This paper explores the relationship between teaching and consulting in clinical ethics teaching and the role of the ethics teacher in clinical decision-making. Three roles of the clinical ethics teacher are discussed and illustrated with examples from the authors' experience. Two models of the ethics consultant are contrasted, with an argument presented for the ethics consultant as decision facilitator. A concluding section points to some of the challenges of clinical ethics teaching.

There has long been interest in identifying and studying ‘‘successful psychopaths.” This study sampled psychologists with an interest in law, attorneys, and clinical psychology professors to obtain descriptions of individuals considered to be psychopaths who were also successful in their endeavors. The results showed a consistent description across professions and convergence with descriptions of traditional psychopathy, though the successful psychopathy profile had higher scores on conscientiousness, as measured within the five-factor model (FFM). These results are useful in documenting the existence (...) of successful psychopathy, demonstrating the potential benefit of informant methodology, and providing an FFM description that distinguishes successful psychopaths from unsuccessful psychopaths studied more routinely within prison settings. (shrink)

This volume explores the experiences of those with little or no power—usually, although not exclusively, animals. The theme of animals as experiencing entities is what links the chapters and characterises the volume. Broadly each author in this volume contributes in one of two ways. The first group, in Section 1, theoretically engages animal subjectivity, animal experiences, and ways in which these are to some extent accessible and knowable to humans. The second group of authors, in Section 2, offer narrative accounts (...) about specific animals or groups of animals and explore to some extent their subjective historical experiences. In summary, the first section diversely theorises about animal experiences, while the second section’s authors assume animals’ subjective experiences and construct narratives that take into account how animals might have subjectively experienced historical phenomena. (shrink)

Volume 19, Issue 7, July 2019, Page 66-67.

The case of a dying baby with is one of the most difficult in pediatric ethics. I have been involved in several such cases and they are extremely challenging for all parties, especially the parents. With the luxury of being an I will comment on this case from the perspective of when it first began and at the end point described in the narrative.

This study extends the examination of moral content in the media by exploring moral messages in television programming and viewer characteristics predictive of the ability to perceive such messages. Generalisability analyses confirmed the reliability of the Media’s Moral Messages (MMM) rating form for analysing programme content and the existence of 10 moral themes prevalent in television media. Standard regression analyses yielded evidence indicating viewers’ moral expertise, as measured by the Defining Issues Test (DIT), familiarity with the programme and level of (...) education predicted their ability to perceive moral messages in a television drama popular in the USA at the time of data collection. Identification of patterns in moral content represented in television programming, as well as knowledge of how viewer characteristics relate to their ability to perceive such content, can provide parents and educators with a means for better comprehending messages regarding human interaction to which they or their children are exposed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bedside VoicesJacqueline J. GloverThis issue of Narrative Inquiry in Bioethics features ten stories of Certified Nursing Assistants (CNAs) who work primarily in long-term care. This is a voice of direct care at the bedside that is not often heard. The addition of these stories in the literature is long overdue and I am honored to be asked to comment. There is much to learn from these bedside caregivers. All (...) of these stories reflect the deep struggle to be respected as a member of the health care team. But I also hear the pain of being caught in the tension between the desire to be skilled, qualified, and professional and the desire to be present in a way that emphasizes service, caring and common human touch. My commentary is informed by my experience in Rural Bioethics and my work at the Center for Bioethics and Humanities at the University of Colorado which has a commitment to Interprofessional Education. The CNAs' stories reveal much that they share with other health care professionals, but also some unique features that can teach us much.CommonalitiesSelf Care and Being Cared ForThe voice of the CNA is a voice that is echoed in a way by all health care professionals. Each of the stories bears witness to the need to take care of yourself and to be cared for in order to be able to continue to care for others. Leilani Roseberry writes "This unresolved grief and constant exposure to dying and death had me looking at every day, even every moment, through the eyes of a dying person. This is an emotion that is very difficult to put into words." She continues elsewhere, "I believe that if I had grief support opportunities available to me in my professional life, my level of care and compassion would have been much more resilient from the very beginning of my work as a CNA. Instead, only after sorting through emotions affecting my personal life and learning they were a compilation of what I experienced professionally, only then have I become much more resilient in the face of grief and mourning." Danny Reed writes, "Caregivers benefit from the same thing patients and residents do: genuine kindness. Take care of the caregivers because one day they will be all you have left in the world." And from James Bradley, "The work itself can be very draining, but to beat the stress of it, you can follow all the usual stuff like going for walks, playing with your kids, watch TV etc. The best advice though is to, as far as possible, leave the work behind when you walk off at the end of your shift. That may be the hardest thing to do but it is the only way to retain the correct professional approach."Self care can certainly be about boundaries and stress management. Health care institutions, including professional schools, increasingly have wellness programs (Johnson, 2000). It was once thought that [End Page 159] professional and emotional distance was necessary to maintain healthy relationships and avoid burn out. But current thinking seems to indicate the opposite. If a health care professional views his or her work only in terms of tasks to be performed without some connection to the meaning of what he or she is doing for the patient as a human being, that person is more likely to burn out (Halpern, 2003). Bradley's use of "correct professional approach" prompted me to think beyond wellness and health to the need to nurture meaning in one's work. The CNAs' essays are filled with the call to recognize the deeper meaning of their work. Tracy Dudzinski writes, "Most people think anyone can do this job. I thought that myself, twelve years ago. But now I know that it takes someone special. Direct care workers do not do this work because they are getting rich. They do it because they love the work and because it is the right thing to do. This is the hardest job I have ever done but it is also the most rewarding job I have ever done."There is increasing attention to the use of reflective writing in... (shrink)

