Pilgrimage, Politics, and Pestilence: The Haj from the Indian Subcontinent 1860–1920. By Saurabh Mishra. New Delhi: Oxford University Press, 2011. Pp. ix +177. $55.

This clinical case report illustrates the potential dilemmas that can arise from knowledge gained through genetic analysis. These conflicts require careful ethical analysis of presumed duties to protect patient privacy and maintain confidentiality, the duty to warn a second party of a health risk, and the duty of veracity. While the questions raised by genetic testing of one individual for disease that reveals potentially important information about relatives, such as risk for Huntington chorea or breast cancer, have been discussed, the (...) continuing expansion in our capacity for sophisticated genetic analysis continues to present new and challenging situations. The resolution of this case and others like it requires close collaboration among the treatment team, geneticists, and clinical ethicists. (shrink)

setting, are warranted. This article details a descriptive study in which patients were interviewed, during hospital stays, about their beliefs and understanding of advanced directions, as well as the processes used in completing them. The study was undertaken in a community hospital located in a rural area in the Midwest. Findings show that many patients were able to clearly articulate what an AD means in terms of making their choices known. However, misconceptions were found in patients' understanding of ADs and (...) only 46% reported discussing their ADs with a physician. Strategies for effective implementation of education programs related to ADs are detailed here. © 1999 Lippincott Williams & Wilkins, Inc.... (shrink)

In the United States, there is no consensus about who should make decisions in acute but non-emergent situations for incapacitated patients who lack surrogates. For more than a decade, our academic medical center has utilized community volunteers from the hospital ethics committee to engage in shared decision-making with the medical providers for these patients. In order to add a different point of view and minimize conflict of interest, the volunteers are non-clinicians who are not employed by the hospital. Using case (...) examples and interviews with the community members, this paper describes how the protocol has translated into practice over the years since its inception. Members reported comfort with the role as well as satisfaction with the thoroughness of their discussions with the medical team. They acknowledged feelings of moral uncertainty, but expressed confidence in the process. Questions raised by the experience are discussed. Overall, the protocol has provided oversight, transparency, and protection from conflict of interest to the decision-making process for this vulnerable patient population. (shrink)

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, (...) we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. (shrink)

Professional identity and competent ethical behaviors of nursing students are commonly developed through curricular inclusion of professional nursing values education. Despite the enactment of this approach, nursing students continue to express difficulty in managing ethical conflicts encountered in their practice. This descriptive correlational study explores the relationships between professional nursing values, self-esteem, and ethical decision making among senior baccalaureate nursing students. A convenience sample of 47 senior nursing students from the United States were surveyed for their level of internalized professional (...) nursing values (Revised Professional Nursing Values Scale), level of self-esteem (Rosenberg’s Self-Esteem Scale), and perceived level of confidence in ethical decision making. A significant positive relationship (p < 0.05) was found between nursing students’ professional nursing values and levels of self-esteem. The results of this study can be useful to nursing educators whose efforts are focused on promoting professional identity development and competent ethical behaviors of future nurses. (shrink)

We examined differences in the knowledge and beliefs that exist among nurse researchers in the USA (n = 119) regarding informed consent and the use of data from patients’ medical records. Using a mail survey, two domains of ethical knowledge and beliefs were assessed: the legal right to privacy and the moral right to privacy. More than half of the participants were very confident in their knowledge of institutional review board procedures, research ethics, informed consent, the legal right to privacy, (...) and the moral right to privacy. In contrast, most rated themselves as uncertain about US federal research regulations and there was wide variation in knowledge about current federal guidelines. Those who were more confident in their knowledge of or had more practical experience with research ethics, were no more likely to answer correctly a question about current federal guidelines regulating the use of patient data from medical records than those who reported less confidence or experience. (shrink)

Numerous ethical issues are raised in cancer treatment and research. Informed consent is challenging due to complex treatment modalities and prognostic uncertainty. Busy oncology clinics limit the ability of oncologists to spend time reinforcing patient understanding and facilitating end-of-life planning. Despite these issues and the ethics consultations they generate, clinical ethicists receive little if any focused education about cancer and its treatment. As the field of clinical ethics develops standards for training, we argue that a basic knowledge of cancer should (...) be included and offer an example of what cancer ethics training components might look like. We further suggest some specific steps to increase collaboration between clinical ethicists and oncology providers in the outpatient setting to facilitate informed consent and proactively identify ethical issues. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

