IRBs in action -- Everyone's an expert? Warrants for expertise -- Local precedents -- Documents and deliberations: an anticipatory perspective -- Setting IRBs in motion in Cold War America -- An ethics of place -- The many forms of consent -- Deflecting responsibility -- Conclusion: the making of ethical research.

In this paper we report on empirical research which investigates social capital of Small and Medium Sized Enterprises (SMEs). Bringing an international perspective to the work, we make a comparison between 30 firms located in West London and Munich in the sectors of food manufacturing/production, marketing services and garages. Here we present 6 case studies, which we use to illustrate the early findings from this pilot project. We identify differences in approach to associational membership in Germany and the U.K., with (...) a greater propensity to "belong" to an official group in Germany. We distinguish clear sectoral similarities across the countries, and indications that certain personality types will seek out engagement and find time beyond busy work life schedules, often merging work/home/leisure life and friends. Some of our cases illustrate that formal institutions, networks and mutual relationships can develop social capital for the SME, although we should take care not to assume a universal win-win situation for those who are engaged and contribute to the common good. Some of the obstacles to cooperation and civic engagement are outlined. (shrink)

In this article, I develop a new account of the liberal view that principles of justice are meant to justify state coercion, and consider its implications for the question of global socioeconomic justice. Although contemporary proponents of this view deny that principles of socioeconomic justice apply globally, on my newly developed account this conclusion is mistaken. I distinguish between two types of coercion, systemic and interactional, and argue that a plausible theory of global justice should contain principles justifying both. The (...) justification of interactional coercion requires principles regulating interstate interference; that of systemic coercion requires principles of global socioeconomic justice. I argue that the proposed view not only helps us make progress in the debate on global justice, but also offers an independently compelling and systematic account of the function and conditions of applicability of justice. -/-. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to (...) determine how members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Finding My Compass*Laura Inter+I was born in the 1980s, and much to my parents surprise, the doctors could not say whether I was a boy or a girl because my body had ambiguous genitalia. They then conducted a chromosome test and the result was XX chromosomes. I was assigned female and only later was diagnosed with congenital adrenal hyperplasia (CAH). Fortunately for me the endocrinologist who treated me (...) did not mention the option of surgery, so my medical treatment consisted only of taking cortisol. Apart from this, from the time I turned one, I was subjected to genital examinations twice a year, during which the endocrinologist would touch my genitals and look to see how they were developing.These unnecessary and intrusive examinations had a profound effect on me. As a young child, I did not understand why I had to lower my pants in front of a stranger—the endocrinologist—and let him touch me. The fact that my mother was present, and approved of this was something that made me feel completely helpless. All this seemed very strange to me; I found it confusing, and terribly uncomfortable, and I just felt it wasn’t right.I remember the doctor always spoke as if I wasn’t right there, and I did not always understand everything the doctor said when I was young, because of all the medical terms he used. I grew up with a feeling of being “inadequate,” of having a sense that something was wrong with me, though I didn’t know exactly what. These exams lasted until I was about 12 years old. Years later, as I began my adult, sexual life, I realized how much those displays had affected me emotionally.I discovered what was “wrong” with me during sex education classes in the first year of high school. There was a class session in which two images were shown: one displaying the external female sex organs, and the other the male sex organs. I noticed that my body was not like either of them. I was very distressed, thinking “I have deformed genitals!” I feared I could not perform sexually as either a man or a woman. I became very depressed. I was sure nobody would want me, that I would never have a relationship. I was unacceptable, “abnormal,” or at least that is what the doctors had said. And in any case my parents never spoke of it, and I didn’t know that I had CAH.Skip forward a few years: I was still looking for answers, I found my medical file and read in the documents “pseudo–hermaphrodite,” and [End Page 95] “congenital adrenal hyperplasia.” I searched the internet, but only found medical opinions that said that in the case of genital ambiguity, the best option was surgery. I wondered to myself: “Why didn’t they operate on me?”I put the question to my parents, and, at fifteen, I found myself being examined once more in the doctor’s office, this time to consider the possibility of a genital surgery which might once and for all, I believed, make me a “normal” person.I have never told anyone outside my family before, but one of those exams was the most humiliating experiences of my life. One doctor wanted to speak with me alone, so she made my mother wait outside the exam room. My mother agreed, thinking that after the doctor talked with me, my mother would be able to be present during the rest of the exam. The doctor asked me questions, some of which made me very uncomfortable: “Do you feel good about being a woman”? Did you ever feel like a man? Why don’t you dress up more, use more makeup? Are you a lesbian? Have you ever had sex? She then said she wanted to see my genitals. I felt awful and wanted my mother present, but I also wanted it to be over quickly, and said nothing. Examining my genitals, the doctor told me they “would not be adequate for sex,” and that she needed to “perform surgery.” Something else that made me uncomfortable was the presence of another doctor in... (shrink)

