A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

Leaders and managers of today's multinational corporations face a plethora of problems and issues directly attributable to the fact that they are operating in an international context. With work-sites, plants and/or customers based in another country, or even several countries, representing a vast spectrum of cultural differences, international trade and offshore operations, coupled with increased globalisation in respect to political, social and economic realities, contribute to new dilemmas that these leaders must deal with. Not the least of these being a (...) Code of Ethics and ethical decision making.This paper examines the differences in culture between a group of managers from the United States and similar group from Croatia using Hofstede's theory of International Cultures. The study explores how these cultural dimensions may help in our understanding of the differences in reported whistleblowing. The authors then postulate four hypotheses regarding various aspects of whistleblowing. These Hypotheses were than tested using a survey administered to a sample of U.S.A. and Croatian managers. Finally, the paper discusses the findings and practical implications for contemporary managers in the international arena. (shrink)

A highly ordered universe is described in terms of neutrino and electrino alone as basic particles, and length and time alone as dimensional units. New theories are obtained of particles, nuclides, atomic spectra, general relativity, and gravitation.

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

Objectives: to assess physicians’ and patients’ views in Saudi Arabia towards involving the patient versus the family in the process of diagnosis disclosure and decision-making, and to compare them with views from the USA and Japan.Design: A self-completion questionnaire was translated to Arabic and validated.Participants: Physicians from different specialties and ranks and patients in a hospital or attending outpatient clinics from 6 different regions in KSA.Results: In the case of a patient with incurable cancer, 67% of doctors and 51% of (...) patients indicated that they would inform the patient in preference to the family of the diagnosis . Assuming the family already knew, 56% of doctors and 49% of patients would tell the patient even if family objected . However, in the case of HIV infection, 59% of physicians and 81% of patients would inform the family about HIV status without the patient’s consent . With regards to withholding ventilatory support, about 50% of doctors and over 60% of patients supported the use of mechanical ventilation in a patient with advanced cancer, regardless of the wishes of the patient or the family. Finally, the majority of doctors and patients were against assisted suicide.Conclusions: Although there was more recognition for a patient’s autonomy amongst physicians, most patients preferred a family centred model of care. Views towards information disclosure were midway between those of the USA and Japan. Distinctively, however, decisions regarding life prolonging therapy and assisted suicide were not influenced to a great extent by wishes of the patient or family, but more likely by religious beliefs. (shrink)

Moral distress is one of the core topics of clinical ethics. Although there is a large and growing empirical literature on the psychological aspects of moral distress, scholars, and empirical investigators of moral distress have recently called for greater conceptual clarity. To meet this recognized need, we provide a philosophical taxonomy of the categories of what we call ethically significant moral distress: the judgment that one is not able, to differing degrees, to act on one’s moral knowledge about what one (...) ought to do. We begin by unpacking the philosophical components of Andrew Jameton’s original formulation from his landmark 1984 work and identify two key respects in which that formulation remains unclear: the origins of moral knowledge and impediments to acting on that moral knowledge. We then selectively review subsequent literature that shows that there is more than one concept of moral distress and that explores the origin of the values implicated in moral distress and impediments to acting on those values. This review sets the stage for identifying the elements of a philosophical taxonomy of ethically significant moral distress. The taxonomy uses these elements to create six categories of ethically significant moral distress: challenges to, threats to, and violations of professional integrity; and challenges to, threats to, and violations of individual integrity. We close with suggestions about how the proposed philosophical taxonomy of ethically significant moral distress sheds light on the concepts of moral residue and crescendo effect of moral distress and how the proposed taxonomy might usefully guide prevention of and future qualitative and quantitative empirical research on ethically significant moral distress. (shrink)

A 4-space formulation of Dirac's equation gives results formally identical to those of the usual Klein paradox. However, some extra physical detail can be inferred, and this suggests that the most extreme case involves pair production within the potential barrier.

