Purpose This paper aims to focus on the role of information and communication technologies in preparation for and management of human and/or nature induced disasters. Design/methodology/approach Drawing from the phenomenal growth of ICTs, initiatives aimed at disaster management, stakeholder theory, prior research and the successful development and implementation of 9-1-1, this paper explores ICTs in the context of human and/or nature induced disasters. Findings This paper discusses a new ICT for mitigating disaster management, scans, using stakeholder theory, relevant initiatives and (...) prior research to identify the stakeholders relevant for successful preparation for and management of disasters, and draws from the 9-1-1 example to discuss how ICTs can be successfully developed and adopted. Research limitations/implications There are opportunities for researchers to develop ICTs that can make countries, developing and developed, more efficient and effective in their preparation for and management of nature and human induced disasters. In addition, researchers can investigate the role of stakeholders in facilitating the adoption of new ICTs developed for disaster management. Researchers could also help public policy in designing the most efficient and effective programs for the adoption of new ICTs. Practical/implications As an example of new ICTs that can potentially mitigate the effect of disasters, this paper discusses the E711 text-message mobile phone service and provides a description of how this protocol operates and can be implemented. There are tremendous opportunities to develop new ICTs in the context of disaster management. Social/implications This paper argues that ICTs such as E711 can have a major impact on all countries in general and poor and developing nations in particular. Specifically, in the bottom of the pyramid markets, developing ICTs for BOP market in the context of managing human and nature induced disasters and ensuring the diffusion of such ICT innovations is both critical and challenging. Originality/value This paper discusses the role and importance of ICTs in disaster management, identifies relevant stakeholders, discusses how ICTs can be diffused and implemented and calls on and hopes to provide an impetus to research on ICTs that can aid in the preparation for and the management of disasters. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 52-53, June 2011.

In Democracy and the Claims of Nature, the leading thinkers in the fields of environmental, political, and social theory come together to discuss the tensions and sympathies of democratic ideals and environmental values. The prominent contributors reflect upon where we stand in our understanding of the relationship between democracy and the claims of nature. Democracy and the Claims of Nature bridges the gap between the often competing ideals of the two fields, leading to a greater understanding of each for the (...) other. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Future of Environmental PhilosophyBen A. Minteer (bio)I think we should be deeply concerned about the future of environmental philosophy. It is the most marginalized of the applied ethics fields (which are often marginalized as a whole within traditional philosophy departments) and with few exceptions, it still has not made significant inroads into neighboring territories—including schools of public policy, natural resources/environment, planning, life sciences, and so on. In my (...) opinion, this is partly due to the general ideological pitch of the field and its narrow methodological orientation, at least historically. The neglect of alternative methods of inquiry, especially qualitative and quantitative work in the social sciences, is particularly troubling.Environmental ethics also has an image problem. In my experience, most natural resource professionals, policy scholars, engineers, and life scientists view our field with considerable skepticism, shaking their heads at what they see as arcane debates that do not touch upon the issues and challenges that motivate their own work. Many of our colleagues in the natural and environmental social sciences, for example, have little patience for the kind of metaethical discussions about intrinsic value, moral pluralism, etc., that have captured much of our attention in the past. They do not see what these kinds of arguments contribute to the scientific, policy, and management curricula, or what they add to their graduate students' training, or to their own research proposals. Typically, if a role for an environmental ethicist is recognized in such settings, it is often just to plug a personnel hole in an National Science Foundation proposal or to serve as a third or fourth reader on a graduate studies committee. Environmental ethics is at best an elective pursuit, it is not seen as essential.I'll be the first to admit that I have blood on my hands here (as do all of us, at least to the extent we have spent time and energy on debates over metaphilosophical issues in the field). And, of course, just because our environmental science and policy colleagues often do not see the true value of the field does not mean that it has no value. Still, I worry that the field seems to be falling into the chasm between traditional philosophy departments and environmental science, policy, and management programs. It is frequently deemed too applied and practical by many [End Page 132] philosophy departments, and too esoteric for schools of public policy, life sciences, and so on. This is not a good situation.How can we fix the image problem? Perhaps one approach would be to develop more solid links with our bioethics cousins (both philosophically and institutionally). There is a revealing story here about the different fortunes of bio- and environmental ethics, and I think we might learn from the success of the former. There will be barriers to such an alliance, however, some of which are intellectual (e.g., the rejection of conventional ethical categories and theories by many environmental ethicists is not shared by most bioethicists) while others are institutional (e.g., What practical shape would a "clinical" model of environmental ethics take? What is the market for this service? and so on).Another route would be to provide more organized and systematic attention to emerging, large-scale environmental science and policy issues—climate change, sustainability, poverty alleviation, and biodiversity loss, to name a few—that are (unfortunately, given their seriousness) viewed as "growth areas" in environmental science and policy studies. At my own institution (Arizona State University) we are moving away from an older departmental and disciplinary model to a more integrative institutional form and a transdisciplinary research culture. So, for example, we have a new school of global studies, a new school of sustainability, and so on. These are composed of a range of disciplines cutting across the natural, technical, and social sciences. There is certainly room in these initiatives and programs for a practical and progressive environmental ethics, but it must be conversant in subjects such as intergenerational equity, conservation science, economic valuation, environmental justice, and the normative dimensions of environmental science policy. I think there is an important role for us to play in these sorts of endeavors (which are popping... (shrink)

