The purpose of this article is to respond to Jacques Derrida’s reading of Immanuel Kant’s laws of hospitality and to offer a deeper exploration into Kant’s separation of a cosmopolitan right to visit ( Besuchsrecht) and the idea of a universal right to reside ( Gastrecht). Through this discussion, the various laws of hospitality will be examined, extrapolated and outlined, particularly in response to the tensions articulated by Derrida. By doing so, this article will offer a (...) reinterpretation of the laws of hospitality, arguing that hospitality is not meant to capture all the conditions necessary for cosmopolitan citizenship or for a thoroughgoing condition of cosmopolitan justice as Derrida assumes. This is because hospitality could be understood as the basic normative requirement necessary to establish an ethical condition for intersubjective communication at the global level, where discursive communication regarding the substance of a future condition of cosmopolitan justice is to be subjected to global public reason. (shrink)

Andrew Murphie 'Is Philosophy Ever Enough?' _Film-Philosophy_, Deleuze Special Issue vol. 5 no. 38, November 2001.

Despite his wide-ranging and incisive engagement with Heidegger's thought across his career, Derrida seems to have written very little about Heidegger's Ereignis manuscripts, which, according to many commentators, constitute the place where Heidegger's thinking comes closest to Derridean deconstruction. Taking up Derrida's comments in Hospitality 1 on the figure of ‘selfhood’ in Heidegger's Contributions to Philosophy, this essay argues that this dense but important moment of engagement with the Ereignis manuscripts reveals the extent to which Heidegger's thinking of selfhood, (...) in spite of its fundamentally relational character, remains thoroughly determined by ipseity, the philosopheme that links selfhood, possibility, and sovereignty within the metaphysics of presence. Beginning with a reconstruction of the link between power and selfhood in Derrida's thinking of ipseity and a close-reading of the key passage in Hospitality 1, the essay then turns to Heidegger's engagement with Hölderlin to show both the depth of Heidegger's commitment to a relational thinking of selfhood and the philosophical and rhetorical safeguards by which he ensures that the relations of difference that constitute the self continue to function in the name of the ipseity, understood as the very Ur-form of sovereign power. (shrink)

In 2017, Barth and Barber released the third edition of their textbook “Hospitality Law: Managing Legal Issues in the Hospitality Industry.” This review focuses on the scope and depth of the legal areas it covers. It examines whether the book strikes the right balance between practicality, feasibility, and conventions within the hotel industry. The authors aim to provide guidance to hospitality students and hospitality managers in developing legal literacy for their professional lives. The review finds that (...) Barth and Barber have successfully compiled a comprehensive and relevant compilation of legal issues within the hospitality industry. They support and illustrate their explanations with authentic case law and relevant examples, demonstrating the practicality of the work. While there may be some criticism regarding the depth of legal argumentation, it should be pointed out that this criticism should be viewed in light of the book's intended purpose. The primary goal was not to create an exhaustive analysis of the multi-faceted nuances in legal discourse within hospitality law. Instead, it aimed to sensitise and assist hospitality students and professional hospitality managers in the United States with their everyday decision-making processes. We suggest that the textbook could further benefit from integrating recent insights from applied (legal) linguistics and legal semiotics. It is concluded that the book remains a valuable resource for teaching hospitality law to non-legal professionals but also for researchers interested in the intersection of language and law in the hospitality industry. (shrink)

The point of departure of this article is that hospitality in education has not been theorized in terms of emotion and affect, partly because its law have been discussed in ways that have not paid much attention to the role of emotion and affect. The analysis broadens our understanding of the ethics and politics of hospitality by considering it as a spatial and affective relational practice. In particular, concepts from affect theory such as the notion of affective atmospheres (...) and atmospheric walls are discussed to highlight the notion of affective hospitality. It is argued that a greater awareness of the micro-politics of hospitality in its everyday enactment in various educational settings can show educators how specific practices of hospitality work to produce affective spaces in which the socio-historical context of privilege may be interrupted. The paper concludes with a discussion of the ethical, political and pedagogical implications of affective hospitality. (shrink)

