We describe the ethics consultation service (ECS) at the Cleveland Clinic and report on its activities over a 24-month period in which 478 consultations were performed. To our knowledge, this is the largest case series of ethics consultations reported to date. Established more than 25 years ago, the ECS at the Cleveland Clinic is staffed by multiple consultants with advanced training in bioethics. Several of these ethicists work closely with specialized clinical units and research departments, where they participate in multidisciplinary (...) meetings and provide specialized assistance. This combination of historical experience, large numbers of consultation requests, and specialized clinical ethicists suggests that the experience at the Cleveland Clinic may be helpful to ethicists and others who may be considering how to structure and sustain a vibrant ECS. Our results highlight the diversity of activities performed by a high-volume ECS at a tertiary care facility. Our hope in sharing the inner workings of the ECS at the Cleveland Clinic is to promote dialogue on common practices and approaches across medical institutions that support ethics consultation. (shrink)

It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients’ medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees (...) in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation. (shrink)

The clinical ethicist met with Ms. H to clarify what information she wants and does not want to know. First, she wants to receive any treatment that could prolong her life, regardless of how the treatment affects her ability to engage in activities of daily living. Second, she wants to be included in the decision‐making process as much as possible, as long as clinicians use only “positive” language. Ms. H considers the words “dying,” “chemotherapy,” “radiation,” and “cancer” to be “bad (...) words.” For conversations in which these words cannot be avoided, she wants her clinicians to talk to her son. Her desired engagement includes hearing about risks, benefits, and alternatives to treatments if clinicians use only “positive” language. Finally, she says that she rarely sees doctors and that she is “very scared” of hospitals, despite exhibiting a comfortable demeanor.Should clinicians honor Ms. H's waiver of specified information and, if so, to what degree? (shrink)

America's research universities, approximately 125 in number,play important roles in the nation's research system, and help toset the tone for all institutions of research and higherlearning. As the research universities have formed closer linkswith industry, new problems have arisen that have precipitated amajor debate. The academic medical centres and related lifescience departments present some of the most challenging newissues, which are analysed in this paper within the framework ofthe biomedical research system that has evolved in the UnitedStates since the Second (...) World War. (shrink)

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

This introduction to the Common Knowledge symposium titled “Comparative Relativism” outlines a variety of intellectual contexts where placing the unlikely companion terms comparison and relativism in conjunction offers analytical purchase. If comparison, in the most general sense, involves the investigation of discrete contexts in order to elucidate their similarities and differences, then relativism, as a tendency, stance, or working method, usually involves the assumption that contexts exhibit, or may exhibit, radically different, incomparable, or incommensurable traits. Comparative studies are required to (...) treat their objects as alike, at least in some crucial respects; relativism indicates the limits of this practice. Jensen argues that this seeming paradox is productive, as he moves across contexts, from Lévi-Strauss's analysis of comparison as an anthropological method to Peter Galison's history of physics, and on to the anthropological, philosophical, and historical examples offered in symposium contributions by Barbara Herrnstein Smith, Eduardo Viveiros de Castro, Marilyn Strathern, and Isabelle Stengers. Comparative relativism is understood by some to imply that relativism comes in various kinds and that these have multiple uses, functions, and effects, varying widely in different personal, historical, and institutional contexts that can be compared and contrasted. Comparative relativism is taken by others to encourage a “comparison of comparisons,” in order to relativize what different peoples—say, Western academics and Amerindian shamans—compare things “for.” Jensen concludes that what is compared and relativized in this symposium are the methods of comparison and relativization themselves. He ventures that the contributors all hope that treating these terms in juxtaposition may allow for new configurations of inquiry. (shrink)