Benton MacKaye's name is rarely evoked in the fields of environmental history and philosophy. The author of the Appalachian Trail in the early 1920s and a co-founder of the Wilderness Society with Aldo Leopold and Bob Marshall in the 1930s, MacKaye's unique contribution to American environmental thought is seldom recognized. This neglect is particularly egregious in the current debate over the intellectual foundations of the American wilderness idea, a discussion to which I believe MacKaye has much to contribute. Specifically, I (...) believe that his pragmatic vision for wilderness conservation, a project supported through an appeal to the values of a reconstructed "indigenous" communal environment, owes much to the social philosophy of Josiah Royce, MacKaye's former teacher at Harvard. While the Appalachian Trail never delivered on MacKaye's goals of progressive reform and failed to unite the regional planning and conservation communities of the time, his vision remains highly relevant to our present-day deliberations about the relationship between wild nature and society at the dawn of the 21st century. (shrink)

What is the biological basis for human cognition? Our understanding why human brains make us smarter than other animals is still in its infancy. In recent years, astrocytes have been shown to be indispensable for neuronal survival, growth, synapse formation, and synapse function. Now, in a new study from Maiken Nedergaard and Steven Goldman's groups (Han et al., 2013), human glia progenitor cells have been transplanted into mouse forebrains. These progenitors survived, migrated widely, and gave rise to astrocytes that displayed (...) the characteristics of human astrocytes in the rodent host brains. Strikingly, the mice with transplanted human cells displayed improved long term potentiation (LTP) and learning, suggesting the potential importance of human astrocytes in the unique cognitive abilities of human brains. This landmark paper is an important first step toward future investigations of whether and how human astrocytes play a role in distinguishing the cognitive abilities of humans from those of other animals. (shrink)

Providing a bold and original rethinking of environmental ethics, Ben Minteer's Refounding Environmental Ethics will help ethicists and their allies resolve critical debates in environmental policy and conservation practice. Minteer considers the implications of John Dewey's pragmatist philosophy for environmental ethics, politics, and practice. He provides a new and compelling intellectual foundation for the field - one that supports a more activist, collaborative, and problem-solving philosophical enterprise. Combining environmental ethics, democratic theory, philosophical pragmatism, and the environmental social sciences, Minteer makes (...) the case for a more experimental, interdisciplinary, and democratic style of environmental ethics - one that stands as an alternative to the field's historically dominant "nature-centred" outlook. Minteer also provides examples of his pragmatic approach in action, considering a wide range of application and issues, including invasive species, ecological research, biodiversity loss, protected area management, and conservation under global climate change. (shrink)

This book provides a richly interdisciplinary assessment of the thought and work of Bryan Norton, one of most innovative and influential environmental philosophers of the past thirty years. In landmark works such as Toward Unity Among Environmentalists and Sustainability: A Philosophy of Adaptive Ecosystem Management, Norton charted a new and highly productive course for an applied environmental philosophy, one fully engaged with the natural and social sciences as well as the management professions. A Sustainable Philosophy gathers together a distinguished group (...) of scholars and professionals from a wide array of fields to engage Norton’s work and its legacy for our shared environmental future. A study in the power of intellectual legacy and the real-world influence of philosophy, the book will be of great interest scholars and students in environmental philosophy, public policy and management, and environmental and sustainability studies. By considering the value and impact of Norton’s body of work it will also chart a course for the next generation of pragmatic environmental philosophers and sustainability scholars grappling with questions of environmental value, knowledge, and practice in a rapidly changing world. (shrink)