Medical decision making on behalf of unrepresented patients is one of the most challenging ethical issues faced in clinical practice. The legal environment surrounding these patients is equally complex. This article describes the efforts of a small coalition of interested healthcare professionals to address the issue in Colorado. A brief history of the effort is presented, along with discussion of the legal, ethical, practical, and political dimensions that arose in Colorado’s effort to address decision making for unrepresented patients through an (...) extension of the existing Colorado Medical Treatment Decision Act (CRS 15-18). A discussion of lessons learned in the process is included. (shrink)

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...) to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that i...

In 2016, the Colorado legislature passed an amendment to Colorado’s medical proxy law that established a process for the appointment of a physician to act as proxy decision maker of last resort for an unrepresented patient (Colorado HB 16-1101: Medical Decisions For Unrepresented Patients). The legislative process brought together a diverse set of stakeholders, not all of whom supported the legislation. Following passage of the statutory amendment, the Colorado Collaborative for Unrepresented Patients (CCUP), a group of advocates responsible for initiating (...) the legislative process, coordinated a unique effort to engage these stakeholders in the creation of a set of voluntary guidelines to assist facilities and individual careproviders in the implementation of policies and procedures enabled by the statute. This article delineates the questions and concerns of stakeholders, describes how those issues were addressed within the guidelines, and proposes additional opportunities for research to assess the impact of the legislation in Colorado. (shrink)

Immanuel Kant’s “abstract” concept of dignity is contrasted with the “empathy-linked” approach. Because the empathy-link approach gives a central role to a patient’s desires and interests, it is a more plausible account than the Kantian approach (defended by J. David Velleman), which places dignity over and above a patient’s interests and desires. This distinction is brought to bear on issues of assisted suicide, the moral status of the embryo, genetic choices, and how a psychotherapist should “listen” to her patients.

In follow-up to a large-scale ethics survey of neuroscientists whose research involves neuroimaging, brain stimulation and imaging genetics, we conducted focus groups and interviews to explore their sense of responsibility about integrating ethics into neuroimaging and readiness to adopt new ethics strategies as part of their research. Safety, trust and virtue were key motivators for incorporating ethics into neuroimaging research. Managing incidental findings emerged as a predominant daily challenge for faculty, while student reports focused on the malleability of neuroimaging data (...) and scientific integrity. The most frequently cited barrier was time and administrative burden associated with the ethics review process. Lack of scholarly training in ethics also emerged as a major barrier. Participants constructively offered remedies to these challenges: development and dissemination of best practices and standardized ethics review for minimally invasive neuroimaging protocols. Students in particular, urged changes to curricula to include early, focused training in ethics. (shrink)

Farrell, B. A. The criteria for a psycho-analytic interpretation.--Gardiner, P. Error, faith, and self-deception.--Cohen, G. A. Beliefs and roles.--Deutsch, J. A. The structural basis of behaviour.--Hampshire, S. Feeling and expression.--Putnam, H. The mental life of some machines.--Davidson, D. Psychology as philosophy.--Nagel, T. Brain bisection and the unity of consciousness.--Williams, B. The self and the future.--Parfit, D. Personal identity.