Journal of International Political Theory, Ahead of Print. The contemporary international regime of law and politics regarding human migration largely follows Immanuel Kant’s contradictory approach, supporting the cosmopolitical rights of humans to move and expect hospitality while privileging the rights of sovereign states to assert territorial security against movement. International Relations scholars informed by Jacques Derrida’s ethical theory argue that one may press this tension to positive dynamics through affirmation of the aporia that a secured home is a requirement (...) for the possibility of the hospitality that might undo conflict between migrants and emplaced citizens. Yet, the attraction of Derrida’s critical Kantianism and this revival of hospitality depends on asserting the primacy of habitation to how citizen subjects stand with respect to foreigners who move. It depends on neglecting how any assumption of home is not based on a given home but, rather, on movements to impose the boundaries and bounty of a home. No one faces the movement of others who seek to make home from the position of home but only also in movements of homemaking. Both the citizen and the migrant move in forms of imposition. And it is only in a politics of imposition that rights to move can be affirmed and gain respect. (shrink)

The contemporary international regime of law and politics regarding human migration largely follows Immanuel Kant’s contradictory approach, supporting the cosmopolitical rights of humans to move and expect hospitality while privileging the rights of sovereign states to assert territorial security against movement. International Relations scholars informed by Jacques Derrida’s ethical theory argue that one may press this tension to positive dynamics through affirmation of the aporia that a secured home is a requirement for the possibility of the hospitality that (...) might undo conflict between migrants and emplaced citizens. Yet, the attraction of Derrida’s critical Kantianism and this revival of hospitality depends on asserting the primacy of habitation to how citizen subjects stand with respect to foreigners who move. It depends on neglecting how any assumption of home is not based on a given home but, rather, on movements to impose the boundaries and bounty of a home. No one faces the movement of others who seek to make home from the position of home but only also in movements of homemaking. Both the citizen and the migrant move in forms of imposition. And it is only in a politics of imposition that rights to move can be affirmed and gain respect. (shrink)

Our students ought to know about the history of formal hospital segregation and desegregation. To that end, this article urges those who teach foundational health law and policy courses to do three things. First, to teach the Simkins case. Second, to swap out the usual Medicare signing ceremony picture for one that includes W. Montague Cobb, M.D., Ph.D. Third, to highlight how the implementation of that program for the elderly led, in a matter of months, to the desegregation of hospitals (...) throughout the country. (shrink)

Despite the long history of beliefs about the therapeutic properties of work for people with mental ill health, rarely has therapeutic work itself been a focus for historical analysis. In this article, the development of a therapeutic work ethic (1813—1979) is presented, drawing particular attention to the changing character and quality of beliefs about therapeutic work throughout time. From hospital factories to radical ‘antipsychiatric’ communities, the article reveals the myriad forms of activities that have variously been considered fit work for (...) people with mental health problems. While popular stereotypes of basket-weaving paint a hapless portrait of institutional work, a more nuanced reading of therapeutic work and its political and philosophical commitments is advanced. The article concludes by arguing that the non-linear and inherently contested development of therapeutic work is less the effect of paradigmatic shifts within the therapeutic professions, but rather evidence of a broader human struggle with work. (shrink)

Changes in modern societies originate the perception that ethical behaviour is essential in organization’s practices especially in the way they deal with aspects such as human rights. These issues are usually under the umbrella of the concept of social responsibility. Recently the Report of the International Bioethics Committee of UNESCO on Social Responsibility and Health has addressed this concept of social responsibility in the context of health care delivery suggesting a new paradigm in hospital governance. The objective of this paper (...) is to address the issue of corporate social responsibility in health care, namely in the hospital setting, emphasising the special governance arrangements of such complex organisations and to evaluate if new models of hospital management (entrepreneurism) will need robust mechanisms of corporate governance to fulfil its social responsiveness. The scope of this responsible behaviour requires hospitals to fulfil its social and market objectives, in accordance to the law and general ethical standards. Social responsibility includes aspects like abstention of harm to the environment or the protection of the interests of all the stakeholders enrolled in the deliverance of health care. In conclusion, adequate corporate governance and corporate strategy are the gold standard of social responsibility. In a competitive market hospital governance will be optimised if the organization culture is reframed to meet stakeholders’ demands for unequivocal assurances on ethical behaviour. Health care organizations should abide to this new governance approach that is to create organisation value through performance, conformance and responsibility. (shrink)