The exhibition Space/Sight/Self was designed to study the role of portraiture in contemporary art as a nexus of three issues identity, vision, and place. The goal was to produce a portrait, as it were, of contemporary portraiture. This catalog documents the exhibition and helps to facilitate viewers' reflections and responses about the spaces, sights, and selves that enable us to construct and question our identity.".

Resumen Las opiniones que aparecen en la página web TripAdvisor, como muestra relevante de la promoción del Turismo 2.0, se convierten, dadas las características de este discurso, en macroactos de habla directivos en los que convergen actos de distinta naturaleza. Si bien se presentan como opiniones, trascienden los límites de la mera información para convertirse en actos directivos, ya que el opinante se ve implicado en la construcción de una especie de guía de ayuda a otros viajeros. Por tanto, el (...) objetivo de este trabajo es categorizar los distintos tipos de las denominadas por la página web TripAdvisor “opiniones” como sugerencias, consejos, recomendaciones y advertencias, y analizar las estrategias de atenuación a las que se recurre en su formulación al servicio de distintas actividades de imagen. Los resultados muestran una tendencia que nos lleva a proponer la distinción entre estos tipos de actos directivos sobre la base de: la recurrencia a estrategias de atenuación, factores como el poder o la voluntad del opinante, el coste-beneficio para el destinatario, así como las propias calificaciones de las opiniones – en las categorías “excelente”, “muy bueno”, “normal”, “malo” y “pésimo”– establecidas por la propia página web. Tener en cuenta todas estas variables nos ha permitido constatar la existencia de un continuo de los actos de habla que se corresponden con diferentes grados de estrategias de atenuación, también en función de las categorías de evaluación y de los mecanismos utilizados para producir el acto. (shrink)

Greek κρατύς and cognates (κράτος, κρατερός, etc.) are related to Vedic krátu- ‘resolve’ and Avestan xratu- ‘[guiding] intellect’. The cumulative phraseological evidence supports this etymological proposal: in at least ten cases, Greek personal names and phrasemes exhibiting a cognate of κρατύς (that is, κράτος and compounds with first member κρατ[α]ι-) combine with terms whose Indo-Iranian linguistic cognates are joined with Vedic krátu- and Avestan xratu-. Furthermore, Indo-Iranian expressions, in which Vedic krátu- and its compounds are referred to a god as (...) attributes, are structurally comparable to Greek κρατὺς Ἀργεϊφόντης. Since Ἀργεϊφόντης is likely to reflect ‘shining (cf. Greek φαίνω) with whiteness/brightness (ἀργει-)’, it is possible to identify Vedic phraseological matches for the Greek formula, namely expressions in which Vedic krátu- and its derivative krátumant- combine with the notion of ‘shining widely’, Vedic ví-bhā (Vedic bhā being a linguistic congener of φαίνω). The phraseological correspondence between Vedic krátu- … agní- ‘Agni, [endowed with] resolve’, and κρατὺς Ἀργεϊφόντης ‘Argeiphontes, endowed with superior might (κράτος)’ may be added to the dossier of common phraseology which the Greek god shares with the Old Indic fire-deity. (shrink)

