Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

At a time when even a brief hospital stay means becoming terrifyingly dependent on the kindness of strangers, this compassionate and practical book by a prominent medical ethicist gives power back to patients while providing invaluable guidance to their friends and families. "A cutting-edge book about cutting-edge issues (that) every American must know. . . ".--Alan Dershowitz.

Seit 1923 erscheinen in der Sammlung Tusculum ma gebende Editionen griechischer und lateinischer Werke mit deutscher bersetzung. Die Originaltexte werden zudem eingeleitet und umfassend kommentiert; nach der neuen Konzeption bieten schlie lich thematische Essays tiefere Einblicke in das Werk, seinen historischen Kontext und sein Nachleben. Die hohe wissenschaftliche Qualit t der Ausgaben, gepaart mit dem leserfreundlichen Sprachstil der Einf hrungs- und Kommentarteile, macht jeden Tusculum-Band zu einer fundamentalen Lekt re nicht nur f r Studierende, die sich zum ersten Mal einem (...) antiken Autor n hern, und f r Wissenschaftler, die spezifische Aspekte eines Werkes vertiefen m chten, sondern f r alle, die sich durch vertrauensw rdige bersetzungen einen Zugang zur Antiken Welt verschaffen wollen. In der Reihe wurden bisher ber 270 Titel publiziert, alle erh ltlich als Buch und eBook. Dadruch werden bislang vergriffene Titel und Rarit ten wieder vollst ndig verf gbar gemacht. Zus tzlich zu der Buchreihe erscheint bei De Gruyter zum 90-j hrigen Jubil um das eBook-PaketTusculum Online, eine digitale Sammlung aller von 1923 bis 2013 erschienenen Titel -eine geb hrende W rdigung eines wichtigen St cks deutscher Verlagsgeschichte. Mehr Informationen rund um Tusculum erhalten Sie unter: www.degruyter.com/tusculum. (shrink)

Excerpt from Norm und Verfall des Staates Wohl wußte Nietzsche, daß die physiologischen Grund kenntnisse, denen er doch so großen Wert beimaß, ihm fehlten. Schwankte er doch, ob er die südliche Einsamkeitmit der Luft deutscher Universitäten vertauschen sollte; aber damals würde er diese Grundlagen vergeblich in der Wissenschaft gesucht haben. Heute würde er eher finden, was er brauchte. Die Vor stellung, daß anerz'ogene Eigenschaften sich vererben, ist fast überwunden. Züchtung und Erziehung sind scharfe Gegensätze geworden, die der Bildner des Volkes (...) streng auseinanderhalten muß. Weniger durchdacht sind aber bisher die Folgerungen, daß der Kampf gegen die phy sisehe E nt a r t u n g des einzelnen und der Rasse ganz verschieden ist von dem Kampf gegen den V e r f all des Geistes und des Staates. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

The archipelago context of Maluku represents the living dynamics of Christian communities in that area, which becomes an ecclesiological foundation of the Gereja Protestan Maluku. Christianity, the embryo of the GPM, is the fruit of the evangelical works by European missionaries, particularly Dutch missions from the 18th century onwards. The Dutch-type Christianity had been adapted into models so that the form of institution and Protestant teachings in Maluku moved dynamically following socio-political and cultural changes along with the colonial and the (...) post-colonial history of Indonesian and Malukan society. It attempts to describe the manifestation of the Calvinism-model of Christianity that is continuously being contextualised through absorbing various elements of worldview, tradition, and the religiosity of the archipelago society. Cultural hermeneutics is used to interpret the socio-cultural phenomena in which the church lives in and to construct its theological understanding about Christian identity. The ecclesiological construction of GPM, in turn, is structured by plural social orders. The reality also influences the perspective about GPM from many different worldviews of the Malukan archipelago society. The contextual ecclesiological perspective, therefore, is constructed based on intermingled understandings that theology of the church can only be built by considering multifold dimensions of a particular society. The result of this research pertains to the constructive understanding of a specific ecclesial context of the GPM in their struggles for theologising their existence as God’s people and, at the same time, as an integral part of certain society in Maluku and Indonesia.Contribution: As the living contextual church that struggles for proclaiming God’s love, the GPM has a theological responsibility to conduct its church mission based on its ecclesiological understanding and practices contextually. The article contributes to the enrichment of the theological discourse on the crucial roles of a church in Maluku, in the eastern part of Indonesia. (shrink)

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the QI tool , to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work. Although the process was marked by resistance and disagreement, (...) it was also noteworthy for the sustained engagement by participants over the year of the project, and a high level of acceptance by its conclusion. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a ninestep algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased initiatives conducted (...) in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

In this study, 191 subjects, 93 male and 98 female undergraduate business students, were asked to respond to a 51 item questionnaire to examine their perception of what constituted a "just society". The subjects agreed on 16 characteristics which a just society would have. Out of 51 there were only 10 statements whereon average responses showed significant differences based on gender.

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

We challenge the idea that a cognitive perspective on therapeutic change concerns only memory processes. We argue that inclusion of impairments in more generative cognitive processes is necessary for complete understanding of cases such as depression. In such cases what is identified in the target article as an “integrative memory structure” is crucially supported by processes of mental model construction.

Neue Formen der Telekommunikation lassen die Sorge um Privatheit wieder aufkeimen. Zu diesen zählen E-Mails im Internet. Wie können Privatheitsrechte bezüglich E-Mails ethisch begründet werden? Eine differenzierte Formulierung der relevanten Privatheitsrechte ermöglicht die analytische Rechtstheorie von Stig Kanger. Für die Begründung dieser Rechte in unterschiedlichen Beziehungen (z.B. gegenüber Systembetreuer/inne/n, dem Staat oder Arbeitgeber/inne/n) spielen Personsein, persönliche und intime Beziehungen, aber auch politische und soziale Freiheiten eine wesentliche Rolle. Wann verzichten Menschen jedoch auf diese Rechte und von welchen Überlegungen werden sie (...) zurückgedrängt? Die Autorin behandelt nicht nur diese Ethischen Fragen, sondern gibt ebenso eine Reihe aktueller Informationen über technische, positiv-rechtliche und politische Entwicklungen. (shrink)

Zusammenfassung Der vorliegende Beitrag greift die Frage nach einem möglichen Zusammenhang von sozialer Integration Jugendlicher und deren Mitgliedschaft in Sportvereinen auf. Dabei wird die Qualität der Peerbeziehungen der Jugendlichen fokussiert, denn zu den Leistungen, die den Sportvereinen zugeschriebenen werden, gehört auch die Anbahnung und Förderung freundschaftlicher, unterstützender Gleichaltrigenbeziehungen. Doch gelingt es den Sportvereinen, die an sie gestellten Erwartungen zu erfüllen? Unter Bezugnahme auf das Konzept sozialer Netzwerke werden im vorliegenden Beitrag zwei Aspekte der Qualität der Peerbeziehungen Jugendlicher untersucht: die Intensität (...) der Beziehungen sowie das Ausmaß wahrgenommener sozialer Unterstützung. Auf der Grundlage einer systematischen Sekundäranalyse relevanter Jugendsurveys wird nach empirischen Anhaltspunkten für Integrationsvorteile für die vereinsgebundenen Heranwachsenden bzw. Unterschieden in der Qualität der Peerbeziehungen von vereinsorganisierten und nicht vereinsgebundenen Jugendlichen gesucht. (shrink)