Hospital ethics committees (HECs) are expected to play extremely broad and pivotal roles such as case consultation, education of staffs on healthcare ethics, and institutional policy formation. Despite the growing importance of HECs, there are no standards for setup and operation of HECs, and composition and activities of HECs at each institution are rarely disclosed in Japan. In addition, there is also a lack of information sharing and collaboration among HECs. Therefore, the authors established the Consortium of Hospital Ethics Committees (...) (CHEC) in October 2020, which has been regularly hosting a couple of core activities. One is the Healthcare Ethics Forum, held monthly online for CHEC members to freely discuss HECs and healthcare ethics consultation. The other is the Collaboration Conference of Hospital Ethics Committees, intended to provide a place for HEC members and administrative officers from across Japan to exchange information of their HECs, learn from each other, and cooperate to operate HECs appropriately. In this paper, the authors introduced CHEC as well as reported the results of a questionnaire survey conducted at the first conference among participating facilities, suggesting the diverse structures and activities of HECs in Japan. (shrink)

The purpose of this article is to outline a Kantian form of cosmopolitan law and the jurisprudence involved in the creation of a cosmopolitan constitution. This article explores and discusses Kantian cosmopolitan law, the idea of cosmopolitan right, the laws of hospitality and a Kantian approach to constitutional cosmopolitanism. In doing so, the article argues beyond Kant's discussion of constitutionalism, suggesting that a written constitution not only articulates many of Kant's cosmopolitan concerns, but also provides a reasonable ethical (...) foundation for an international society. Throughout this discussion, more particular aspects of Kant's legal conception of cosmopolitanism are examined, focusing on the possibility of an ethical cosmopolitan order based on jurisprudence, the necessity of a minimal consensus bound by constitutional provisions, and the corresponding legal obligations maintained by cosmopolitan law. (shrink)

In this paper I argue that Kant's concept of cosmopolitan right is the philosophical basis for contemporary international human rights. The law of world citizenship or cosmopolitan right is necessary in order to secure hospitable interactions between individuals and states. Such interactions in turn create an international civil culture or "cosmopolitan condition" which 1 is the source of the further specification and eventual codification of human rights. Human rights, I conclude, are universal because of their international significance and scope and (...) are inherently linked to cosmopolitan values. (shrink)

In this paper I argue that Kant's concept of cosmopolitan right is the philosophical basis for contemporary international human rights. The law of world citizenship or cosmopolitan right is necessary in order to secure hospitable interactions between individuals and states. Such interactions in turn create an international civil culture or "cosmopolitan condition" which 1 is the source of the further specification and eventual codification of human rights. Human rights, I conclude, are universal because of their international significance and scope and (...) are inherently linked to cosmopolitan values. (shrink)

