IntroductionOne of the most important duties of hospital ethics committees is to provide medical ethics consultation to the staff and patients. This study was conducted with the aim of the needs assessment of the staff for optimal provision of medical ethics consultation services.Materials and methodsThe data collection tool was a self-administered questionnaire. Hospital managers, chief nursing officers, ward managers, and head nurses of all hospitals affiliated with Tehran and Iran University of Medical Sciences entered the study. The questionnaire (...) together with an invitation letter was sent to the samples. In the next stage, telephone follow-up of the incomplete forms was performed by the research team.ResultsA total of 448 persons participated in this study (response rate: 54.2%). The mean frequency of the need for ethics consultation in each ward was 5.2 times in the last 3 months with a median of 3. The highest needs for consultation, which were common in all wards, were observed in treatment rejection by the patient, providing necessary information to obtain informed consent and obtaining consent to high risk procedures, conflict between the decisions made by the patient and the family members, decision making for the high risk patient, request for futile or inappropriate treatments, giving bad news, and decision making for the incompetent patient.ConclusionThe prevalence of ethical issues in clinical wards is variably high. The ethical issues in the clinical setting are mainly related to respect for the patient’s autonomy and competency for decision making. (shrink)

Background: As actors with the key responsibility for the protection of human research participants, Research Ethics Committees (RECs) need to be competent and well-resourced in order to fulfil their roles. Despite recent programs designed to strengthen RECs in Africa, much more needs to be accomplished before these committees can function optimally.Objective: To assess training needs for biomedical research ethics evaluation among targeted countries.Methods: Members of RECs operating in three targeted African countries were surveyed between August and November 2007. (...) Before implementing the survey, ethical approvals were obtained from RECs in Switzerland, Cameroon, Mali and Tanzania. Data were collected using a semi-structured questionnaire in English and in French.Results: A total of 74 respondents participated in the study. The participation rate was 68%. Seventy one percent of respondents reported having received some training in research ethics evaluation. This training was given by national institutions (31%) and international institutions (69%). Researchers and REC members were ranked as the top target audiences to be trained. Of 32 topics, the top five training priorities were: basic ethical principles, coverage of applicable laws and regulations, how to conduct ethics review, evaluating informed consent processes and the role of the REC.Conclusion: Although the majority of REC members in the targeted African countries had received training in ethics, they expressed a need for additional training. The results of this survey have been used to design a training program in research ethics evaluation that meets this need. (shrink)