The primary function of a book review is to articulate and present an understanding of the book's thesis and argument, and to make a judgment as to its value, so that readers will themselves understand and be guided by the understanding and judgment of the reviewer. Reviews are supposed to be interpretations created for the sake of a potential audience for a book. Unfortunately, most reviews fail to fulfill this function insofar as they merely paraphrase the text they are supposed (...) to interpret, fail to provide an understanding of it, or are so critical that they miss the significance of the book. In short, they fail to provide the kind of interpretation that constitutes their proper hermeneutic task. Glover's .. (shrink)

Benchmarks against which healthcare ethics consultation (HCEC) services can assess their performance are needed. As first-generation benchmarks continue to be developed, it is the obligation of the field to continually evaluate how these measures reflect the performance of any single HCEC service. This will be possible only with widespread reporting of standardized data points. In their article in this issue of The Journal of Clinical Ethics, Glover and colleagues provide a valuable preliminary approach for assessing appropriate consult volumes for (...) a HCEC service. The limitations of their study read as a call to action for the field of clinical ethics to expand and standardize data reporting so that more robust metrics can be developed. In response to this call by Glover and colleagues, the Cleveland Clinic HCEC service provides consult data from 2015 through 2019 for one of its medical centers, and offers an additional volumebased metric, consult-to-ICU-to-bed ratio (CiBR), that may add nuance to any normative assessment of HCEC service consult volume. Given that volume-based metrics are the native language of the clinical environment, efforts to improve such metrics in the field through transparency and standardization are warranted. However, the expositive power of volume-based metrics is limited; additional domains related to quality and outcomes are needed. (shrink)

Glover proposes a planning–control model for the parietal lobe that contrasts with previous formulations that suggest independent mechanisms for perception and action. The planning–control model potentially solves practical functional problems with a proposed independence of perception and action, and offers some new directions for a study of human performance.

Glover's planning–control model accommodates a substantial number of findings from subjects who have motor deficits as a consequence of brain lesions. A number of consistently observed and robust findings are not, however, explained by Glover's theory; additionally, the claim that the IPL supports planning whereas the SPL supports control is not consistently supported in the literature.

Medical practice should evolve alongside medical ethics. As our understanding of the ethical implications of physician-patient interactions becomes more nuanced, physicians should integrate those lessons into practice. As early as the 1930s, epidemiological studies began to identify that the rates of medical procedures varied significantly along geographic and socioeconomic lines. Dr. J. Alison Glover recognized that tonsillectomy rates in school children in certain school districts in England and Wales were in some cases eight times the rates of children in (...) other districts, with the only significant predictive factors being the current chief medical officer in the area and the socioeconomic well-being of the child's parents. Unfortunately, Dr. Glover's work revealed that the increase in tonsillectomies did not improve the health of adolescent patients and appeared to be performed “as a routine prophylactic ritual for no particular reason and with no particular result.”. (shrink)

ABSTRACT The paper examines J. Glover's 1970 account of the evasion of responsibility. Attention is focused on the Eichmann case and Glover's contention that moral condemnation of Eichmann depends on the view that there is a duty to submit one's actions to moral criticism. Two uses of the word ‘moral’ are distinguished (one use for moral commitment, the other for logical diagnosis) and it is argued that Glover's thesis is accordingly ambiguous. It is contended that Glover (...) must either abandon his stipulative account of the concept of morality or accept the objectivity of moral judgements or modify his unqualified thesis that everybody ought to submit his conduct to moral criticism. An account of problems of evading responsibility involves us, it is maintained, in an area of moral philosophy, the Dialectic of Morals, where knock‐down arguments are sparse. (shrink)

The prophets of the Old Testament did make predictions, and biblical scholars are paying more attention to that fact. Now, serious theological reflection on what came of the predictions of the prophets is needed.