To date no one has identified or described the population of incapacitated patients being treated in an inpatient setting who lack proxy decision-makers. Nor, despite repeated calls for protocols to be developed for decision-making, has any institution reported on the utilization of such a protocol. In 2005, our urban tertiary care hospital instituted a protocol utilizing community members of the ethics committee to meet with the medical providers and engage in shared decision-making for patients without proxies. We conducted a retrospective (...) chart review and in this paper describe nearly 200 patients who were identified and treated according to the protocol over a 12 year period. After an aggressive search, family members were located for a surprising number of patients, leaving 80 patients who needed decisions to be made utilizing the PWP committee. We review the decisions required, the results of the shared decision-making meetings, and the patient outcomes. Our experience has shown that a protocol involving community volunteers to make decisions for PWPs in a timely manner is feasible and ethically defensible. The protocol has been accepted by physicians and utilized with increasing frequency. Because it was possible to gather at least minimal information on most patients, a standard of “informed best interest” was used to make decisions. PWP committee recommendations varied, but in all cases agreement was reached with the attending physicians. (shrink)

Standardizing consultation processes is increasingly important as clinical ethics consultation becomes more utilized in and vital to medical practice. Solid organ transplant represents a relatively nascent field replete with complex ethical issues that, while explored, have not been systematically classified. In this paper, we offer a proposed taxonomy that divides issues of resource allocation from viable solutions to the issue of organ shortage in transplant and then further distinguishes between policy and bedside level issues. We then identify all transplant related (...) ethics consults performed at the Cleveland Clinic between 2008 and 2013 in order to identify how consultants conceptually framed their consultations by the domains they ascribe to the case. We code the CC domains to those in the Core Competencies for Healthcare Consultation Ethics in order to initiate a broader conversation regarding best practices in these highly complex cases. A discussion of the ethical issues underlying living donor and recipient related consults ensues. Finally, we suggest that the ethical domains prescribed in the Core Competencies provide a strong starting ground for a common intra-disciplinary language in the realm of formal CEC. (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

There are growing discontinuities between the research practices of data science and established tools of research ethics regulation. Some of the core commitments of existing research ethics regulations, such as the distinction between research and practice, cannot be cleanly exported from biomedical research to data science research. Such discontinuities have led some data science practitioners and researchers to move toward rejecting ethics regulations outright. These shifts occur at the same time as a proposal for major revisions to the Common Rule—the (...) primary regulation governing human-subjects research in the USA—is under consideration for the first time in decades. We contextualize these revisions in long-running complaints about regulation of social science research and argue data science should be understood as continuous with social sciences in this regard. The proposed regulations are more flexible and scalable to the methods of non-biomedical research, yet problematically largely exclude data science methods from human-subjects regulation, particularly uses of public datasets. The ethical frameworks for Big Data research are highly contested and in flux, and the potential harms of data science research are unpredictable. We examine several contentious cases of research harms in data science, including the 2014 Facebook emotional contagion study and the 2016 use of geographical data techniques to identify the pseudonymous artist Banksy. To address disputes about application of human-subjects research ethics in data science, critical data studies should offer a historically nuanced theory of “data subjectivity” responsive to the epistemic methods, harms and benefits of data science and commerce. (shrink)

What makes teaching a moral endeavor? How can we prepare classroom practitioners for engaging in that moral endeavor in meaningful and effective ways? This volume brings together leading scholars who draw upon both their academic expertise and substantial wisdom of practice to offer a variety of perspectives on the challenge of preparing today’s teachers for the moral work of teaching. Book Features: Examines the role that teacher preparation and development can play in addressing the moral work of teaching. Highlights the (...) work of leading scholars from educational psychology, educational philosophy, and teacher education. Provides compelling insights for identifying the next generation of our nation’s best teachers. Contributors: Wolfgang Althof, Karen Benson, Marvin Berkowitz, Donald Blumenfeld-Jones, Elizabeth Campbell, Julie Canniff, Mary Crawford, Lana Daly, Rebecca Evers, Catherine Fallona, Gary Fenstermacher, Anthony Holter, Lisa Johnson, Daniel Lapsley, Darcia Narvaez, Virginia Navarro, Larry Nucci, Joy Pelton, Virginia Richardson, Don Senneville, David Light Shields, Barbara Stengel, Jonatha Vare, Marilyn Watson. (shrink)