Dirac's equation is reviewed and found to be based on nonrelativistic ideas of probability. A 4-space formulation is proposed that is completely Lorentzinvariant, using probability distributions in space-time with the particle's proper time as a parameter for the evolution of the wave function. This leads to a new wave equation which implies that the proper mass of a particle is an observable, and is sharp only in stationary states. The model has a built-in arrow of time, which is associated with (...) a restriction to positive-energy solutions. The usual solution for a Coulomb field is retained, though it now implies a slightly different charge distribution. The conventional nonstationary solutions become invalid. The new formulation appears to offer a resolution of difficulties that have been associated with Dirac's equation. It also predicts the occurrence of virtual pairs at a level that may be experimentally testable, and suggests a mechanism for self-cancellation of the vacuum energy. (shrink)

Or a Treatise on Language. ... oironff inclination for na : this is one of the most s s language exposes'*! ... cs- •al, enables me to gratify my unenviable propensity. , Among the results is a Treatise on the Philosophy of / Human Knowledge.

On the life and philosophy of Bhāskarācārya, 8th cent., Vedanta philospher and commentator of Brahmasūtra.

The validity of the double effect doctrine is examined in euthanasia and abortion. In these two situations killing is a method of treatment. It is argued that the doctrine cannot apply to the care of the dying. Firstly, doctors are obliged to harm patients in order to do good to them. Secondly, patients should make their own value judgments about being mutilated or killed. Thirdly, there is little intuitive moral difference between direct and indirect killing. Nor can the doctrine apply (...) to abortion. Doctors kill fetuses as a means of treating the mother. They also kill them as an inevitable side effect of other treatment. Drawing a moral distinction between the direct and the indirect killing gives counterintuitive results. It is suggested that pragmatic rules, not ethics, govern practices around euthanasia and cause it to be more restricted than abortion. (shrink)

Antonio Argandoña, Norbert Bilbeny, Victòria Camps, Miquel Calsina, Àngel Castiñeira, Cristian Palazzi, Ferran Requejo, Raimon Ribera, Begoña Román, Ferran Sàez, Miquel Seguró, Francesc Torralba, Josep Maria Vallès, Rosamund Thomas Ramon Llull Journal of Applied Ethics 2012 3(3):9-16.

This essay aims to critically assess the later Foucault's ethical turn by using Levinas's ethical metaphysics as critical yardstick. Foucault's notion of ethical subjectivity constitutes a site of resistance against externally imposed subjugating subject identities. Apart from a practice of freedom, Foucault also insists that it engenders the subject with a generous responsiveness towards others. Despite Foucault's other-aspirations, it seems probable that care of the self would fall short ethically when compared to Levinas's insistence upon an unconditional openness towards the (...) Other. Upon closer investigation, however, we find that Levinas's ethical metaphysics is founded upon phenomenological analyses of our immanent 'economic' existence here and now in the world. Although he maintains that metaphysics or 'transcendence, the welcoming of the other by the same' (Levinas, 1979:43/13) is primary, the immanent process of the subject's 'auto-personification' ( ibid ., p.147/120) serves as a necessary condition for the possibility of becoming ethical, of welcoming the Other. Moreover, contrary to Foucault's self-caring subject, who actively partakes in its own ethical self-formation, Levinas's existent has no educable ethical sensibility. It is powerless against the gravitational pull of its egoism, condemned to a hopeless amorality unless the Other intervenes and saves it from itself. I shall therefore argue that Foucault's account of ethical self-becoming invests the subject with a meta -physical potential, which it is denied by Levinas's ethical metaphysics. South African Journal of Philosophy Vol. 25(2) 2006: 113-125. (shrink)

This is a monumental study of the transcendental deduction—that argument of legendary obscurity lying at the heart of Immanuel Kant’s Critique of Pure Reason. Allison begins from the methodological precept that “Kant’s argument can best be understood in light of the internal development of his thought”, and his book thus provides a systematic historical account of the deduction and its emergence from earlier texts. It begins with two chapters on the major pre-critical writings, which trace the emergence of Kant’s “methodological” (...) concerns with the limits and possibilities of metaphysical theorizing. However, this concern... (shrink)