At a time of unprecedented migration and social displacement, following a century ravaged by war and hegemonic shift, the question of hospitality presents itself with unparalleled urgency. Taking his cue from Immanuel Kant’s cosmopolitics, Jacques Derrida addressed this question by deliberating on the nature of the political obligation to the other person. Invoking the work of Emmanuel Levinas, this demand is first of all ethical, and unconditional. But Derrida was also acutely aware of the residual violence of the hospitable (...) gesture, which always takes place in a scene of power. The resultant aporias at the heart of hospitality provoked debate between the two authors at the 2007 Critical Legal Conference, and this paper seeks to elucidate and elaborate on this encounter. At stake are the matters of the potential political forms of hospitality, whether it should always been striven for and, ultimately, how one can conceptually reconcile its ethics with its violence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 35.1 (2005) 71-98MuseSearchJournalsThis JournalContents[Access article in PDF]Hospitality after the Death of GodTracy McNultyPierre Klossowski's fiction has been only sporadically published in English, and largely dismissed as perverse erotica or soft-core porn. When his 1965 trilogy Les lois de l'hospitalité was partially translated in English (under the title Roberte, ce soir & The Revocation of the Edict of Nantes), its Library of Congress classification characterized it simply as (...) "erotic fiction—French." Even in France, Klossowski has become the very signifier of perversion. His artwork graces the cover of Serge André's L'imposture perverse and of numerous erotic novels, he has been "diagnosed" as a pervert by writers on both sides of the Atlantic, and unironic readers of his Sade mon prochain hail him as Sade's disciple and heir.1Admittedly, the larger stakes of Klossowski's work are easily obscured by its free adaptation of the stock themes of libertine literature. His fictional works, like his visual compositions (essentially representations of rape scenes, often on historical themes—Diana and Actaeon, the Rape of Lucretia), explore the conflict between a woman's chaste moral attitude and her gradual surrender to an assailant's advances. The Laws of Hospitality concerns the erotic awakening of "hospitality" in a woman, which exposes a contradiction within her moral character and reveals her symbolic identity to be without foundation. Its protagonist Octave, who bears more than a passing resemblance to his creator, is a collector of artworks that eroticize the moment of moral hesitation experienced by women submitting to the sexual advances of a chance stranger—or even a "spiritual" apparition. His "laws of hospitality" are the fruit of his desire to experience this operation firsthand; they name a practice wherein the master of the house "offers" his wife to fortuitous guests, in order to savor the moment of her surrender.However, the stakes of Klossowski's "perverse" meditations are very different from the Sadeian project of uprooting religious morality. Sade challenges the patriarchal and religious authorities of his day by demonstrating that the paternal signifier on which their laws are based is without foundation. In proving that the law cannot hold [End Page 71] up against the repeated assaults of libertinage, he mounts a systematic deconstruction of the symbolic order of language by the real of jouissance. But although Klossowski may share Sade's perverse drive to "humiliate the law with the object,"2 his target is not the signifier as such, but rather the imaginary consistency afforded by what he calls the "grammatical fiction of the 'I,'" the illusion of autonomous personhood. The "object" he confronts it with is not the natural "truth" of jouissance, but rather the feminine object who disrupts the identity of the "master" who offers her.Klossowski's reflections on the special status of femininity in Enlightenment culture—at once marginal and singularly "extimate"—have never been fully appreciated, despite their enormous interest for the study of culture. In a way unique among contemporary authors, Klossowski sheds light on Jacques Lacan's enigmatic insight that the cultural importance of the feminine object consists in its sublimated status as an "object raised to the dignity of the Thing" [Lacan 112]. His fiction underscores the close ties between the feminine and what Freud called das Ding, the Thing uncannily internal to subjectivity that Lacan later identified with the function of the Nebenmensch, as the apotheosis of the Christian idea of the prochain, or neighbor [Lacan 151–52].Although Klossowski's erotic scenario invites comparisons with Sade's and Fourier's utopian calls to dissolve the privative boundaries between subjects, what he understands by "hospitality" is not the abolition of personal identity, but rather the staging of its internal contradiction.Hospitality, at the Limits of the LawThe act of hospitality—whose theological and philosophical origins this former Dominican novice and Latin scholar was intimately acquainted with—concerns a very particular tension. Etymologically, the host is the "master," the one who "eminently personifies" identity: not only his own identity, but also that of the group in whose... (shrink)