Although a detailed analysis of Darwin’s lexicon inOn the Origin of Specieshas not been undertaken, critical literature claims that there are lexical signs of a teleological nature in the language used in this work. I intend to refute, through an analysis of the lexicon in Darwin’s work, the criticisms that claim a teleological subtext in Darwin’s language and that conceive said language to be a reflection of a teleological conception of nature. I will place special emphasis on the lexical material (...) that Darwin uses in those paragraphs dedicated to the description of the function of Natural Selection. (shrink)

Utilitarianism is one of the “grand Enlightenment” moral philosophies. It provides a means of evaluating the ethical implications of common and unusual situations faced by psychiatrists, and offers a logical and ostensibly scientific method of moral justification and action. In this first of our two papers, we trace the evolution of utilitarianism into a contemporary moral theory and review the main theoretical critiques. In the second paper we contextualize utilitarianism in psychiatry and consider its function within the realm of the (...) professional ethics of psychiatrist as physician, before applying it to two dilemmas faced by psychiatrists as individuals and as members of a profession. We conclude that psychiatry must search beyond utilitarianism in grappling with everyday clinical scenarios. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Philosophical Rhetoric of Socrates’ MissionRobert Metcalf"We shall dismiss this business of Chaerephon, as it is nothing but a cheap and sophistical tale [sophistikon kai phortikon diegema]"—Colotes, according to Plutarch's Moralia 14, 1116f-1117a.Socrates' account of his "mission" on behalf of the god at Delphi is one of the most memorable parts of his most famous memorial in Plato's Apology. But it is also controversial as to what it (...) means to Socrates and what it should mean to readers of Plato's text.1 First, there is the curious fact that the story occurs nowhere outside the competing versions of Socrates' defensespeech in Plato and Xenophon, and in the latter version the oracular report differs significantly in content and import: there the Pythia proclaims, not that no one is wiser than Socrates, but that no one is more generous or more just or more "soundminded" (sophron), and Xenophon's Socrates uses this as evidence that he "outshone the rest of mankind" and "deserves congratulations from gods and men alike" (Apology 14-18).2 Furthermore, the sequence of events that make up Socrates' "mission" is itself difficult to discern, from its apparent prompting by the oracular message to Chaerephon, to Socrates' initial effort to refute it, to his ultimate practice of elenchos in order that the oracle (or, at least, his interpretation of the oracle) might remain unrefuted.3 Not surprisingly, it was already a matter of controversy in the third century BC, as we read in the above quotation from Plutarch's Moralia. Whereas Arcesilaus interpreted the story of the Delphic oracle, and the account of elenctic practice occasioned by the oracle, as a model for his own skeptical orientation, Colotes, the Epicurean, charged that he had been duped by Socrates' sophistic oratory.4 To be sure, Colotes' charge of sophistry is meant to be abusive and has value for us only insofar as it counters a piously uncritical reading of Socrates' self-portrayal in Plato's Apology.5 In what follows I shall argue that an appreciation of the irony and mock-humility with which Socrates accounts for his "mission" to philosophize [End Page 143] affords us insight into the philosophical rhetoric that is essential to Socrates' practice of elenchos.But let us begin by examining those strange elements in Socrates' account that have made it "notorious" in the way suggested by the ancient debate.6 Socrates introduces the story of the oracle only after he dismisses, somewhat cursorily, the charges circulated by his "first accusers"—namely, that he investigates the things under the earth and heavenly things, and that he educates people for money (19b-20c). Insisting that he does not dishonor the knowledge involved in these activities (19c, 20b-c), Socrates nonetheless offers little defense apart from simply disowning such knowledge, presumably because these activities are not related to that "matter" (pragma) which has earned him his peculiar reputation (20c-d). It is here, in his explanation of this matter, that Socrates recounts the story of Chaerephon and the Pythia.7 As he begins the story he repeats his vow from the beginning of his defense to tell the jury only the truth (20d), assures them that he is not joking, and then is compelled to plead with them not to make any disturbances—"even," he says, "if I seem to you to be boasting [mega legein] somewhat" (20e). These successive declarations are all necessary, for the story has it that Socrates acquired his reputation through the human wisdom for which Socrates was singled out by the oracle at Delphi (20d-e).Socrates' puzzlement over the oracle and his effort to subject it to elenchos are offered as an explanation for the elenctic practice by which he comes, over time, to acquire his reputation.8 Although he does not say that his practice of elenchos begins with his investigation of the oracle's meaning, he does portray his subsequent practice of elenchos as being "in accordance with the god [kata ton theon]" (22a), an activity for which the god stands as a trustworthy witness (20e), and thus as a "matter of the god [to tou theou]" (21e). Ironically, the account Socrates... (shrink)