In a recent article in Religious Studies, Professor P. W. Gooch attempts to wean the orthodox Christian from anthropological materialism by consideration of the question of the nature of the post-mortem person in the resurrection. He argues that the view that the resurrected person is a psychophysical organism who is in some physical sense the same as the ante-mortem person is inconsistent with the Pauline view of the resurrected body; rather, according to him, Paul's view is most consistent with that (...) which affirms the disembodied survival of the person. ‘I want to argue’, he writes, ‘for the thesis that a Pauline resurrection body may well be ontologically the same as a disembodied person.’ I intend to show that Professor Gooch has failed to provide any support for this view and indeed that his own view falls prey to the criticisms which he has raised against other views. (shrink)

The alleged conflict between religion and science most pointedly focuses on what it is to be human. Western philosophical thought regarding this has progressed through three broad stages: mind/body dualism, Neo-Darwinism, and most recently strong artificial intelligence (AI). I trace these views with respect to their relation to Christian views of humans, suggesting that while the first two might be compatible with Christian thought, strong AI presents serious challenges to a Christian understanding of personhood, including our freedom to choose, moral (...) choice itself, self-consciousness, and the relevance of God to our beginning, being, and ending. (shrink)

I argue that the atheological claim that the existence of pain and suffering either contradicts or makes improbable God's existence or his possession of certain critical properties cannot be sustained. The construction of a theodicy for both moral and natural evils is the focus of the central part of the book. In the final chapters I analyze the concept of the best possible world and the properties of goodness and omnipotence insofar as they are predicated of God.

Heidegger affirms that we find authenticity in resolutely affirming our own death; but how might the death of another provide meaning for one’s life? We explore how Mel Gibson portrays the meaning of Jesus’ death for others in his movie, ’The Passion of the Christ’, by considering the movie’s diverse views of atonement. The movie contains clear statements of the ancient ’Christus victor’ and moral transformation themes, though Gibson misses that moral transformation requires more than a resilient death. Although he (...) leaves other views of atonement, such as healing and compensation, undeveloped, Gibson emphasizes Mary’s relationship to Jesus as coredemptrix. (shrink)

Generally the theist's defense against the argument from evil invokes the libertarian ideal. But this route is not open to compatibilist Reformed theologians. They must show either that God's possibly creating humans with a more perfect nature is either an impossibility or that his doing so violates some fundamental principle of value. I argue that the compatibilist Reformed theologian is unsuccessful in both. Specifically, in the latter case, there is no ground for thinking that redemption and its associated evil (as (...) found in the concept of a fortunate fall) are superior to persistent innocence. (shrink)

This anthology discusses important issues surrounding environmental law and economics and provides an in-depth analysis of its use in legislation, regulation and legal adjudication from a neoclassical and behavioural law and economics perspective. Environmental issues raise a vast range of legal questions: to what extent is it justifiable to rely on markets and continued technological innovation, especially as it relates to present exploitation of scarce resources? Or is it necessary for the state to intervene? Regulatory instruments are available to create (...) and maintain a more sustainable society: command and control regulations, restraints, Pigovian taxes, emission certificates, nudging policies, et cetera If regulation in a certain legal field is necessary, which policies and methods will most effectively spur sustainable consumption and production in order to protect the environment while mitigating any potential negative impact on economic development? Since the related problems are often caused by scarcity of resources, economic analysis of law can offer remarkable insights for their resolution. Part I underlines the foundations of environmental law and economics. Part II analyses the effectiveness of economic instruments and regulations in environmental law. Part III is dedicated to the problems of climate change. Finally, Part IV focuses on tort and criminal law. The twenty-one chapters in this volume deliver insights into the multifaceted debate surrounding the use of economic instruments in environmental regulation in Europe. (shrink)