Texas festivals are given credit for providing benefits for both the festival's community and for the people who visit the community. As a result of these perceived benefits, communities across Texas stage a broad range of festivals and events. These events require substantial planning and skilled management to be successful. Those involved in the planning are often volunteers and have little or no background in event planning and management. Regardless of their experience level however, most event coordinators have ongoing (...) class='Hi'>needs for information that will help them produce successful events. To produce a successful event, coordinators seek information from a variety of sources. These sources may include their personal network of friends and colleagues to professional consultants or formal workshops, conferences, and seminars. The primary purpose of this project is to provide information that will help the Texas Agricultural Extension Service Recreation, Park & Tourism Program evaluate its future role in responding to the needs of Texas festival coordinators. To accomplish this end, this study seeks to identify information needs of Texas festival coordinators and to describe how current sources of information are utilized by festival coordinators. This paper outlines the development and implementation of an information needs assessment of Texas festival coordinators and a description of current information sources being used by them. The project seeks to identify gaps in the provision of information and the access Texas festival coordinators perceive they have to information. The "importance"/"access" scale of this survey clearly identifies a range of important information topics which organizations could address. The following are the top 10 information needs of Texas festival coordinators as indicated by mail survey respondents: 1. Writing press releases 2. How to measure advertising success 3. Regulations for food, fire, safety, etc. 4. How to find regional talent 5. Insurance issues 6. Americans with Disabilities Act (ADA) 7. How to find and contract for professional entertainment 8. How to determine space requirements for event activities 9. How to create a layout for people/vehicle flow and activities 10. Estimating amount and type of security need It is indicated that most coordinators are aware of the six organizations and agencies that serve the needs of the festival industry. 1. International Festivals & Events Association (IFEA) 2. Texas Agricultural Extension Service (TAEX) - Department of Recreation, Park & Tourism at Texas A&M University 3. Texas Travel Industry Association (TTIA) 4. Texas Festivals & Events Association (TFEA) 5. Texas Department of Economic Development (TDED) 6. Texas Department of Transportation (TxDOT) Of respondents to the needs assessment mail survey, 82.8% to 72.6% of Texas festival coordinators are aware of the programs and services of these organizations and agencies. While coordinators show a high level of awareness of conferences, seminars, and workshops, only 13% to 24.7% have attended. Coordinator networks and the internet are viable sources of information. The majority (88%) of festival coordinators (n=216) indicated they have access to the internet and 81.9% of respondents (n=215) said they use the internet. Organizations can use this study and its results to focus on information needs that coordinators indicate are important and have low accessibility. January and February followed by June and July would be the best months for conferences, seminars, and workshops. Seminars may be held during the "off peak" months of January and February while brochures about how to better market an event can be distributed during the peak festival times of September and April. Coordinators' responses as to the best months they would be able to attend Certified Festival Manager (CFM) training also corresponded with event seasonality patterns. Using multiple distribution methods can improve access to festival planning information. Workshops, internet sites, brochures, and publications are just a few of the ways organizations may vary their distribution of information resources. Coordinators indicted their main source of information comes from coordinator networks (48.9%). This finding should be used to note the importance of networking at coordinator informational events. The internet is a viable source of information. Of the respondent coordinators, 98% indicted they have access to the internet. It is reasonable to suggest that more information can be provided via the internet. There are clearly overlapping functions among these organizations', however, many programs are carried out as partners in serving the festival industry. While this study did not examine these overlapping roles, it would be appropriate that areas of overlap should be examined more closely. (shrink)

The clinical encounter between providers and patients is insufficient: most factors influencing health outcomes occur outside the clinic. Community Health Needs Assessments address this insufficiency via collaboration between hospitals and the communities they serve to address systemic sociological-economic variables impacting health outcomes. Considering this, why are Health Care Ethics Consultation services limited to the clinical setting? We can cultivate better ethics outcomes by addressing systemic sociological-economic factors that cause recurring ethics issues in the hospital. In this article, I argue (...) for the need for a Community Ethics Needs Assessment. CENA is a novel concept; thus, this article is exploratory. I argue for the necessity of a CENA and, more importantly, outline what methodology a CENA would use to both identify and address an ethics need. (shrink)

This paper details the implementation of the Clinical Ethics Needs Assessment Survey (CENAS) through a pilot study in five units within Hamilton Health Sciences. We describe how these pilot sites were selected, how we implemented the survey, the significant results and our interpretation of the findings. The primary goal of this paper is to share our experiences using this tool, specifically the challenges we encountered conducting a staff ethics needs assessment across different units in a large (...) teaching hospital, and the facilitators to our success. We conclude with a discussion of the limitations of this study, our plans for using the results to develop a proactive ethics education strategy, and suggestions for other organizations wishing to adapt the CENAS to assess their staff ethics needs. Our secondary goal is to advance the “quality agenda” for ethics programs by demonstrating how a tool like the CENAS can be used to design more effective educational interventions, and to support strategic planning and proactive priority-setting for ethics programs. (shrink)

A needs assessment survey of ethics review committees (ERCs) across Africa was conducted in order to establish their major needs and areas of weaknesses in terms of ethical review capacity. The response rate was 84% (31 of 37 targeted committees), and committees surveyed were located in 18 African countries. The majority of the responding committees (61%) have been in existence between 5 and 10 years; approximately 74% of the respondents were institutional committees, with the remainder being either (...) national (6/31) or regional (2/31). In terms of the ethical review process, nine of the 31 committees that responded did not have standard operating procedures (SOPs), and seven of the 22 that did have SOPs had never revised them after their initial development (an average period of three years). Of the 31 committees, 10 operated without any ethical guidelines. Many of the committees (13/30) met once per month, and the number of proposals reviewed annually varied, ranging from five to over 100. All respondents relied on paper-based data management and archiving systems. Overall, the survey identified the major constraints on ERCs as lack of office equipment, outdated or lack of SOPs, lack of electronic data management systems, inadequate resources, lack of or insufficient expertise on the committees, and poor recognition of the importance of the role of the committees. Consequently, the authors are addressing the identified needs and weaknesses through the Bill and Melinda Gates Foundation-funded capacity building project. The impact of the intervention project will be assessed during and at the end of the four-year longitudinal project. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare (...) providers across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