Managers are expected to actively build their role, shaping and adjusting it day after day on their own company needs and on market upheaval. In our society development became one of the keywords: development at all costs, continuous growth, economic growth, professional development, purchasing power growth. Inside this logic a self-empowerment or coaching project are frequntly required, and really often the consultant acts inside the same logic of development at all cost. When the adviser agrees to this request without opening (...) a space to analyze the question, but simply working on the given target in order to supply the comforting answer, he acts inside the same weird and directive logic leading to the prevalence of the role on the person. Working through an effective empowerment perspective means working together with the person in the role: improving his self-awareness, promoting a reflection on targets and values, ensuring an elaboration space for emotions and experiences. The aim is to bring into question the answer taken for granted, trying to look from a different perspective what we do, what we are, what we say. (shrink)

In Australia, the university ethics approval process is guided by the National Statement on Ethical Conduct in Human Research. The National Statement does not provide a hurdle to be overcome or avoided, nor is it a Godzilla-like monster that must be slain for truth to survive. Rather the National Statement provides an affirmation of an abiding respect for all life and a mechanism for beginning the intelligent questioning, theorization and contextualization for a work of art. Focusing specifically on the emergent (...) discipline of artistic research, this article addresses the question of how the supervisory process may take on the ‘spirit’ of the National Statement to engender genuine ethical debate, rather than merely focus on the instrumental obstacles that seem to get in the way of the research. It specifically addresses the emergent field of artistic research and the concomitant resistance to ethical regulation of artistic research, in which bureaucratic instrumentalism and compliance or censorship are considered to potentially emasculate the vitality of an art work and the ability of art to serve as a truthsayer or agent provocateur. In this, the attitude of the supervisor toward research ethics in artistic research is considered a key factor in determining their students attitudes towards the ethics process. This article will present several initiatives undertaken with the intent of more fully engaging supervisors and students with research ethics. (shrink)

Automobile insurance companies are joining the move to managed care in the hopes of reducing health-care expenditures arising out of automobile accidents. Industry interest is strong enough that large managed care organizations, such as Concentra Managed Care, Inc., and HNC Insurance Solutions, are beginning to offer their existing network of providers to persons seeking medical care for automobile accident injuries and their evaluation software to insurers.While insurance companies have successfully pressed four state legislatures and one commissioner of insurance for authorization (...) to offer consumers a managed care option in automobile insurance policies, these efforts have not gone unchallenged. Vocal opponents, primarily lawyer and chiropractic organizations, question whether persons injured in accidents will receive care when needed, what the quality of care received will be, and whether any savings will be passed on to consumers. (shrink)

The case of Vo v. France represents the latest phase of the European Court of Human Rights’ thinking on the scope of Article 2 of the European Convention on Human Rights (the right to life) in relation to foetal life where a foetus had been lost owing to a medical accident. The Court by a majority decided that, “even assuming” Article 2 applied to the instant case (albeit to the life of the pregnant woman rather than that of the foetus), (...) it had not been violated. While the facts in Vo were extreme and exceptional, the Court will shortly hear the case of D v. Ireland concerning access to abortion for foetal anomaly, an application made under Articles 3, 8, 10 and 14 of the European Convention. If the case of D were declared admissible, the Court would then have to consider whether a denial of access to abortion for foetal anomaly constitutes inhuman and degrading treatment contrary to Article 3, or an interference with a pregnant woman’s right to respect for private life under Article 8 (and if so, how the doctrine of the margin of appreciation applies). The Grand Chamber precedent of Vo displays ambivalence about whether Article 2 should apply to foetal life, and its resort to the “even assuming” formula spared Member States the difficulty of having to justify their various abortion regimes, by reference to this Article. It remains to be seen whether in a case like D that is directly concerned with abortion, the Court will take a more definite stance on the correct balance to be struck between the State’s interest in protecting foetal life and the Convention rights of pregnant women. (shrink)