Diving into the Gospel of John displays the rich and diverse arguments John presents for his thesis that Jesus is the Messiah, the Son of God, and that through believing, readers/listeners will find eternal life. John’s arguments are developed in four parts. The first two chapters develop the author’s literary techniques that are often based on ambiguity and his key symbols and concepts, the understanding of which are essential to fully appreciate the Gospel. Chapters three through six progressively portray the (...) author’s evidence for his thesis in the form of signs, testimony of those who encounter Jesus, Jesus’s self-identification, and Jesus’s relationships to others. Chapters seven and eight show how the author uses theatrically-patterned dialogues and triadic discourses to convey Jesus’s identity and mission. Finally, chapters nine through eleven provide important hints that the author gives for his thesis: Jesus’s appeals to time, the indirect use of seven as the number of completeness, and invocation of parentage in pointing to salvation. Through diving into the Gospel, readers will discover the richness of John’s argument, the Jesus he portrays, and the God Jesus reveals. The book aims to stimulate commitment, challenge mind and spirit, and encourage further study and conversation. (shrink)

Richard Swinburne claims that Christ’s death has no efficacy unless people appropriate it. According to religious inclusivists, God can be encountered and his grace manifested in various ways through diverse religions. Salvation is available for everyone, regardless of whether they have heard about Christ’s sacrifice. This poses the question whether Swinburne’s view of atonement is available to the inclusivist. I develop an inclusivist interpretation of the atonement that incorporates his four features of atonement, along with a subjective dimension that need (...) not include specific knowledge of Christ’s sacrifice. (shrink)

I ARGUE THAT THE NOTION OF THE BEST POSSIBLE WORLD IS MEANINGLESS AND THEREFORE A CHIMERA, BECAUSE FOR ANY WORLD WHICH MIGHT BE SO DESIGNATED, THERE COULD ALWAYS BE ANOTHER WHICH WAS BETTER, EITHER IN BEING POPULATED BY BEINGS WITH BETTER OR A GREATER QUANTITY OF GOOD CHARACTERISTICS, OR ELSE BY BEING MORE OPTIMIFIC.

We ask God to involve himself providentially in our lives, yet we cherish our freedom to choose and act. Employing both theological reflection and philosophical analysis, the author explores how to resolve the interesting and provocative puzzles arising from these seemingly conflicting desires. He inquires what sovereignty means and how sovereigns balance their power and prerogatives with the free responses of their subjects. Since we are physically embodied in a physical world, we also need to ask how this is compatible (...) with our being free agents. Providence raises questions about God's fundamental attributes. The author considers what it means to affirm God's goodness as logically contingent, how being almighty interfaces with God's self-limitation, and the persistent problems that arise from claiming that God foreknows the future. Discussion of these divine properties spills over into the related issues of why God allows, or even causes, pain and suffering; why, if God is all-knowing, we need to petition God repeatedly and encounter so many unanswered prayers; and how miracles, as ways God acts in the world, are possible and knowable. Throughout, the author looks at Scripture and attends to how providence deepens our understanding of God and enriches our lives. (shrink)

I argue that if deliberation is incompatible with (fore)knowing what one is going to do at the time of the deliberation, then God cannot deliberate. However, this thesis cannot be used to show either that God cannot act intentionally or that human persons cannot deliberate. Further, I have suggested that though omniscience is incompatible with deliberation, it is not incompatible with either some speculation or knowing something on the grounds of inference.

Here is a contemporary social paradox: Modern liberal democracy rests upon a platform of a pluralistic civil society. Philanthropy, by providing vital resources, is an essential feature of that civil society. Yet philanthropy also plays an ambiguous role in democracy. Therefore philanthropy potentially both supports and detracts from democracy. This essay explores the nature of this paradox and its implications for the practice of contemporary philanthropy.Neither "civil society" nor "democracy" has a single, universally accepted meaning in the contemporary world. In (...) differing historical and philosophical contexts, civil society has been used to describe a broad spectrum of social phenomena—the realm of social .. (shrink)

The book adapts St. Thomas's Third Way of demonstrating the existence of God in light of contemporary issues in philosophy. Major topics in this study are causation, the principles of causation and sufficient reason, logical and real necessity, causation of the cosmos, and non-dependency of the cosmological on the ontological argument.