As ethics committees and programs become integrated into the “usual business” of healthcare organizations, they are likely to face the predicament of responding to greater demands for service and higher expectations, without an influx of additional resources. This situation demands that ethics committees and programs allocate their scarce resources (including their time, skills and funds) strategically, rather than lurching from one ad hoc request to another; finding ways to maximize the effectiveness, efficiency, impact and quality of ethics services is essential (...) in today’s competitive environment. How can Hospital Ethics Committees (HECs) begin the process of strategic priority-setting to ensure they are delivering services where and how they are most needed? This paper describes the creation of the Clinical Ethics Needs Assessment Survey (CENAS) as a tool to understand interprofessional staff perceptions of the organization’s ethical climate, challenging ethical issues and educational priorities. The CENAS was designed to support informed resource allocation and advocacy by HECs. By sharing our process of developing and validating this ethics needs assessment survey we hope to enable strategic priority-setting in other resource-strapped ethics programs, and to empower HECs to shift their focus to more proactive, quality-focused initiatives. (shrink)

The Patient Protection and Affordable Care Act, passed in 2010, is considered by many to be the most significant healthcare overhaul since the 1960s, but part of its promise — improvement of population health through requirements for non-profit hospitals to provide “community benefit” — has not been met. This paper examines the history of community benefit legislation, how community benefit dollars are allocated, and innovative practices by a few hospitals and communities that are addressing primarily non-medical factors that influence health (...) such as social disadvantage, attitudes, beliefs, risk exposure, and social inequalities. (shrink)

Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk (...) class='Hi'>assessment tools. (shrink)

Fear of cancer is mostly related to cancer recurrence, metastasis, additional cancer, and diagnostic tests. Its legacy as a lethal disease has raised fear of approaching death. Currently, cancer’s total suffering and the worsening phenomena have raised fear, especially among female patients. Family caregivers (FCGs) who are responsible for the day-to-day cancer care at home need to help the patients deal with this fear frequently. Due to the limited care competencies, they need supportive care from healthcare professionals in cancer fear (...) management. This study aims to assess how types of demanded healthcare information affect the FCG’s role in reducing the fear of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand on cancer-specific information and information on cancer physical needs were more likely to need support in reducing the fear of female cancer patients. Meanwhile, FCGs with a higher demand for information on support services were less likely to need support to reduce cancer patients’ fear. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced fear. This study reveals that the demanded cancer-specific information, e.g., cancer’s prognosis or likely outcome and information on cancer physical needs, need to be met in priority to assist FCG’s role in cancer fear management. (shrink)

The ideology of evidence-base medicine (EBM) has dramatically altered the way we think, conceptualize, philosophize and practice medicine. One of its major pillars is the appraisal and classification of evidence. Although important and beneficial, this process currently lacks detail and is in need of reform. In particular, it largely focuses on three key dimensions (design, [type I] alpha error and beta [type II] error) to grade the quality of evidence and often omits other crucial aspects of evidence such as biological (...) plausibility, reproducibility, generalizability, temporality, consistency and coherence. It also over-values the randomized trial and meta-analytical techniques, discounts the biasing effect of single centre execution and gives insufficient weight to large and detailed observational studies. Unless these aspects are progressively included into systems for grading, evaluating and classifying evidence and duly empirically assessed (according to the EBM paradigm), the EBM process and movement will remain open to criticism of being more evidence-biased than evidence-based. (shrink)

