been joined at the bedside by a new group of professional experts, bioethicists, whose presence raises a host of urgent questions. How has bioethics evolved into a legitimate specialty? When is such expertise necessary? How do bioethicists make their decisions? And whose interests do they serve? Renowned sociologist Charles L. Bosk has been observing medical care for thirty-five (...) years. In What Would You Do? he brings his extensive experience to bear on these questions while reflecting on the ethical dilemmas that his own ethnographic research among surgeons and genetic counselors has provoked. Bosk considers whether the consent given to ethnographers by their subjects can ever be fully voluntary and informed. He questions whether promises of confidentiality and anonymity can or should be made. And he wonders if social scientists overestimate the benefits of their work while downplaying the risks. Vital for practitioners of both the newly prominent field of bioethics and the long-established craft of ethnography, What Would You Do? will also engross anyone concerned with how our society addresses difficult health care issues. (shrink)

Social justice demands that we attend carefully to the epistemic terrains we inhabit as well as to the epistemic resources we summon to make our lived experiences tangible to one another. Not all epistemic terrains are hospitable—colonial projects landscaped a good portion of our epistemic terrain long before present generations moved across it. There is no shared epistemicterra firma,no level epistemic common ground where knowers share credibility and where a diversity of hermeneutical resources play together happily. Knowers engage one another (...) on a politically saturated,unlevel knowing fieldwhere members of dominant groups work to forcibly maintain their epistemic home-terrain advantage. I use the metaphor of the unlevel knowing field to capture these oppressive epistemic structures. The unlevel knowing field is a hungry place where all knowledge that fails to nurture and sustain dominant ways knowing risks being dragged onto the dominator's epistemic home turf to be mined, coopted, consumed, or destroyed. Knowledge and willful ignorance circulate with equal vigor in this hungry world. From the standpoint of oppressed/resisting peoples, the unlevel knowing field is a minefield, an epistemic twilight zone, which must be traversed with considerable care and endless attention. The harms epistemic injustice produces are not disembodied harms. Repeated acts of injustice weather our bodies, dull our minds, weaken our hearts, and traumatize the spirit of our communities. They create public-health precarities and invite mental, emotional, physical, and spiritual illness into our being. Epistemic oppression is a cruel thief. It is disorienting, exhausting, and deadly. It triggers anger, anxiety, depression, and resistance. It steals our time, energy, and attention away from more beautiful things. (shrink)

Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral (...) disagreement, conflict, and ‘outsiders’ are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well‐known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper. (shrink)

The field of assisted reproduction is advancing rapidly and is ripe for regulation and guidance. In 2018, over four thousand frozen eggs and embryos were lost to approximately one thousand patients at Ahuja University Hospital in Cleveland, Ohio, due to an accidental thaw of a cryopreservation tank. The precedent that will be set by the Ahuja class‐action case is significant for both past events and future possibilities and is core to the discussion of policy involving the cryopreservation of (...) gametes and embryos. (shrink)

The field of medical rehabilitation is relatively new.... Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, sometimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high-technology acute care medicine or genetic engineering.... Those in biomedical ethics could and did easily overlook the quiet, less obtrusive (...) issues of rehabilitation.... The Hastings Center set out in 1985 to rectify that situation.... To explore the issues, the Center assembled a group of practitioners in the field, Hastings Center staff members, and individuals experienced in other areas of medical ethics.... The report that follows was written by Arthur Caplan and Daniel Callahan, assisted by Dr. Janet Haas of the Moss Rehabilitation Hospital in Philadelphia... (shrink)

Most hospitals and nursing homes have individuals who engage in ethics consultation, and most do so with very little, if any, training. The goal of this article is not to advance the scholarly literature on training clinical ethics consultants, but instead to provide a road map for individuals doing ethics consultation who would like more training. In this way, I hope to advance the field in some small way, by educating, empowering, and encouraging small- to medium-sized hospitals to train (...) the members of their ethics committee who engage in ethics consultation. (shrink)

Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account (...) of the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

Background The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). Purpose The authors describe how the clinical and (...) research experiences of nurses give them a unique voice in the field of bioethics. Results Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. Conclusion Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public. (shrink)

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and (...) conducted a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)