Advance refusals of life-sustaining treatment involve three potentially conflicting interests: those of the patient; those of the doctor; and those of the law. The state's interest in protecting life can clash with the patient's right to self determination which, in turn, can conflict with the doctor's desire to act in the patient's best interests. Against this background, we present the case of a patient who was treated (arguably) contrary to his advance refusal but in accordance with English law.

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

Just Life reorients ethics and politics around the generativity of mothers and daughters rather than the right to property and the sexual proprieties of the Oedipal drama. Invoking two concrete universals – everyone is born of a woman and everyone needs to eat – Rawlinson rethinks labor and food as relationships that make ethical claims and sustain agency. Just Life counters the capitalization of bodies under biopower with the solidarity of sovereign bodies.

While the history of philosophy has traditionally given scant attention to food and the ethics of eating, in the last few decades the subject of food ethics has emerged as a major topic, encompassing a wide array of issues, including labor justice, public health, social inequity, animal rights and environmental ethics. This handbook provides a much needed philosophical analysis of the ethical implications of the need to eat and the role that food plays in social, cultural and political life. Unlike (...) other books on the topic, this text integrates traditional approaches to the subject with cutting edge research in order to set a new agenda for philosophical discussions of food ethics. The Routledge Handbook of Food Ethics is an outstanding reference source to the key topics, problems and debates in this exciting subject and is the first collection of its kind. Comprising over 35 chapters by a team of international contributors, the Handbook is divided into 7 parts: the phenomenology of food gender and food food and cultural diversity liberty, choice and food policy food and the environment farming and eating other animals food justice Essential reading for students and researchers in food ethics, it is also an invaluable resource for those in related disciplines such as environmental ethics and bioethics. (shrink)

In this book, readers will learn what perseverance is, how and why to show it, how to use mindfulness to better practice perseverance, and how to encourage it in others. Social and emotional learning (SEL) concepts support growth mindset throughout, while Grow with Goals and Mindfulness Exercise activities further reinforce the content. Vibrant, full-color photos and carefully leveled text engage young readers as they learn more about showing perseverance. Also includes sidebars, a table of contents, glossary, index, and tips for (...) educators and caregivers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

This paper investigates the exemplarity of medicine in Foucault's analyses of knowledge generally. By tracing the development of his concept of power and its relation to knowledge, it offers an account of Foucault's unconventional philosophical project. Finally, it specifies Foucault's strategy for undermining processes of normalisation.

Giving Voice To Values (GVV) serves as a framework to teach individuals methods to speak up when they witness actions that are contrary to their professional and personal values. This essay illustrates how GVV serves as a catalyst to advance both research and teaching activities.

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its supposedly generic human subject, as well as the fact that the tradition does not view womens rights as human rights. This essay traces the way in which this invisible gendering of the universal renders the other gender invisible and silent. It shows how this attenuation of the human in man is a source of sickness, both cultural and individual. Finally, it suggests several ways in which images (...) drawn from womens experience and womens bodies might contribute to a constructive rethinking of basic ethical concepts. (shrink)

Medical practice is animated by the intention to cure; it aims to relieve the immense variety of sufferings to which human beings are subject in virtue of the conditions of their embodied existence. My purpose here is to demonstrate how a philosophical analysis of the formal structures and kinds of human suffering provides an essential foundation for determining certain ethical dimensions of the physician's relation to his suffering patient. Can paternalism in medical practice be justified by the aim of relieving (...) suffering? What are the scope and limits of the patient's responsibility for his suffering, and what difference does this make in the physician's response to it? How is the suffering that medical treatment itself exacts in the name of cure to be justified? Such questions can be answered only by an analysis of the sense or value of suffering in human life. Keywords: suffering, sin, autonomy, paternalism, patient values CiteULike Connotea Del.icio.us What's this? (shrink)

Universals are a class of mind independent entities, usually contrasted with individuals, postulated to ground and explain relations of qualitative identity and resemblance among individuals. Individuals are said to be similar in virtue of sharing universals. An apple and a ruby are both red, for example, and their common redness results from sharing a universal. If they are both red at the same time, the universal, red, must be in two places at once. This makes universals quite different from individuals, (...) and controversial. (shrink)