In many settings, and perhaps especially in low-middle income countries, training institutions do not adequately prepare their students for the ethical challenges that confront them in professional life. We conducted a survey to assess the training needs in research ethics among the faculty at the University of Zambia, School of Medicine using a structured questionnaire distributed to faculty members in January 2015. The study was approved by the University of Zambia Biomedical Research Ethics Committee. Seventy-five faculty members of various (...) ranks completed the questionnaire. It was found that 31% of the faculty had not received any research ethics training. Of those who had received training, most of them had received it through short workshops of five days or less, while only 27.7% received ethics training as a component of an academic degree and 22.2% obtained it through electronic web-based courses. While most faculty reported being well-prepared to guide their students in developing a research methods section of a research protocol, only 25.3% felt they were well-prepared to guide on ethical considerations. This study has demonstrated gaps in research ethics training among faculty members at UNZASoM. Mandatory instruction in research ethics among faculty and students is recommended. (shrink)

ObjectiveThis study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome and comorbid obesity following after continuous positive airway pressure therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management.MethodsQualitative research was conducted using three focus groups with a representative sample of 32 inpatients undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe Hospital, Verbania, (...) Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes.ResultsSix main themes were extracted: Living the diagnosis as a shock; You should not sleep on it: the importance of prevention; The adjustment to CPAP; Barriers and facilitators to the use of CPAP; Three in a bed; and The relationship with the healthcare system.ConclusionResults of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program. (shrink)

In this article we present a study of assessments of nanotechnology in food and agriculture. The study was conducted as a part of a project studying the need for integrated assessment of emerging science and technologies. The article first introduces central hopes and concerns regarding nanotechnology in food and agriculture, and how these are assessed in different assessment spheres. The question of whether there is a need for more integration in assessments in this field is then introduced and (...) the multiple interpretations of this notion are discussed, first in a sustainability context and then in the specific context of emerging science and technologies. This serves as the basis for analysing the current status of integration of nano-food assessments. The validity of our findings is discussed and the article ends with a summary of the main conclusions from the discussion. (shrink)

A multi-method, multi-informant method was used to collect data from diverse stakeholders about school climate to inform school improvement efforts as part of the Positive Behaviour Intervention Supports framework. Teachers, administrators, school staff and students completed surveys and parents participated in focus groups to gather perspectives about school climate. Respondents identified safety as a strength at the school, staff and student results suggested interpersonal relationships as an area for improvement and staff identified parent involvement as an area for growth. Both (...) positive and negative perceptions of school climate emerged from the parent focus group. While there are limitations to the generalisability of the results, this case study provides a useful approach for schools to assess their school climate and establish goals for improvement. (shrink)

Are the wishes of the dead more important than the needs of the living? This question is prompted by consideration of the Hershey Trust Company, a perpetual charitable trust that not only owns and operates the Milton Hershey School in Pennsylvania, but also owns a controlling interest in various Hershey-related for-profit entities. This unusual arrangement, and the conditions under which it was formed, have produced a situation in which a small, private boarding school for low-income students has an endowment (...) of $12 billion (in addition to its other corporate and real estate interests). The trust has been operating according to its founder’s wishes for decades, but some have wondered whether its resources could be put to better use for more urgent needs. This case will invite students to consider the question of how we should weigh the needs of the living against the wishes of the dead. (shrink)

Is philosophy the pursuit of knowledge, as first year students with a dictionary sometimes write? With an aim to inspire and encourage philosophical inquiry, offering an invitation to participate in a process of discovery? Or are philosophers charged with teaching the history of such pursuits – who argued, proved, disproved what? On the first account, philosophy is a subject that resists information-transmission, and requires exploration, creativity, discussion and dialogue. On the second, teaching centres on information-transmission, etching old ideas into the (...) minds of budding scholars, in short time slots. Though there need not be a division, there is a need to recognise where approaches differ. In this way, we can ensure sufficient time and space for the sometimes unquantifiable: imaginative, creative pursuits in philosophy, with space for independent, original thinking. This paper explores these ideas alongside approaches to teaching, and offers a paradigm for incorporating dialogue in the learning an... (shrink)