Conventional wisdom suggests that environmental pragmatists balk at the mere mention of intrinsic value. Indeed, the leading expositor of the pragmatic position in environmental philosophy, Bryan Norton, has delivered withering criticisms of the concept as it has been employed by nonanthropocentrists in the field. Nevertheless, I believe that Norton has left an opening for a recognition of intrinsic value in his arguments, albeit a version that bears little resemblance to most of its traditional incarnations. Drawing from John Dewey’s contextual approach (...) toward moral inquiry, I offer a reconstructed notion of intrinsic value that avoids the metaphysical pitfalls identified by Norton. I argue that this contextual understanding of noninstrumental claims has the advantage of turning our attention toward, and not away from, the critical realm of practice and policy, and that it is especially compatible with the norms of democratic deliberation. By way of example and in defense of my position, I conclude with a rejoinder to Holmes Rolston’s claims about the role of foundational intrinsic value commitments in settling the human-nature dilemma at Royal Chitwan National Park in Nepal. (shrink)

The concept of person is integral to bioethical discourse because persons are the proper subject of the moral domain. Nevertheless, the concept of person has played no role in the prevailing formulation of human death because of a purported lack of consensus concerning the essential attributes of a person. Beginning with John Locke's fundamental proposition that person is a ‘forensic term’, I argue that in Western society we do have a consensus on at least one necessary condition for personhood, and (...) that is the capacity for conscious experience. When we consider the whole brain formulation of death, and the most prominent defense of it by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, we can readily identify the flaws that grow out of the failure to define human death as the permanent loss of the capacity for conscious experience. Most fundamental among these flaws is a definition of human death that reduces persons to the capacity of the brain to regulate purely physiological functioning. Such a formulation would, in theory, apply to any member of the animal kingdom. I suggest that an appropriate concept of death should capture what it is about a particular living being that is so essential to it that the permanent loss of that thing constitutes death. What is essential to being a human being is living the life of a person, which derives from the capacity for conscious experience. (shrink)

Many nonanthropocentric environmental ethicists subscribe to a ``principle-ist'''' approach to moral argument, whereby specific natural resource and environmental policy judgments are deduced from the prior articulation of a general moral principle. More often than not, this principle is one requiring the promotion of the intrinsic value of nonhuman nature. Yet there are several problems with this method of moral reasoning, including the short-circuiting of reflective inquiry and the disregard of the complex nature of specific environmental problems and policy arguments. In (...) the present paper, we advance an alternative, pragmatic contextualist approach to environmental ethics, one grounded in the moral theory of John Dewey. We present the results of an empirical study of public environmental ethics and natural resource management attitudes to support our position, and we conclude with a few recommendations for future inquiry in the field of environmental ethics. (shrink)

Ecological research and conservation practice frequently raise difficult and varied ethical questions for scientific investigators and managers, including duties to public welfare, nonhuman individuals (i.e., animals and plants), populations, and ecosystems. The field of environmental ethics has contributed much to the understanding of general duties and values to nature, but it has not developed the resources to address the diverse and often unique practical concerns of ecological researchers and managers in the field, lab, and conservation facility. The emerging field of (...) “ecological ethics” is a practical or scientific ethics that offers a superior approach to the ethical dilemmas of the ecologist and conservation manager. Even though ecological ethics necessarily draws from the principles and commitments of mainstream environmental ethics, it is normatively pluralistic, including as well the frameworks of animal, research, and professional ethics. It is also methodologically pragmatic, focused on the practical problems of researchers and managers and informed by these problems in turn. The ecological ethics model offers environmental scientists and practitioners a useful analytical tool for identifying, clarifying, and harmonizing values and positions in challenging ecological research and management situations. Just as bioethics provides a critical intellectual and problem-solving service to the biomedical community, ecological ethics can help inform and improve ethical decision making in the ecology and conservation communities. (shrink)

Abstract:The specialty of psychiatry has a long-standing, virtually monolithic view that a desire to die, even a desire for a hastened death among the terminally ill, is a manifestation of mental illness. Recently, psychiatry has made significant inroads into hospice and palliative care, and in doing so brings with it the conviction that dying patients who seek to end their suffering by asserting control over the time and manner of their inevitable death should be provided with psychotherapeutic measures rather than (...) having their expressed wishes respected as though their desire for an earlier death were the rational choice of someone with decisional capacity. This article reviews and critiques this approach from the perspective of recent clinical data indicating that patients who secure and utilize a lethal prescription are generally exercising an autonomous choice unencumbered by clinical depression or other forms of incapacitating mental illness. (shrink)