Jacques Derrida: Law as Absolute Hospitalityãeepresents a comprehensive account and understanding of Derridaâe(tm)s approach to law and justice. Through a detailed reading of Derridaâe(tm)s texts, Jacques de Ville contends that it is only by way of Derrida's deconstruction of the metaphysics of presence, and specifically in relation to the texts of Husserl, Levinas, Freud and Heidegger - that the reasoning behind his elusive works on law and justice can be grasped. Through detailed readings of texts such as To speculate âe" (...) on Freud, Adieu, Declarations of Independence, Before the Law, Cogito and the history of madness, Given Time, Force of Law and Specters of Marx, De Ville contends that there is a continuity in Derridaâe(tm)s thinking, and rejects the idea of an âe~ethical turnâe(tm). Derrida is shown to be neither a postmodernist nor a political liberal, but a radical revolutionary. De Ville also controversially contends that justice in Derridaâe(tm)s thinking must be radically distinguished from Levinasâe(tm)s reflections on âe~the otherâe(tm). It is the notion of absolute hospitality - which Derrida derives from Levinas, but radically transforms - that provides the basis of this argument. Justice must on De Villeâe(tm)s reading be understood in terms of a demand of absolute hospitality which is imposed on both the individual and the collective subject. A much needed account of Derrida's influential approach to law,ãeeJacques Derrida: Law as Absolute Hospitalityãeewill be an invaluable resource for those with an interest in legal theory, and for those with an interest in the ethics and politics of deconstruction. (shrink)

The complex regulatory framework governing the U.S. health care system can be an obstacle to programming that address health-related social needs. In particular, health care fraud and abuse law is a pernicious barrier as health care organizations may minimize or forego programming altogether out of real and perceived concern for compliance. And because health care organizations have varying resources to navigate and resolve compliance concerns, as well as different levels of risk tolerance, fears related to the legal landscape may further (...) entrench inequities in access to meaningful programs that improve health outcomes. This article uses food and nutrition programming as a case study to explore the complexities presented by this area of law and to highlight pathways forward. (shrink)

Kant’s theory of international politics and his right of hospitality are commonly associated with expansive projects of securing human rights or cosmopolitan governance beyond state borders. This article shows how this view misunderstands Kant’s criticism of the law of nations tradition as handed down into the eighteenth century as well as the logic of his radical alternative, which was designed to explain the conditions of possibility of global peace as a solution to the Hobbesian problem of a war of (...) all against all in the state of nature. I resolve longstanding confusion over the meaning and justification of Kant’s right of “hospitality” by showing how it functions not as a freestanding positive claim demanding enforcement but as a way of ruling out specious justifications for war against those the traditional law of nations permitted one to label “enemies.” This poses important questions for contemporary theories of global justice. (shrink)

This paper focuses on the current international refugee crisis and the ways in which it is leading to sharp symbolic and physical violence through the process of “othering.” Based on Hannah Arendt’s discussion of statelessness and the question of the right to have rights, and Giorgio Agamben’s discussion of Homo Sacer, as well as drawing on other key authors such as Judith Butler, we argue that conditions of extreme human vulnerability and dangers of totalitarianism are being radically worsened by the (...) ethnicized and racialized denial of the other, that is, of human rights. Rather than advocating an abstract cosmopolitanism, however, without strong purchase in contemporary social life, the paper concludes by noting the need to place oneself in a position of discomfort, in order to confront the tension between particularistic attachments and universalist aspirations, between the multiplicity of laws and the ideal of a rational order common to all polities, between belief in the unity of humankind and the healthy antagonisms and tensions generated by human diversity. (shrink)

The United States Court of Appeals for the First Circuit recently upheld a United States District Court for the District of Maine Judge's decision to dismiss a Maine plaintiff's medical malpractice claim against a Massachusetts hospital defendant for want of personal jurisdiction over the hospital. The Court of Appeals found it unreasonable to hale hospitals into an out-of-state court merely because they accept out-of-state patients.Plaintiff Danielle Harlow is a Maine resident who suffered a stroke at the age of six while (...) undergoing a medical procedure at Children's Hospital of Boston, Massachusetts. The stroke, allegedly caused by the Hospital's negligence, led to brain damage resulting in partial paralysis and cognitive and behavioral impairments. The procedure was supposed to treat Harlow's rapid heartbeat, a condition related to her Wolff-Parkinson-White Syndrome. Harlow's pediatrician in Maine recommended that she visit Children's Hospital in Boston to treat her arrhythmia. (shrink)