Purpose This paper aims to seek to ascertain the corporate social responsibility information needs of customers of microfinance institutions. It also ascertains their media preferences for CSR disclosure. Design/methodology/approach The study adapted Wilson’s concept of information needs as the conceptual basis of this study. Case study research design was used. The respondents consisted of customers of MFIs in Ghana. Semi-structured interview was used to collect the data. Data were analysed using thematic analysis technique. Findings The study found that (...) the CSR information needs of MFIs’ customers relate to moral disclosure, business survival disclosure, financial and business terms and conditions disclosure, donations disclosure and capacity building and training disclosure. The study also found that family and friends are the most reliable sources of CSR information for MFIs’ customers. Originality/value There is a great deal of literature available on CSR disclosure. However, limited studies have investigated the information needs of customers regarding CSR disclosure. Again, CSR disclosure in the Microfinance sector has received limited attention in the existing literature. This study expanded the existing literature by investigating the CSR information needs of MFIs’ customers. (shrink)

This paper investigates the meaning of needs claims to determine conditions under which they can be falsified. Interpreting needs as necessary requirements, I consider two distinct versions of the statement “A needs X.” One is hypothetical: “If A is to do or obtain Y, then A needs X.” The other is categorical - “A needs X at hand” - and is derived from the hypothetical statement when A is in some manner to do Y. I (...) argue that, despite some cases in which needs claims cannot be falsified, formal criteria can be adduced to falsify or, at least, challenge both versions of needs claims. (shrink)

ABSTRACTWhile many attempts have been made to institutionalize ethical training in the United States Armed Forces, the intended aim of each undertaking – changing the overall perception, understanding, and appreciation of ethics – is not fully achieved. Additionally – and conspicuously absent from each of the ethical initiatives of the warfighting institution – no method to evaluate and assess the ethical behavior of its members exists in the Armed Forces. Because Service members do not have a standard from which to (...) measure personal behavior, they cannot adequately assess if they are meeting those standards. Such a void necessarily precludes continuous ethical maturation. In order to make ethical behavior resonate within its ranks, the United States Armed Forces must change the institutional impression of ethics by implementing an Ethical Fitness Assessment, which would standardize the description and evaluation of ethical behavior and lay the foundation for translating ethical knowledge into ethical prac... (shrink)

In this paper I will examine how the Mental Capacity Act 2005 regulates the assessment of decision-making capacity in England and Wales. I will argue that there are difficulties in reconciling the Act with how people make decisions in practice. I will explore how ideas from the ethics of care and from phenomenology can be used to take better account of how capacity flows from a person's relationships as well as their individual abilities. I will conclude by discussing some (...) of the ethical issues that have arisen in my assessments of decision-making capacity and how I have tried to respond. (shrink)

Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80–90% of studies with industry affiliation found no harm from the product, while only about 10–20% of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between mercury exposure (...) and autism spectrum disorder show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no “consistent” evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest. (shrink)

The American Journal of Bioethics, Volume 12, Issue 4, Page 41-43, April 2012.

Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80–90% of studies with industry affiliation found no harm from the product, while only about 10–20% of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between mercury exposure (...) and autism spectrum disorder show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no “consistent” evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest. (shrink)

Andrew Davis; 1. The Need for a Philosophical Treatment of Assessment, Journal of Philosophy of Education, Volume 32, Issue 1, 7 March 2003, Pages 1–18, https:/.

Andrew Davis; 1. The Need for a Philosophical Treatment of Assessment, Journal of Philosophy of Education, Volume 32, Issue 1, 7 March 2003, Pages 1–18, https:/.

We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey’s publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, (...) as included in the NJ Directive, in ways that undermine our conclusions. They suggest we erroneously described their model as a two-criterion allocation framework; that recognising other operant criterion reveals it ‘likely mitigate[s] rather than exacerbate[s] racial disparities during triage’, and allege that concerns about inequitable outcomes are ‘without evidence’. We highlight two major studies robustly demonstrating why concerns about disparate outcomes are justified. We also show that White and Lo seek to retrospectively—and counterfactually—correct the version of the Model Guideline included in the NJ Directive. However, as our facsimile reproductions show, neither the alleged four-criteria form, nor other key changes, such as dropping the Sequential Organ Failure Assessment score, are found in the Directive. These points matter because our conclusions hence stand, because the public version of the Model Guidance had not been updated to reduce the risk of inequitable outcomes until June 2021 and NJ’s Directive still does not reflect these revisions, and, hence, represents a less equitable version, as acknowledged by its authors. We comment on broader policy implications and call for ways of ensuring accurate, transparent and timely updates for users of high-stakes guidelines. (shrink)