Le conseil d’administration du CNRS a adopté le 23 juin 2011 la charte interne de l’expertise, qui adapte aux spécificités de ses propres activités le texte de la Charte nationale de l’expertise. La charte interne du CNRS est guidée par la volonté de répondre efficacement à deux enjeux majeurs de l’expertise scientifique : la crédibilité des experts et la qualité du processus et du produit de l’expertise.The CNRS governing board adopted its internal Charter on Expert Studies on 23 June 2011, (...) which adapts the National Charter on Expert Studies to the specific features of CNRS activities. The internal CNRS Charter rests on the principle of efficient striving to address two major issues concerning scientific expert studies : the credibility of experts and the quality of expert study processes and output. (shrink)

Interview of M. Laura Lattanzi and Paz López to the artist and writer Leticia Obeid.

Why do men and women compete? And what makes them compete more or less? An answer to the first question follows directly from Darwin. If Homo sapiens, like other species, is a product of natural selection, then we should have evolved to compete in order to reproduce. An answer to the second question follows from more recent versions of Darwinism. People, like other organisms, are likely to compete socially - to form dominance hierarchies - to the extent that it is (...) costly for subordinates to flee ecologically. This paper first reviews evidence that winners at political competition have consistently won at reproductive competition. Next, it documents the slow shift toward declining political competition - toward democracy, and toward declining reproductive competition - toward monogamy, in the course of Western history. Last, it offers a model of what might account for that change. (shrink)

This article seek to highlight the aspects — explicit or implicit — that indicate the close attention paid by much American musicology of this century to the phenomenological level of musical events or, more generally, of the sound event. Starting from general considerations on American music and some of its protagonists, the article focuses on Elliott Carter, on his poetics, and on his theories expressed in his writings.Carter's compositional choices and his consciousness of the intrinsic complexity they assume theoretically provide (...) a starting point for a phenomenological study of many aspects of compositional experience: from consideration of instrumental language with its structural phenomenological (and historical) implications, to more global evaluation of the centrality of temporal and rhythmic subjects. (shrink)