This article discusses two complementary themes that play an important role in contemporary South African political philosophy: (1) the racist tradition in Western philosophy; and (2) the role of ubuntu in regaining an authentic African identity, which was systematically suppressed during the colonial past and apartheid. These are also leading themes in Mogobe Ramose’s African Philosophy Through Ubuntu. The first part concentrates on John Locke. It discusses the thesis that the reprehensible racism of many founders of liberal political philosophy has (...) lethally infected liberal theory. This view neglects the distinction between genesis and justification. Political liberalism has since cleansed itself of the prejudices of its spiritual ancestors. Liberal human rights exclude racism as a matter of principle. The second part discusses the claim that the ubuntu philosophy provides a better basis for a constitution in a modern society than political liberalism. A major problem is that ubuntu is an essentially contested concept. Some philosophers consider ubuntu to be a moribund notion (Matolino); others see it as a vital concept par excellence. In the latter case, it is elaborated from sundry incompatible political views, ranging from African nationalism (Ramose) via humanist communitarianism (Metz) to liberalism (Mboti). Conclusion: as an essentially contested ideological concept, ubuntu should not be a decisive constitutional standard for the application of state force. In contrast, the constitutional model of political liberalism provides a reasonable alternative, as it is designed precisely to solve the problem of social plurality and ideological contest. (shrink)

Giving Voice To Values (GVV) serves as a framework to teach individuals methods to speak up when they witness actions that are contrary to their professional and personal values. This essay illustrates how GVV serves as a catalyst to advance both research and teaching activities.

Ornaments are the most common and ubiquitous art form of the Late Pleistocene. This fact suggests a common, fundamental function somewhat different to other kinds of Paleolithic art. While the capacity for artistic expression could be considerably older than the record of preserved art would suggest, beads signal a novel development in the efficiency and flexibility of visual communication technology. The Upper Paleolithic was a period of considerable regional differentiation in material culture, yet there is remarkable consistency in the dominant (...) shapes and sizes of Paleolithic beads over more than 25,000 years and across vast areas, even though they were made from diverse materials and, in the case of mollusc shells, diverse taxonomic families. Cultural and linguistic continuity cannot explain the meta-pattern. The evidence indicates that widespread adoption of beads of redundant form was not only about local and subregional communication of personal identity or group affinity, but also an expansion in the geographic scale of social networks. The conformity of the beads grew spontaneously and in a self-organizing manner from individuals’ interest in tapping into the network as a means for spreading social and environmental risk. (shrink)

As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

The Spanish future subjunctive demonstrates how linguistics can inform modern language policy. The FS is described as an archaism to be eliminated from contemporary legal texts. We analyze a corpus of over 3000 tokens of the FS in Spanish legal texts dated between the 13th and 16th century. The FS has two functions in legal discourse. The casuistic function allows for indicating paradigmatic subordination; the forwarding function introduces new information. Our quantitative results suggest an increase in the usage frequency of (...) the FS in legal discourse, where an inverse trend appears in other genres. As shown by a linear regression analysis, the FS started appearing significantly closer to the beginning of the law article, indicating an increase in the forwarding function in time. In view of our results, reformers of legal Spanish should consider the functions of the FS in legal discourse when advising its suppression. (shrink)

"Jada's working on her science project. She's finding out whether plants grow best in water, milk, juice, or soda. There's just one problem--she keeps getting interrupted. From her cousin texting and her friends stopping by to her little brother playing with the plants, Jada runs into one obstacle after another. Find out how [she] relies on grit to keep on going"--Back cover.

Motorheadbangers, the official fan club for rock giants, Motorhead, has never stopped. Like the band on tour, in the studio and playing live to audiences across the world, Motorheadbangers, through its stalwart fan base, has matched the band's enthusiasm to keep going against all the odds. Since the first fanzine the fan club membership has written of their experiences at seeing and meeting one of the greatest rock n roll bands in the world. In this way, Motorhead's history has been (...) catalogued. However, the majority of those fanzines have long been out of print. (shrink)

The purpose of this exploratory and descriptive study was to examine old-age dementia in the Hmong community of Milwaukee, Wisconsin. Formal and informal Hmong leaders were interviewed to determine the prevalence of dementia in the Hmong community and how it is perceived and experienced. Interviews revealed few cases of dementia among the Hmong. Dementia was perceived as a natural part of the life cycle, rather than as a devastating disease that robs individuals of their autonomy. Treatment is not sought for (...) dementia. Some of the common manifestations of dementia, such as wandering and combativeness, were rare or non-existent in the Hmong community. Individuals with dementia are cared for in their sons' homes. Nursing home placement in advanced dementia was only acceptable if sanctioned by the entire extended family. Further research on the Hmong perception of and experience with dementia needs to be conducted in other Hmong communities to validate the generalizability of these results. (shrink)