The paper contributes to the current discussion on the role of participatory methods in the context of technology assessment (TA) and science and technology (S&T) governance. It is argued that TA has to be understood as a form of democratic policy consulting in the sense of the Habermasian model of a “pragmatist” relation of science and politics. This notion implies that public participation is an indispensable element of TA in the context of policy advice. Against this background, participatory TA (...) (pTA) is defended against recent criticism of procedures of lay participation which states that pTA is lacking impact on S&T decision making, that pTA instead of opening S&T policies to new perspectives is used as a means to support mainstream S&T policy and that in pTA procedure the authentic lay perspective is systematically contorted by dominant expert knowledge. (shrink)

Adequate assessment of (un)consciousness is not only of theoretical interest but also has a practical and ethical importance, especially when it comes to disorders of consciousness (DOC). Accurately determining the presence or absence of consciousness in patients with DOC allows informed decisions to be made about long-term care support, referral for rehabilitation, pain management and withdrawal of life support. We believe that a theoretical account of what conscious experience is and how it emerges within the brain will advance the (...) search for appropriate neuromarkers of the presence or absence of consciousness in non-communicative brain-damaged patients. (shrink)

On February 24, 2022, Russia invaded its neighboring nation, Ukraine, in what is widely regarded in the West as a grave breach of international law. Since that time, the Russian military has been i...

Surgery is the most invasive intervention taken on behalf of health, but significant discrepancies exist between patient expectations and standard operating room practices, especially in teaching institutions. These discrepancies arise from the dual obligations of surgical faculty to present and future patients. On the one hand, in line with a patient’s autonomous election of a procedure and choice of a doctor, faculty are charged with treating patients to the utmost capacity of their knowledge and skill; on the other, in support (...) of a critical community good, they must prepare novice physicians to treat those who will require at least this level of knowledge and skill in the future. Within a broad, contrasting framework of approaches to knowledge, judgment, experience, and nature as described by Hume and Kant, this article explores the complicated concepts of trust, loyalty, assessment, and communications that presently exist between surgical patients, faculty surgeons, and surgical trainees within academic medical centers. (shrink)

Surgery is the most invasive intervention taken on behalf of health, but significant discrepancies exist between patient expectations and standard operating room practices, especially in teaching institutions. These discrepancies arise from the dual obligations of surgical faculty to present and future patients. On the one hand, in line with a patient’s autonomous election of a procedure and choice of a doctor, faculty are charged with treating patients to the utmost capacity of their knowledge and skill; on the other, in support (...) of a critical community good, they must prepare novice physicians to treat those who will require at least this level of knowledge and skill in the future. Within a broad, contrasting framework of approaches to knowledge, judgment, experience, and nature as described by Hume and Kant, this article explores the complicated concepts of trust, loyalty, assessment, and communications that presently exist between surgical patients, faculty surgeons, and surgical trainees within academic medical centers. (shrink)

The presented paper addresses the concept of technoscience and its possible implications for technology assessment. Drawing on the discourse about converging technologies, it formulates the assumption that a general shift within science from epistemic cultures to techno-epistemic cultures lies at the heart of the propagated convergence between nano-, bio-, info- and cogno-sciences and technologies. This shift is adequately captured—so the main thesis—by the technoscience label. The paper elaborates on the shared characteristics of the new technosciences, especially their hybrid character (...) and their non-linear integration of basic research, object construction and technological innovation. Recent calls for new modes of technology governance (e.g. for upstream technology assessment and public participation) are discussed against the background of these technoscience characteristics. It is concluded that an adequate model of emerging technosciences and a detailed understanding of their characteristics is of paramount importance for current practices of technology assessment. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. (...) Results Of the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. (...) Results Of the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” (...) who self-identified as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

Volume 20, Issue 2, February 2020, Page 20-22.