Ms. X is a person with cerebral palsy and schizophrenia. She has intractable bedsores that are a result of her immobility and to poor wound care related to her delusional thinking. Despite intensive community support, the wounds have worsened to the point that she has needed multiple hospitalizations to prevent systemic sepsis, a life‐threatening condition. She is capable of placement decisions and wishes for independence at home but is incapable of making wound care decisions and does not appreciate that immediately (...) returning home from the hospital, instead of going into a special care facility, would likely result in sepsis. The resulting dilemma about discharge planning highlights the complexity involved in weighing concerns around mental illness and capacity for treatment and placement of care. The extent of the care that is required and available in a community or health care system and the slow but relatively certain progression of the symptoms also make the decision challenging. Two commentaries take very different approaches in exploring the question whether Ms. X should be supported to go home or to a special care facility. (shrink)

On March 9, 1993, in the first ruling of its kind, the Maryland Court of Appeals declared that physicians and hospitals may be sued for failing to inform patients of a practitioner’s human immunodeficiency virus status. What is more significant, these suits may be pursued even in instances when the physician has followed universal precautions and the patient did not contract the virus that causes acquired immunodeficiency syndrome. The Maryland court addressed two central questions in Faya v. Almaraz. First, do (...) HIV-infected physicians have a legal duty to inform their patients of their HIV status? And, second, can patients recover damages for fear induced by a physician’s conduct? While one finds numerous precedents that authorize actions to recover damages based purely on fear of disease and emotional distress, the Faya court’s holdings on the issue significantly expand the scope of potential liability. Moreover, the court’s analysis of the informed consent and HIV-infected physician issue is incomplete, inconsistent, and represents an unjustified and unwise departure from traditional informed consent theory. It, and its progeny, may have widespread and dire repercussions. (shrink)

The evolution of the idea of hospitality can be traced alongside the development of Western civilization. Etymologically, the host is the “master,” but this identity is established through expropriation and loss—the best host is the one who gives the most, ultimately relinquishing what defines him as master. In The Hostess, Tracy McNulty asks, What are the implications for personhood of sharing a person—a wife or daughter—as an act of hospitality? In many traditions, the hostess is viewed not as (...) a subject but as the master’s property. A foreign presence that both sustains and undercuts him, the hostess embodies the interplay of self and other within the host’s own identity. Here McNulty combines critical readings of the Bible and Pierre Klossowski’s trilogy The Laws of Hospitality with analyses of exogamous marital exchange, theological works from the Talmud to Aquinas, the writings of Kant and Nietzsche, and the theory of femininity in the work of Freud and Lacan. Ultimately, she contends, hospitality involves the boundary between the proper and the improper, affecting the subject as well as interpersonal relations. Tracy McNulty is assistant professor of romance studies at Cornell University. (shrink)

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law (...) to establish a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)

Objectives: Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment.Design: Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons.Setting: Israel five years after the passage of the Patients' Rights Act.Main measurements: Patients' rights and informal ethics committee structure and (...) function.Results: One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction.Conclusions: Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement. (shrink)

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local authorities have gone beyond (...) the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area. (shrink)

Various types of health settings use clinical ethics committees (CEC) to deal with the ethical issues that confront both healthcare providers and their patients. Although these committees are now more common than ever, changes in the content of ethical dilemmas through the years is still a relatively unexplored area of research. The current study examines the major topics brought to the CEC of a psychiatric hospital in Israel and explores whether there were changes in their frequency across nearly three decades. (...) The present paper reports on a thematic analysis of the written verbatim transcripts from 466 ethical topics brought to the CEC between the years 1991 and 2016. The following major topics related to ethical dilemmas were identified: confidentiality (30%), patient autonomy (23%), health records (14%), dual relationship (12%), allocation of resources (11%), inappropriate professional and personal conduct (9%), and multicultural sensitivity (1%). Topics related to confidentiality increased significantly over the years, as did inappropriate professional and personal conduct. In addition, the analysis showed that the content of the ethical cases and the resolutions suggested by the CEC also varied over the years. In conclusion, although most ethical topics have remained relatively stable over time, the discourse around them has evolved, requiring a dynamic assessment and reflection by the mental health practitioners serving as members of a CEC. (shrink)