A growing number of contributors to environmental philosophy are beginning to rethink the field’s mission and practice. Noting that the emphasis of protracted conceptual battles over axiology may not get us very far in solving environmental problems, many environmental ethicists have begun to advocate a more pragmatic, pluralistic, and policy-based approach in philosophical discussions abouthuman-nature relationships. In this paper, we argue for the legitimacy of this approach, stressing that public deliberation and debate over alternative environmental ethics is necessary for a (...) culture of democracy to be upheld in decision making and policy formulation. Then we argue for a democratically tempered environmental ethics that is grounded in a practical understanding of the character of moral claims regarding the natural world. We offer the results of an empirical study of environmental ethics held by the public to illustrate the diversity in their moral commitments to nature. Finally, we conclude with a discussion of the implications of this ethical pluralism for policy discussions about the management of American public lands. (shrink)

Abstract:Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to the Ethical (...) and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards. (shrink)

In the regime of Anglo-American tort law, every person has a responsibility to comport him- or herself with “due care” in going about day-to-day activities so as not to imperil the health, safety, or general welfare of others. The gold standard for determining what constitutes due care in any particular situation is what a reasonable person, similarly situated, would do. Determinations of due care are necessarily fact specific. Nevertheless, the general objective is to strike an appropriate balance between an unrealistically (...) high standard of caution and one that fails to take into account the known or foreseeable risks of any human endeavor. The same standard applies to individuals regardless of their age, gender, race, and level of education or economic status. The standard also applies to fictional “persons” such as corporations. The usual or prevailing custom and practice in an industry or occupation may provide relevant evidence of what constitutes “due care” in the activities common to it, but that evidence can be effectively overcome or rebutted by competent, credible evidence that the custom and practice either diverges from what it has been asserted to be or that the custom and practice is itself unsafe or otherwise poses an unreasonable risk of harm to others. Until quite recently, a singular exception to this general principle of tort law was made for the medical profession. We will consider this exception in the next section. (shrink)

Among the most significant findings of SUPPORT was that 50% of ICU patients suffered from moderate to severe pain during the last days of life. At the time of its publication late in 1995, SUPPORT was merely the latest in a long series of articles in the medical literature documenting the widespread and significant undertreatment of pain, beginning with a 1973 study of hospital inpatients. Much has been written about the phenomenon of undertreated pain and inadequate care of patients at (...) the end of life, and many positive suggestions for reform of clinical education and clinical practice have been iterated and reiterated in the two decades separating the studies. Proposals for modifying clinician behaviors in this aspect of patient care have tended to focus on particular barriers to effective pain management and palliative care. (shrink)

In the mid to late 1980s a debate arose over the moral and legal authority of advance medical directives. At the center of this debate were two point-counterpoint law journal articles by Rebecca Dresser and Nancy Rhoden. What appeared to have the makings of an ongoing critical dialogue ended with the untimely death of Nancy Rhoden. Rebecca Dresser, however, has continued her challenge of advance directives in numerous publications, most recently in a critique of Ronald Dworkin's Life's Dominion. Like Rhoden, (...) Dworkin has been a staunch advocate of advance directives as an exercise of what has come to be referred to as prospective or precedent autonomy. In this paper I will consider a number of the issues that Dresser has repeatedly raised about the infirmities of advance directives, and suggest that it is from an understanding of and appreciation for the narrative dimension of the life of a person that advanced directives draw one of their most powerful justifications. (shrink)

Many of the leading contributors to the field of environmental ethics demonstrate a preference for foundationalist approaches in their theoretical justifications of environmentalism. In this paper, I criticise this tendency as it figures in the work of Holmes Rolston III, J. Baird Callicott, and Eric Katz. I illustrate how these writers' desire for philosophical absolutes leads them to reject the moral resources present within human culture; a move that carries with it a number of troubling philosophical and political problems. I (...) conclude that environmental theorists would be better served by taking a more contextual, social, and pragmatic approach to justifying their moral projects regarding nature, and that this mode of inquiry will ultimately lead toward a more philosophically sound and democratically authentic environmental ethics. (shrink)