Our world suffers. Some people suffer more than others. Since the first part of 2020, ours is justly described as a time of uncertainty, threat, and upheaval. In this article, we offer reflections threaded narratively, told from the specificity of our societal contexts in Iran, Canada, and Australia. What might we learn in the present and anticipated future from people living chronically within conditions of uncertainty and immobility and also those experiencing uncertainty and immobility for the first time? We argue (...) that reflexive comparative analysis bridging social and visual analysis, anchored in embodied conditions of such people, offers a way to learn from responses to COVID-19 while also being an exercise in ethical research practice. This reflection builds on and extends from our scholarly collaborations that have been ongoing since 2015. Our title recognizes this specific virus as stealthy. Importantly, our choice of words identifies resident Iranians—whose experiences were the original impetuses for this paper, and whose lives provide its empirical basis —as equally steely. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part 2Laura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part Two of a two part Scope Note on Religious Perspectives on Bioethics. Part One was published in the June 1994 issue of this Journal. This Scope Note has been arranged in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1I.GeneralVI.HinduismII.African Religious TraditionsVII.IslamIII.Bahá'í FaithVIII.JainismIV.Buddhism and ConfucianismIX.JudaismV.Eastern OrthodoxyPart 2I.Native (...) American ReligiousChristian Scientist TraditionsEpiscopal/AnglicanII.ProtestantismEvangelicalGeneralJehovah's WitnessAnabaptist (Church of theLutheranBrethren, Friends SocietyMethodist/Wesleyan(Quaker), and Mennonite/NazareneAmish/Hutterite)Presbyterian/ReformedAssemblies of GodSeventh-day AdventistBaptistUnitarian UniversalistChurch of Jesus Christ of theUnited Church of Christ Latter-day SaintsIII.Roman CatholicismChristian Church (Disciples of Christ)[End Page 357]IntroductionThe many religions of the world bring diverse, and occasionally divergent attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine for these faith traditions in the United States, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing on bioethics, for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Native North American ShamanismAvery, Charlene. Native American Medicine: Traditional Healing. Journal of the American Medical Association 265 (17): 2271, 2273, 1 May 1991. A brief description of the general principles of Southwestern Native American religions is provided. Most tribes believe that health and religious well-being are interconnected.Day, Thomas W. Cross-Cultural Medicine at Home. Minnesota Medicine 75 (3): 15-17, March 1992. The Ojibwe tribe's view of health incorporates spiritual health and emphasizes a holistic approach to health care that encompasses a harmonious balance between the individual, community, and nature, as well as between body, mind, and spirit.Hirschfelder, Arlene B., and Molin, Paulette. The Encyclopedia of Native American Religions. New York: Facts on File, 1992. 367 p. A survey of Native American religions is provided, including tribal histories, descriptions of religious ceremonies, and biographical sketches.Hultkrantz, Åke. Health, Religion, and Medicine in Native North American Traditions. In Healing [End Page 358] and Restoring: Health and Medicine in the World's Religious Traditions, ed. Lawrence Sullivan, pp. 327-58. New York: Macmillan, 1989. Hultkrantz summarizes the Native American attitude toward medicine and health care, explaining that belief in the supernatural and its powers is one of the most important tenets of life. Ailing persons are aided by those who have been trained to act as mediators between the sick individual and the supernatural powers. Attitudes toward health and disease, and the role of the medicine man are demonstrated through the use of examples taken from many tribes.Hultkrantz, Åke. Shamanic Healing and Ritual Drama: Health and Medicine in Native North American Religious Traditions. New York: Crossroad, 1992. 197 p. Hultkrantz surveys the varied traditions of Native North Americans and their outlook on medical care, health, and religion, and emphasizes that Native American medical beliefs... (shrink)

This is a meta-reflection on the methodological and epistemological challenges of doing ethnographic theology in a context outside the church or religious communities. Particularly, it argues that in a multi- or inter-disciplinary setting theologians are placed in a precarious position when it comes to use of language, theories and concepts if they want to speak simultaneously to the people they encounter in the field and to their “own” scientific community. The article asks how a researcher can do theology in a (...) secular environment without doing violence towards ones interlocutors and still be considered to “belong” in the theological community? Based on the lived experiences of ongoing research and particularly concerning the gathering and telling the stories of Women in the Natural sciences, the author weaves together Eileen Campbell-Reed’s and Sarah Coakley’s methodological frameworks in order to present her own method of contemplative dance. The author uses rich metaphors and the sensory experience of “Home” and “Exile” in relationship to the movements in a foot to bring forth her embodied insights about dancing in the messy entanglement of ethnographic research. (shrink)

Foucault’s debt to Kant is usually examined with respect to his ethos of critique. In fact, Kant’s writings on aesthetic judgment, teleological judgment, and anthropology constitute an important, if implicit, object of Foucault’s genealogical efforts to free Western culture from a scientia sexualis that oppresses sexual minorities. Comparing Foucault’s use of Kant to the use made by psychoanalytic theorists of sexual difference, this paper argues that the concept of non-teleological pleasure found in Kant’s critique of aesthetic judgment may provide grounds (...) for queer thinkers to resist and reconfigure associations between death, knowledge, and sexuality as a function of organisms—associations inherited from the post-Kantian philosophical anthropology and biological medicine of the nineteenth century. (shrink)

Crisis in the Courtroom: The Discursive Conditions of Possibility for Ruptures in Legal Discourse This article addresses the conditions of possibility for the precautionary turn in legal discourse. Although the precautionary turn itself has been well-detailed in both legal and political discourse, insufficient attention has been paid to what made this shift possible. This article remedies this, starting by showing how the events of 9/11 were unable to be incorporated within current discursive structures. As a result, these discursive structures were (...) dislocated and a new ‘crisis discourse’ emerged that succeeded in attributing meaning to the events of 9/11. By focusing on three important cases from three different jurisdictions evidencing the precautionary turn in legal discourse, this article shows that crisis discourse is indeed employed by the judiciary and that its logic made this precautionary approach to counterterrorism in the law possible. These events, now some 16 years ago, hold relevance for today’s continuing presence of crisis and crisis discourse. (shrink)