The physician’s duty of confidentiality is based on the observance of the patient’s privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients’ data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. The (...) present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital. The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices. (shrink)

The purpose of the paper is to consider genesis and approaches to forming a security culture of tourism and hospitality enterprises that are superstructures of economic, industrial, professional, household, ecological, psychological and social security. In the research, apart from general scientific methods, we used the collection and analysis of primary information obtained from the survey of 220 respondents. Three areas that have a decisive influence on the security of tourism and hospitality enterprises have been identified: organizational culture, decision-making (...) responsibility, and competitiveness. The decision-making methods for different leadership styles were identified. There were conceptualized connection and strength of correlation between types of strategic decisions, leadership styles and organizational culture of tourism and hospitality enterprises. It has been proposed the factors’ configuration relevant to the security of tourism and hospitality enterprises, which focuses on the economic security formation as a function of organizational culture, responsibility for decision making and competitiveness. The styles of leadership and decision-making styles have been revealed, which determine the effectiveness of economic security of tourism and hospitality enterprises. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study investigated (...) the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

ABSTRACT In Mexico informed consent is a legal requirement that ensures that patients who are invited to participate in clinical trials are provided with all the information needed to decide whether to participate, or not, in a research protocol. To improve our understanding of the problems physicians in developing countries encounter, when obtaining informed consent (IC), we examined their opinion on the importance of IC in clinical research, the quantity and quality of the information provided to the participant, and the (...) conditions in which the IC is obtained. Investigators considered that IC was useful to the patients, providing information that helped the patient to make a decision about his/her participation. Nevertheless, they felt that for some aspects of the research, like drug development in general, the use of placebos, and the randomization process, many of the patients were not capable of fully understanding the information provided, referring to the complexity of the information and illiteracy as the main reasons. Many investigators were not acquainted with some of the guidelines established in the Mexican General Law of Health,1 36% of them admitting to not having completed their IC letters. Most investigators gave only minutes to the patient to make a decision and 20% of ICs were obtained while the patient was hospitalized. Except for one investigator, all of them considered that specific training in medical ethics would be useful for the daily clinical work. (shrink)

Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five of (...) which involved unrepresented patients. In thirteen cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient’s best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST or to change code status to Do Not Resuscitate/Do Not Intubate. Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision. In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers. (shrink)

Despite seeming uniformity in the law, end-of-life controversies have highlighted variations among state brain death laws and their interpretation by courts. This article provides a survey of the current legal landscape regarding brain death in the United States, for the purpose of assisting professionals who seek to formulate or assess proposals for changes in current law and hospital policy. As we note, the public is increasingly wary of the role of organ transplantation in determinations of death, and of the (...) variability of brain death diagnosing criteria. We urge that any attempt to alter current state statutes or to adopt a national standard must balance the need for medical accuracy with sound ethical principles which reject the utilitarian use of human beings and are consistent with the dignity of the human person. Only in this way can public trust be rebuilt. (shrink)

This paper considers the philosophical foundations of the law relating to migration. It examines the kinds of reasons that might justify the restriction of liberty as people move about on the face of the earth—something humans have done since time immemorial. The paper also examines the various interests that might be at stake in moral calculations regarding migration: economic interests, cultural interests, religious interests, or just sheer preferences. Drawing on the work of Locke, Kant, and Sidgwick, it considers conceptions like (...) common ownership of the earth, the right of hospitality, and the difference between defending property and restricting access to economic interaction. The paper also considers the ambiguity of the commonly heard slogan that states by definition have a right to control their borders. (shrink)

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law (...) to establish a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)