Bryan Norton 's convergence hypothesis, which predicts that nonanthropocentric and human-based philosophical positions will actually converge on long-sighted, multi-value environmental policy, has drawn a number of criticisms from within environmental philosophy. In particular, nonanthropocentric theorists like J. Baird Callicott and Laura Westra have rejected the accuracy of Norton 's thesis, refusing to believe that his model's contextual appeals to a plurality of human and environmental values will be able adequately to provide for the protection of ecological integrity. These theoretical criticisms (...) of convergence, however, have made no real attempt to engage the empirical validity of the hypothesis, the dimension that Norton clearly takes to be the centerpiece of his project. Accordingly, the present paper attempts to provide an empirical analysis of the convergence argument, by means of a study of the Vermont public's environmental commitments and their attitudes toward national forest policy. Our findings support a generalized version of Norton 's thesis, and lead us to suggest that environmental philosophers should try to be more inclusive and empirically minded in their discussions about public moral claims regarding nature. (shrink)

In his professional life, Richard Posner is addressed as “Your Honor,” inasmuch as he is Chief Judge of the U.S. Court of Appeals for the Seventh Circuit. He is also a senior lecturer at the University of Chicago Law School. Finally, he is a prolific author of books and articles in scholarly journals in which he expounds at length and with copious footnotes his particular views of jurisprudence and public policy. One of his frequent intellectual adversaries, legal philosopher Ronald Dworkin, (...) wryly described Judge Posner as “the lazy judge who writes a book before breakfast, decides several cases before noon, teaches all afternoon at the Chicago Law School, and performs brain surgery after dinner.”. (shrink)

Prognostication, the process offormulating and communicating a prognosis, isno longer considered by most physicians to bean essential task in caring for patients withserious illness. Because of this fact, it isnot surprising to find that when physiciansattempt to engage in prognostication, they doit poorly. What may be surprising to thoseoutside the medical community is the extent towhich professional norms have developed whichactively discourage physicians from engaging inprognostication. This article explores thecauses of this state of affairs and thejustifications offered for it. The (...) conclusionis reached that physicians have a professionalresponsibility to competently engage inprognostication based upon the doctrine ofinformed consent, and that a failure or refusalto do so has not only potential legalramifications, but serious negativeimplications for many of the core issues inbioethics, such as the use of advancedirectives, palliative medicine, and medicalfutility. (shrink)

Most environmental philosophers have had little use for 'conventional' philosophical and political thought. This is unfortunate, because these traditions can greatly contribute to environmental ethics and policy discussions. One mainstream concept of potential value for environmental philosophy is the notion of the public interest. Yet even though the public interest is widely acknowledged to be a powerful ethical standard in public affairs and public policy, there has been little agreement on its descriptive meaning. A particularly intriguing account of the concept (...) in the literature, however, may be found in the work of the American pragmatist John Dewey. Dewey argued that the public interest was to be continuously constructed through the process of free, cooperative inquiry into the shared good of the democratic community. This Deweyan model of the public interest has much to offer environmental philosophers who are interested in making connections between normative arguments and environmental policy discourse, and it holds great promise for enhancing environmental philosophy's role and impact in public life. (shrink)

Fragile X syndrome is the most common cause of inherited mental retardation in humans. The fragile X gene (FMR1) has been cloned and the mutation causing the disease is known. The molecular basis of the disease is an expansion of a trinucleotide repeat sequence (CGG) present in the first exon within the 5′ untranslated region of the FMR1 gene. Affected individuals have repeat CGG sequences of above 200. As a result the gene is not producing protein. It has been shown (...) that the FMR1 protein has RNA binding activity, but the function of this RNA binding activity is not known. The timing and mechanism of repeat amplification are not yet understood. An animal model for fragile X syndrome has been generated, which can be used to study the clinical and biochemical abnormalities caused by absence of FMR1 protein product. (shrink)

In a recent special supplement to the Hastings Center Report entitled “Improving End-of-Life Care—Why Has It Been So Difficult?” Robert Burt wrote the following in an essay ominously entitled “The End of Autonomy”: No one should be socially authorized to engage in conduct that directly, purposefully, and unambiguously inflicts death, whether on another person or on oneself. Decisions that indirectly lead to death should be acted upon only after a consensus is reached among many people. No single individual should be (...) socially authorized to exercise exclusive control over decisions that might lead to death, whether that individual is the dying person, the attending physician, or a family member acting as health care proxy. (shrink)