Descartes has been associated with a project of establishing the ego’s separation from and sovereignty over its material environment, a project often held to be constitutive of modernity as well as its discontents. Kyoo Lee’s Reading Descartes Otherwise tries to free our understanding of modernity from this imaginary and reductive reading, which she calls the “Cartesian complex,” by presenting the voice of The Meditations as embodied, phenomenologically astute, and emerging from the interstices of his own repeated dreamlike thought experiments.

Diverse meanings of ‘sovereignty’ and ‘exchange’ force us to interrogate the implicit ontology of states and the associated assumptions about will, matter and spirit used by political theorists, evoking different religious and political traditions. This article contrasts the notion of ‘sovereignty’ found in Joseph Tonda’s Le Souverain Moderne (2005) with the one found in Michael Hardt and Antonio Negri’s Empire (2000). Tonda’s text, I argue, challenges and complicates the appropriateness of referring to early Christianity as a model for resistance to (...) global capitalism in Empire. To help with this contrast, I draw on two Central African authors, Emmanuel Dongala (2006) and Joseph Mwantuali (2007), whose novels illustrate the supernatural as well as thoroughly material significance of state power, wealth and sexuality in the modern Sovereign. (shrink)

Jean Godefroy Bidima’s La Palabre examines the traditional African institution of palaver as a way to create dialogue and open exchange in an effort to resolve conflict and promote democracy. In the wake of South Africa’s Truth and Reconciliation Commissions and the gacaca courts in Rwanda, Bidima offers a compelling model of how to develop an African public space where dialogue can combat misunderstanding. This volume, which includes other essays on legal processes, cultural diversity, memory, and the internet in Africa, (...) offers English-speaking readers the opportunity to become acquainted with a highly original and important postcolonial thinker. (shrink)

Beauvoir's Ethics of Ambiguity suggests that if existentialism is vulnerable to accusations of solipsism and nihilism, this is because Sartre failed to approach ambiguity from the proper angle. Of all the forms of ambiguity described in this text, the most troubling conjoins human separateness with connection. From the essays of the 1940s to her lectures on literature during the 1960s, Beauvoir struggles to articulate the ethics of this form of ambiguity. Her refusal to deny the “anti‐social” aspect of existence finds (...) echoes in today's tensions between feminists and queer theorists. (shrink)

This article describes why and how the author started a medical-legal partnership at her small law school, the curricula associated with the medical-legal partnership, and the experience she and her students have had with the curricula to date. It also provides “lessons learned” which may be useful for individuals interested in expanding interdisciplinary and experiential opportunities at institutions that presently lack traditional sources of such opportunities.

