Chciałem Go pożegnać. Kilkakrotnie próbowałem napisać choć parę słów. O Nim samym. Okazało się, że nie potrafię. Udało mi się tylko przedstawić Jego poglądy na reizm Tadeusza Kotarbińskiego, ale uczyniłem to gdzie indziej. Muszę tu poprzestać na ofiarowaniu Mu tego, co napisałem na Jego dziewięćdziesiąte urodziny, w osiemdziesięciolecie naszej przyjaźni.

The target article by Grady and colleagues (2008) is a valuable and exciting contribution to the debate about the importance of ethics education for nurses. The findings indicated that ethics educa...

In their article “Moral Stress and Moral Distress: Confronting Challenges to Healthcare Systems Under Pressure” Buchbinder et al. (2024) provide a thoughtful conceptual distinction between moral di...

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Jerzy Perzanowski s ideas were based on an original blend of logic and ontology in what he called onto/logic, where the slash is meant to suggest a quotient of ontology by logic. Perzanowski began as a logician, his early works being on modal logic, then gradually shifted his interest to logical philosophy, meaning not so much philosophy of logic as philosophy informed by logic. Perzanowski was a rare breed of analytical philosopher who thought that a philosophical theory of everything (...) was worthwhile. In this systematic spirit, he began with method. He presented his method of total analysis and synthesis quite simply: reduce the object of research to its simplest possible constituents, and then combine them in some way. Better still, combine them in every possible way, thereby producing a space of possibilities analogous to (and in certain cases identical with) the logical space. Thus, analysis and synthesis differ from a trivial disassembly and reassembly.". (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Ethics consultation is a service provided to patients, families, and clinicians to support decisions during ethical dilemmas. This study is a secondary qualitative analysis of 48 interviews from clinicians involved in an ethics consultation at a large academic health center. An inductive secondary analysis of this data set led to the emergence of one key theme, the apparent perspective the clinicians adopted as they recalled a specific ethics case. This article presents a qualitative analysis of the propensity of clinicians involved (...) in an ethics consultation to adopt the subjective viewpoints of their team, their patient, or both simultaneously. Clinicians demonstrated an ability to take the patient perspective (42%), the clinician perspective (31%), or the clinician-patient perspective (25%). Our analysis suggests the potential for narrative medicine to build the empathy and moral imagination necessary to bridge the gap in perspectives between key stakeholders. (shrink)

Jerzy Franczak comprehensively presents Jacques Rancière's thought by emphasizing the relations between politics and literature. The detailed analysis considers the context of modern aesthetics and political philosophy, which is why the book introduces further protagonists, such as Louis Althusser, Michel Foucault, Pierre Bourdieu, or Jean-François Lyotard. Franczak first reconstructs Rancière's original philosophy of literature so as to then immediately apply it in readings of select world literature masterpieces by Gustav Flaubert, Max Jacob, Bertold Brecht, Vladimir Nabokov, and Philip Roth.

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Campbell, Ulrich, and Grady (2016) should be commended for attempting to contribute to the discussion of what many believe is currently a messy concept. They propose that a broader definition of mo...

Table of ContentsAndrzej KLAWITER, Krzystof #ASTOWSKI: Introduction: Originality, Courage and Responsibility List of Books by Leszek NowakSelected Bibliography of Leszek Nowak's WritingsScience and Idealization Theo A.F. KUIPERS: On Two ...

It is shown explicitly that the linearized theory does not constitute any approximation to the exact solutions in the case of free fields. The only regular solution satisfying, as boundary condition, the requirement of a sufficiently rapid decrease at infinity is a flat space. The problem of conservation laws is discussed anew. The continuity equation satisfied by Einstein's pseudotensor does not guarantee the existence of global conservation laws. Solutions violating the energy conservation are interpretable as representing gravitational radiation absorbed or (...) emitted by sources at infinity. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

Author tells the story of his close and very long-lasting acquaintance with Leszek Kołakowski as well as commentates on his intellectual biography and achievements as political and literary essayist, philosopher, historian of ideas, and public figure. In particular, he describes in details the first half of Kołakowski’s life, namely the period when he made his long journey from being communist in his student years to becoming as a young scholar the leading figure of Marxist revisionism in the late fifties and, (...) after a time, a principled critic of Marxism itself and a fervent anti-communist.In many respects, Kołakowski’s itinerary was not exceptional but it had at least two noteworthy characteristics. First, in opposition to quite a few other cases, his way away from communism turned out to be scholarly fruitful as it resulted in an uniquely indepth historical research, covering the founders, the golden age and the breakdown of so called “scientific socialism” (his voluminous work Main Currents of Marxism remains one of the best and the most comprehensive monographs of the topic). Second, Kołakowski’s abandoning of his former Weltanschauung was followed by his discovery of religion as an extremely important part of human experience and sine qua non condition of the survival of civilization, permanently menaced by barbarians. However, it is to be doubt whether he may be considered as a convert or a religious thinker in the strict sense of the word since he believed in horrors of the absence of God rather than in the real presence of his in the world. As defender of transcendence and tradition, Kołakowski certainly became a kind of catholic-Christian without denomination but as acritical philosopher remained at the same time highly skeptical about everything. Dreaming of solid fundaments, he was all his life an uncompromising enemy of any fundamentalism. Being nostalgic about the Absolute, he was incurable anti-absolutist. (shrink)