The aim of this article is to present the circumstances of Noël Coypel’s appointment as rector of the French Academy in Rome and to trace the route of his didactic journey from Paris to Rome with the Prix de Rome scholars entrusted to him. The paper is an attempt to answer the following questions: why a more difficult route through the Alps was chosen, in what way was the journey educational, and what role did the documents given to Coypel play (...) in securing the expedition. The article is based on an analysis of administrative records during the reign of Louis XIV, lists of superintendents and directors of the French Academy in Rome, accounts of royal buildings, and minutes of the Royal Academy of Painting and Sculpture in Paris. The paper uses the analytical method, the comparative method, the synthetic method, source criticism, argumentum ex silentio inference, and the geographical method when discussing the itinerary. Although the trip was purposeful and related to Coypel’s new position, he designed it in such a way as to not so much get to the destination quickly, but to show his students as much as possible. Coypel introduced the royal scholars to masterpieces of painting and sculpture at centers along a route through Dijon, Lyon, Chambéry, the Mont Cenis Pass, Turin, Milan, Bologna and Florence. The crossing of the Alps, though dangerous, was most often chosen because of the artistic reputation of the cities there. The trip was educational at the expense of comfort or safety. Coypel, as a guide and teacher led his charges by overseeing their learning during and through the journey. Wandering to the Eternal City was part of a painter’s education in the seventeenth century and was part of Coypel’s didactic work allowing young people to be inspired by direct exposure to masterpieces. The journey had an eminently didactic and artistic character, but also an initiatory one, as it gradually initiated and prepared the students for the experience of Rome, the center of artistic life at that time. (shrink)

The notion of a pseudo-interior algebra was introduced by Blok and Pigozzi in [BPIV]. We continue here our studies begun in [BK]. As a consequence of the representation theorem for pseudo-interior algebras given in [BK] we prove that the variety of all pseudo-interior algebras is generated by its finite members. This result together with Jónsson's Theorem for congruence distributive varieties provides a useful technique in the study of the lattice of varieties of pseudo-interior algebras.

We explore the relationship between first language attrition and language dominance, defined here as the relative availability of each of a bilingual’s languages with respect to language processing. We assume that both processes might represent two stages of one and the same phenomenon ( Schmid and Köpke, 2017 ; Köpke, 2018 ). While many researchers agree that language dominance changes repeatedly over the lifespan (e.g., Silva-Corvalan and Treffers-Daller, 2015 ), little is known about the precise time scales involved in dominance (...) shifts and attrition. We investigate these time scales in a longitudinal case study of pronominal subject production by a near-native L2-German (semi-null subject and topic-drop but non-pro-drop) and L1-Bulgarian (pro-drop) bilingual speaker with 17 years of residence in Germany. This speaker’s spontaneous speech showed a significantly higher rate of overt pronominal subjects in her L1 than the controls’ rates when tested in Germany. After 3 weeks of L1-reexposure in Bulgaria, however, attrition effects disappeared and the overt subject rate fell within the monolinguals’ range ( Genevska-Hanke, 2017 ). The findings of this first investigation are now compared to those of a second investigation 5 years later, involving data collection in both countries with the result that after 17 years of immigration, no further attrition was attested and the production of overt subjects remained monolingual-like for the data collections in both language environments. The discussion focuses on the factors that are likely to explain these results. First, these show that attrition and language dominance are highly dependent on immediate language use context and change rapidly when the language environment is modified. Additionally, the data obtained after L1-reexposure illustrate that time scales involved in dominance shift or attrition are much shorter than previously thought. Second, the role of age of acquisition in attrition has repeatedly been acknowledged. The present study demonstrates that attrition of a highly entrenched L1 is a phenomenon affecting language processing only temporarily and that it is likely to regress quickly after reexposure or return to balanced L1-use. The discussion suggests that dominance shift and attrition probably involve similar mechanisms and are influenced by the same external factors, showing that both may be different steps of the same process. (shrink)