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ABSTRACT Recent reflection on the role of museums and galleries has focused on their socially situated nature; and that as a social construct, co-produced with its audiences, heritage is in part discursively constituted. This has included acknowledgement that the inherited discourse is hegemonic and exclusive of divergent narratives, leading to moves to create alternatives to contest it, which include temporary exhibitions. These provide a potentially democratic space for discursive incursions freed from the constraints of the permanent museum. But they are (...) also spatially and temporally peripheral, occupying a discursive space outside the standard visit. This raises questions as to whether, once the exhibition is over, the alternative will be subsumed once more. This article explores this issue using a dataset of TripAdvisor reviews to analyse the discursive responses of visitors to temporary and permanent collections, using the Musée d’Orsay's 2019 exhibition Le Modèle Noir as a case study. Analysis shows that Le Modèle Noir reviews exhibit greater discursive fragmentation, reveal a relative lack of appeals to collective identity, and do not connect the exhibition with the permanent collection. Potential implications of this for initiatives that seek to counter the hegemonic narrative are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Healing Power of an Ethics ConsultLaura J. HoeksemaOur interdisciplinary team was inhaling and exhaling conflict, frustration, anger, confusion, guilt, and feelings of helplessness as we cared for a 21-year-old woman who was dying. We had regular disagreements about how our team should best care for her. She was receiving hospice care and had complex medical, psychosocial, physical, and emotional needs. She was frequently transitioning between hospice care at (...) home, living with different family members at different times, and hospice care in the hospital due to uncontrolled symptoms. This led to her having an inpatient hospice team made up of me—her physician—and a nurse, social worker, and chaplain and also an outpatient hospice team with a different physician, nurse, social worker, and chaplain. All of us cared for her regularly in our respective settings. Members of the two care teams advocated passionately for what they thought was best for her. At times, team members were advocating strongly for conflicting interventions. Every member of both teams experienced moral distress related to some aspect of her care.How could we move forward in a unified way to provide her with the best care possible when there was uncertainty and disagreement within the teams about whether we were providing her with ethically appropriate care?Several questions arose about her care:• What is our responsibility in protecting a vulnerable patient when there is concern she’s being taken advantage of by others?• How do we address concerns about possible opioid diversion? Was a dying patient not receiving the pain medication she needed because someone else was using it?• How do we address household members smoking in the presence of someone on oxygen?• Do we honor a dying patient’s wish to live in an environment that we’re concerned is unsafe for her and our staff?• When team members receive contradictory information from a patient, how do we develop a common understanding of the situation?• Was it appropriate for our team to spend hours and hours caring for her each day which prevented us from caring for other patients who also needed our support?• What is our responsibility in relation to supporting her family with their financial and legal concerns?We placed an ethics consult to help us think through the answers to these questions and address the intense moral distress of team members. After listening to us share our experiences, the ethicists acknowledged the complexities of caring for her and affirmed that we were doing a good job. This acknowledgment from someone not directly involved in caring for the patient was meaningful. Having colleagues, who weren’t impacted by the emotional intensity of caring for her, empathize with us helped us gain some perspective in the swirling tornado of our emotions.Moral distress was running rampant. Some team members were distressed that we were giving the patient too much autonomy to make decisions they felt put her at risk. Others felt we should restrict her autonomy significantly to protect her. Some were distressed by family members smoking near her when she was on oxygen. Others were distressed that the investment of time in caring for her was so great that we couldn’t care for other patients in ways they deserved. Team members were very passionate about their beliefs about what was right and wrong as we cared for her. [End Page 21]The ethics consultants addressed the conflicting ethical values and helped us feel more comfortable with the plan of care we developed together. We were asked thoughtful questions to help draw out sources of moral distress. We were given new ways of thinking about conflicting ethical values, which helped us understand the underlying reasons for the conflict our team was experiencing. Highlighting the ethical values that were in conflict and helping each of us understand that the specific aspects of her care that we found distressing were related to our personal values, helped decrease the intensity of disagreements and frustration. The ethicist’s ability to share this knowledge with our team was powerful. Our team realized that we weren’t frustrated or upset with each other. We came to understand that because of the... (shrink)

This paper provides information on different training models within clinical neuropsychology in Finland. Systematic specialization training program began in Finland in 1983. It was first organized mainly by the Finnish Neuropsychological Society and since 1997 by the Finnish universities. At present, close to 400 clinical neuropsychologists have completed the training. The number of professionals still does not cover the needs of the country, and geographical disparities are a constant concern. The training models in Finland have changed over the years and (...) will continue to evolve. Specialization training can be organized by national societies or by universities. It can lead to an academic degree or a diploma. It can be linked to doctoral studies or form a parallel track. Financial model can involve student fees or be governed by ministries. This paper describes and compares different strategies in education that have impact on the output of professionals. One model does not fit all, or even one country at all times. The strategies of the stakeholder ministries can change over time. The experiences from Finland can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession. (shrink)