In November 2018, the practice of health care ethics consultation crossed a major threshold when 138 candidates took the inaugural Healthcare Ethics Consultant Certification Examination. This accomplishment, long in the making, has had and continues to have both advocates and critics. The Healthcare Ethics Consultant Certification Commission, a functionally autonomous body created and funded by the American Society for Bioethics and Humanities, was charged with overseeing creation of the certification process, developing the exam, and formulating certification standards and policies to (...) assess candidates’ qualifications. In this essay, as members of the commission, we describe the process of developing, administering, and scoring the certification examination as well as the historical context and the outlook for certification. By detailing the decisions and actions of the commission, we aim to provide a transparent account of the commission's efforts to develop a psychometrically sound, reliable, and secure examination through a deliberative, fair, and data‐driven process. (shrink)

Systems of units still fail to attract the philosophical attention they deserve, but this could change with the current reform of the International System of Units. Most of the SI base units will henceforth be based on certain laws of nature and a choice of fundamental constants whose values will be frozen. The theoretical, experimental and institutional work required to implement the reform highlights the entanglement of scientific, technological and social features in scientific enterprise, while it also invites a philosophical (...) inquiry that promises to overcome the tensions that have long obstructed science studies. (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 way metrologists conceive of measurement has undergone a major shift in the last two decades. This shift can in great part be traced to a change in the statistical methods used to deal with the expression of measurement results, and, more particularly, with the calculation of measurement uncertainties. Indeed, as we show, the incapacity of the frequentist approach to the calculus of uncertainty to deal with systematic errors has prompted the replacement of the customary frequentist methods by fully Bayesian (...) procedures. The epistemological ramifications of the Bayesian approach merge with a deep empiricist mood tantamount to an “epistemic turn”: measurement results are analysed in terms of degrees of belief, and central concepts such as error and accuracy are called into question. We challenge the perspective entailed by this epistemic turn: we insist on the centrality of the concepts of error and accuracy by underlining the intentional character of measurement that is intimately linked to the process of correction of experimental data. We further circumvent the difficulties posed by the classical analysis of measurement by stressing the social rather than the epistemic dimension of measurement activities. (shrink)

The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.

The confrontation between Philip the Fair and Boniface VIII has long been seen as a major turning point for the medieval papacy, for the rise of national monarchies, and for the political shaping of public opinion in late-medieval France. Philip's campaign to gain and display the support of the clergy, the nobility, and townspeople throughout the realm also generated a large body of documentation, much of which survives today. Although frequently explored and exploited during the last four centuries, the archival (...) record is not as straightforward as it appears. While recognizing it as part of a masterly propaganda campaign, one needs to look not simply at the shaping of opinion, but at the shaping of the written record—a case in which the silences, what is not recorded, are often as important as the voices on which our attention has been focused. But before turning to that issue, a brief review of events may be useful. (shrink)

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)

Patients who enter the health care system for acute care may become “permanent” patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. The care of these patients contributes to the rising costs of health care and will remain largely unaffected by the Affordable Care Act. For example, some resources may be available for treatment of undocumented persons, but Medicaid enrollment is unavailable for this population. Even where patients have access to Medicaid, (...) it takes up to three months between applying for and actually receiving Medicaid benefits. During that time, patients may be ready for hospital discharge. However, post-acute care facilities have no financial incentive or legal obligation to accept patients with no insurance or only pending Medicaid coverage. (shrink)

The guest editors would like to thank the University of Paris and the ENSA Paris-Val de Seine for having provided premises to successfully host the 2018 "Measurement at the Crossroads" conference in Paris.Our thanks extend to our funding sources: the conference was made possible thanks to the generous support of the Institut Humanités, Sciences et Sociétés, the SPHERE laboratory and the Laboratoire Matériaux et Phénomènes Quantiques of the University of Paris, the department of History and Philosophy of Science of the (...) University of Paris, the Laboratoire National de métrologie et d'Essais, and the University of Geneva.We would like to thank the many people who contributed to the organization of... (shrink)

HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka’s _Metamorphosis_ advance understandings of HIV stigma in medical health education? _Metamorphosis_ amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. _Metamorphosis_ (...) may ultimately promote medical health humanities’ social mission—allowing literature to unfold such revelations towards greater equity in health. (shrink)

Against the background of changing assessments of Nominalism and its meanings before Ockham, this book examines the reception of Ockham's thought at Oxford and ...