Charles Dickens began one of his many great works of literature with this seemingly paradoxical, self-contradictory statement. Reflecting on a jury verdict in Northern California in June of 2001, in the context of what has transpired during the decade of the 1990s with regard to the care of dying patients, observations in the genre of Dickens come readily to mind. In 1991, two of the most compelling books on the subject of pain, medicine, and society were published: Eric Cassell's The (...) Nature of Suffering and the Goals of Medicine and David Morris's The Culture of Pain. Both works unflinchingly recognized and explored the implications of the vast clinical literature documenting the failure of modern medicine to respond compassionately and effectively to what had by then become an epidemic of undertreated pain. (shrink)

Bryan Norton's convergence hypothesis, which predicts that nonan‐thropocentric and human‐based philosophical positions will actually converge on long‐sighted, multi‐value environmental policy, has drawn a number of criticisms from within environmental philosophy. In particular, nonanthropocentric theorists like J. Baird Callicott and Laura Westra have rejected the accuracy of Norton's thesis, refusing to believe that his model's contextual appeals to a plurality of human and environmental values will be able adequately to provide for the protection of ecological integrity. These theoretical criticisms of convergence, (...) however, have made no real attempt to engage the empirical validity of the hypothesis, the dimension that Norton clearly takes to be the centerpiece of his project. Accordingly, the present paper attempts to provide an empirical analysis of the convergence argument, by means of a study of the Vermont public's environmental commitments and their attitudes toward national forest policy. Our findings support a generalized version of Norton's thesis, and lead us to suggest that environmental philosophers should try to be more inclusive and empirically minded in their discussions about public moral claims regarding nature. (shrink)

Few disputes in the annals of US environmentalism enjoy the pedigree of the conservation-preservation debate. Yet, although many scholars have written extensively on the meaning and history of conservation and preservation in American environmental thought and practice, the resonance of these concepts outside the academic literature has not been sufficiently examined. Given the significance of the ideals of conservation and preservation in the justification of environmental policy and management, however, we believe that a more detailed analysis of the real-world use (...) and understanding of these ideas is needed. In this paper, we describe the results of a qualitative, semantic study of the concepts of conservation and preservation undertaken in the context of the Chattahoochee National Forest (CNF), located in northern Georgia (USA). Thirty in-depth interviews were conducted with scientists and north Georgia residents either interested or involved in the future management of the forest. Respondents were asked to define conservation and preservation in their own words and to indicate which approach they felt was more appropriate for the management of the CNF. Qualitative content analysis was used to elicit a set of recurring themes for each foundational concept. Taken together, these themes help to flesh out the meaning of conservation and preservation for citizens and scientists today, and illustrate the evolving nature of two of the more significant and venerable ideas animating US environmental policy and management. (shrink)

Most environmental ethicists adhere to a standard intellectual history of the field, one that explains and justifies the dominant commitments to nonanthropocentrism, moral dualism, and wilderness/wildlife preservation. Yet this narrative—which finds strong support in the work of first generation environmental historians—is at best incomplete. It has tended to ignore those philosophical projects and thinkers in the American environmental tradition that challenge the received history and the established conceptual categories and arguments of environmental ethics. One such figure is the agrarian thinker, (...) conservationist, and rural reformer, Liberty Hyde Bailey. A writer whose environmental philosophy combined biocentric attitudes toward nature with more humanistic concerns about intergenerational fairness and civic responsibility, Bailey remains an invisible figure in environmental ethics, despite his clear influence on the later work of such conservation luminaries as Aldo Leopold, Wendell Berry, Wes Jackson, and others. We would benefit from a recovery of Bailey’s environmental philosophy, especially his articulation of a pluralistic ethical outlook defined by the melding of anthropocentric moral and civic concerns with biocentric commitments regarding the beauty and resilience of the properly cultivated landscape. (shrink)

Abstract:Recent contributions to the medical literature have raised yet again the issue of whether the term “terminal” is an intelligible one and whether there is a consensus view of its meaning that is sufficient to justify or even require its use in discussing end-of-life care and treatment options with patients. Following a review of the history and development of informed consent, persistent problems with the communication of prognosis and the breaking of bad news are analyzed. The author argues that candid (...) but compassionate communication between physicians and patients about prognosis is essential to informed decisions about both disease-directed (curative) and palliative therapies. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)