The forestry profession has no offical policy on forest aesthetics: Neither foresters nor the public have clear guidelines as to what a socially acceptable, actively managed forest should lookl ike. Hints of an impplicit policy can be found in the Society of American Foresters position statements on timber harvesting and in various recommendations for best management practices found in state, federal, and industrial forestry publications. These implicit policies may send a hypocritical message to the public about the practice, intent, and (...) ethics of forestry. (shrink)

This paper reports an analysis of the content of the codes of ethics of 15 professional business organizations in the United States, representing the broad range of disciplines found in business. The analysis was conducted to identify common ethical issues faced by business professionals. It was also structured to highlight ethical issues that are either unique to or of particular importance for business professionals. No attempt is made to make value judgments about either the codes of ethics studied or of (...) their content. General ethical values identified include honesty and integrity, general legal compliance, discreditable or harmful acts, and obligations related to social values. More business-specific issues include confidentiality, responsibilities to employers/clients, obligations to the profession, independence and objectivity, and business-specific legal and technical compliance issues. (shrink)

I consider four recently suggested difference between killing and letting die as they apply to active and passive euthanasia : taking vs. taking no action; intending vs. not intending the death of the person; the certainty of the result vs. leaving the situation open to other possible alternative events; and dying from unnatural vs. natural causes. The first three fail to constitute clear differences between killing and letting die, and "ex posteriori" cannot constitute morally significant differences. The last constitutes a (...) difference but is not morally significant. (shrink)

A great deal of interest in codes of ethics exists in both the business community and the academic community. Within the academic community, this interest has given rise to a number of studies of codes of ethics. Many of these studies have focused on the content of various codes.One important way the study of codes of ethics can be advanced is by applying formal tools of analysis to codes of ethics. An understanding of important dimensions that may differ across codes (...) of ethics, a common terminology to describe these dimensions, and a means to measure these dimensions will facilitate applying such tools. They will also facilitate discussion, enable comparisons, and advance our understanding of codes of ethics. The present paper describes a classification scheme to use in studying codes of ethics. This scheme uses six important dimensions to distinguish among codes of ethics: length, focus, level of detail, shape, thematic content, and tone. The paper also introduces metrics that can be used to measure the dimensions. (shrink)

I reply to Houston Craighead, who presents two arguments against my version of the cosmological argument. First, he argues that my arguments in defense of the causal principle in terms of the existence being accidental to an essence is fallacious because it begs the question. I respond that the objection itself is circular, and that it invokes the questionable contention that what is conceivable is possible. Against my contention that the causal principle might be intuitively known, I reply to his (...) contention that again I have begged the question. Begging the question is not applicable in that I have not argued that a denial of the principle it possible, only that if it be denied, other endeavors likewise become impossible. Second, against my contention that the causal principle is really necessary, he asserts that the necessity predicated of propositions is solely logical necessity. I reject his contention that a really necessary proposition must either be logically necessary or else a plain contingent factuality. (shrink)

Plagiarism strikes at the heart of academe, eroding the fundamental value of academic research. Recent evidence suggests that acts of plagiarism and awareness of these acts are on the rise in academia. To address this issue, a vein of research has emerged in recent years exploring plagiarism as an area of academic inquiry. In this new academic subject, case studies and analysis have been one of the most influential methodologies employed. Case studies provide a venue where acts of plagiarism can (...) be discussed and analyzed in a constructive manner, and that is the primary purpose of this article. Unlike previous studies, however, we focus on the role of the publisher, a key player in dealing with acts of plagiarism, but one who has received little attention in the academic literature. Specifically, we examine how an academic publisher addressed allegations of plagiarism and how the publisher’s decision-making affected the outcome. We analyze the case by applying the guidelines from different frameworks and ethical theory and develop recommendations from the lessons evidenced, the second main objective of our article. This analysis advances the dialog on academic plagiarism by exploring the role of the publisher from a deontological perspective of ethical absolutism. (shrink)