INTRODUCTION Adam Wodeham, OFM (d.) has received only passing mention in the textbooks on the history of medieval philosophy. Although recognized as a major ...

While we know the year in which many bachelors of theology read the Sentences at Paris, we do not have equivalent information on bachelors of theology at Oxford. This note discusses the limitations of the principal source for Oxford, the Biographical Register of the University of Oxford, and illustrates the importance of consulting the manuscript sources, especially both series of registers of common letters in the Vatican Archives.

Federal law under the Individuals with Disabilities in Education Improvement Act stipulates that services provided to students with diagnosed disabilities must be individualised based on the as...

Despite the interpersonal nature of family meetings and the frequency in which they occur, the clinical ethics literature is devoid of any rich descriptions of what clinical ethicists should actually be doing during family meetings. Here, we propose a framework for describing and understanding “transitioning” facilitation skills based on a retrospective review of our internal documentation of 100 consecutive cases wherein a clinical ethicist facilitated at least one family meeting. The internal documents were analyzed using qualitative methodologies, i.e., “codes”, to (...) identify emergent themes. We identified four different transitioning strategies clinical ethicists use to reach a meaningful resolution. These transitioning strategies serve as a jumping-off point for additional analyses, future research, evaluating clinical ethics consultation, and overall performance improvement of a consultation service. (shrink)

In recent decades the publication of additional documentary sources and doctrinal and prosopographical studies for the University of Paris in the 1330s has radically expanded our information about theologians in what was once an obscure decade. Using a variety of evidence, this article outlines what we now know about bachelors of the Sentences active at Paris in the 1330s, part of what the author once called “the dormition of Paris.”.

This reexamination of documents purporting to show that Henry of Ghent served on a commission of 16 theologians that compiled the 219 articles condemned in 1277 produces a different picture. It shows that Henry did not serve on a special commission appointed by bishop Tempier but was present at a meeting of all masters, who condemned the articles. It also shows that Tempier did not bypass masters in the faculty of theology, but had them vote on the articles.

Le débat sur l’existence réelle du point a occupé une place importante dans les débats philosophiques parisiens du deuxième quart du xive siècle. La contribution de Jean Buridan à ce débat est bien connue mais à ce jour, l’identité d’un certain « magister M. de Montescalerio », adversaire réaliste de Buridan et auteur d’une Determinatio de puncto, est restée inconnue. Cet article établit l’identité de cet important maître actif vers 1340 à la faculté des arts de Paris et en retrace (...) la carrière. (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)

Walter Chatton’s Reportatio has been dated to 1322-23, possibly at London, and his Lectura either as a revision of bachelor lectures given earlier at Oxford, or given after 1323. Stephen Brown has shown that material in Chatton’s Lectura dates to 1323-1324 when Chatton and Ockham were disputing in the same place, presumably London, before Ockham left England forever. The present article shows how arguments dating to one place and time can be used in a later work, and should not be (...) used to date that work. (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)

Two complementary debates of the turn of the nineteenth and twentieth century are examined here: the debate on the legitimacy of hypotheses in the natural sciences and the debate on intentionality and ‘representations without object’ in philosophy. Both are shown to rest on two core issues: the attitude of the subject and the mode of presentation chosen to display a domain of phenomena. An orientation other than the one which contributed to shape twentieth-century philosophy of science is explored through the (...) analysis of the role given to assumptions in Boltzmann’s research strategy, where assumptions are contrasted to hypotheses, axioms, and principles, and in Meinong’s criticism of the privileged status attributed to representations in mental activities. Boltzmann’s computational style in mathematics and Meinong’s criticism of the confusion between representation and judgment give prominence to an indirect mode of presentation, adopted in a state of suspended belief which is characteristic of assumptions and which enables one to grasp objects that cannot be reached through direct representation or even analogies. The discussion shows how assumptions and the movement to fiction can be essential steps in the quest for objectivity. The conclusion restates the issues of the two debates in a contemporary perspective and shows how recent developments in philosophy of science and philosophy of language and mind can be brought together by arguing for a twofold conception of reference.Keywords: Assumption; Hypothesis; Description; Mode of presentation; Ludwig Boltzmann; Alexius Meinong. (shrink)