While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

America's research universities, approximately 125 in number,play important roles in the nation's research system, and help toset the tone for all institutions of research and higherlearning. As the research universities have formed closer linkswith industry, new problems have arisen that have precipitated amajor debate. The academic medical centres and related lifescience departments present some of the most challenging newissues, which are analysed in this paper within the framework ofthe biomedical research system that has evolved in the UnitedStates since the Second (...) World War. (shrink)

The clinical ethicist met with Ms. H to clarify what information she wants and does not want to know. First, she wants to receive any treatment that could prolong her life, regardless of how the treatment affects her ability to engage in activities of daily living. Second, she wants to be included in the decision‐making process as much as possible, as long as clinicians use only “positive” language. Ms. H considers the words “dying,” “chemotherapy,” “radiation,” and “cancer” to be “bad (...) words.” For conversations in which these words cannot be avoided, she wants her clinicians to talk to her son. Her desired engagement includes hearing about risks, benefits, and alternatives to treatments if clinicians use only “positive” language. Finally, she says that she rarely sees doctors and that she is “very scared” of hospitals, despite exhibiting a comfortable demeanor.Should clinicians honor Ms. H's waiver of specified information and, if so, to what degree? (shrink)

Schools of Faith represents a diversity of essays from scholars in several continents. The contributors, all leading theologians and ethicists, offer reflections on historical and contemporary themes which are significant for wider debates in theological education and church life in today's world. The range of contributor and content provides a fitting tribute to the work of Iain R. Torrance over many years. Amid the numerous subjects discussed, the authors focus on liturgy, textual criticism, public theology, the ethics of war, Christian (...) doctrine, divine action, ecumenism, inter-faith dialogue, spiritual formation, the office of the minister, and the interface between religion and literature. The multi-faceted nature of this collection signifies its importance for historical, systematic and practical theology. (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for (...) critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

The expository material in this book is ninety-nine pages long and covers very sketchily the philosophy of language, classical logic, symbolic logic, informal fallacies, the philosophy of science, and probability theory. To supplement the text material, the authors have included 142 pages of exercises, which may be removed from the book by tearing along the perforations. The authors have deliberately written a brief text so that the instructor "will be left free to elaborate according to his own judgment as his (...) classroom situation warrants." Eight pages are devoted to quantificational logic. The high price of this paperback text does not seem to be warranted by either the brief expository material, the removable pages of exercises, or the uniqueness of this approach.—R. L. S. (shrink)

This text, serving as an introduction to Aristotelian, symbolic, inductive, and practical logic, presents the techniques of these approaches to logic, some of the philosophical problems of logic, and some of the attempts to solve philosophical problems by means of various logical techniques. It discusses the problem of universals and null classes; briefly introduces the theory of types; and presents Lukasiewicz's formalization of Aristotelian syllogistic logic as an example of a formal system. Classical logic and propositional logic are carefully and (...) fully presented. The text, however, is weak in its presentation of quantificational logic. After a correct, but brief and very inadequate introduction to quantificational logic, the readers are referred to Quine, Methods of Logic, or to Copi, Symbolic Logic, for a more adequate development. The chapter on inductive logic discusses the uses and dangers of generalizations and introduces the probability calculus; the chapter on informal logic discusses criteria of rationality and presents the usual informal fallacies. There are problems and exercises after many of the sections, and answers in the back of the book.—R. L. S. (shrink)

The idea that there are three types of argumentation, deduction, induction, and a third type variously called hypothesis, abduction, or retroduction, first appeared in an 1867 paper by Charles S. Peirce, “On the Natural Classification of Arguments”. According to Peirce’s tripartite division of argumentation, induction is not merely any form of argument that fails to be deductive, but argumentation that generalizes from a sample. In later writings Peirce broadened his notion to mean any testing of hypotheses through observation—as Peirce said, (...) “trying how things will act”. If we understand an observation to be a sample of experience, as Peirce did in 1901 (R L 409:3... (shrink)

Many religious people are alarmed about features of the current age - violence in the media, a pervasive hedonism, a marginalization of religion, and widespread abortion. These concerns influence politics, but just as there should be a separation between church and state, so should there be a balance between religious commitments and secular arguments calling for social reforms. Robert Audi offers a principle of secular rationale, which does not exclude religious grounds for action but which rules out restricting freedom except (...) on grounds that any rational citizen would accept. The book describes the essential commitments of free democracy, explains how religious and secular moral considerations can be integrated to facilitate co-operation in a world of religious pluralism, and proposes ideals of civic virtue that express the mutual respect on which democracy depends. Audi offers a balanced and sophisticated treatment of the relations between religion and politics in a modern, secular society. (shrink)

Atherosclerosis is the major cause of death in the industrialised world. Though much work on the pathogenesis of atherosclerosis points to 'oxidised' low density lipoprotein (LDL) as a key aetiological feature in the generation of the atherosclerotic plaque, the nature of this 'oxidised' LDL in vivo remains an enigma. We argue here that glycated LDL shows many of the characteristics attributed to 'oxidised LDL' and may be the source of the latter in vivo. These include the increased uptake and impaired (...) degradation of glycated LDL by macrophages and the stimulation of transendothelial chemotaxis of monocytes, cytokine secretion and platelet aggregation. We hypothesise that the covalent binding of glycated LDL to the endothelial cell wall may result in the formation of the early atherosclerotic lesion of the fatty streak and that apolipoprotein E may mediate the physiological clearance of glycated moieties. The proposed role of glycation in the pathogenesis of atherosclerosis would explain its high incidence among diabetics and the contentious epidemiological and experimental correlations between dietary sugar and atherosclerosis. (shrink)

Explains the intersubjective nature of the self and the function of role taking in the development of the personal level of intersubjectivity out of primordial, pre-personal sociality or corporeal intersubjectivity of the lived body. Pragmatic philosophy of George Herbert Mead; Existential-phenomenology of Maurice Merleau-Ponty; Fundamental and pervasive rapport; More.

IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

With growth in the quantity of business ethics journals in recent years, assessments of journal quality are helpful to ethics researchers and administrators, as researchers consider available publication venues, and administrators consider the value of faculty research. The few published evaluations of business ethics journals have predominantly utilized two methods of journal quality determination: citation analysis and surveys of active researchers. This study employs a novel method to assess business ethics journals: 83 Association to Advance Collegiate Schools of Business business (...) schools provided their internally developed journal lists that were used to evaluate faculty research, and the submitted lists were then analyzed for the presence and assessment of business ethics journals. This analysis yielded a ranking of 24 business-ethics-centric journals, and this ranking reflects the collective judgments of AACSB business school faculties. The results of this study are pragmatic in that the journal evaluation data employed metrics actually used by business schools to determine the quality of business ethics journals. These findings also provide additional impetus for the recognition of business ethics as a distinct business discipline and business ethics research as a unique field of scholarly endeavor. While studies of business ethics may be influential when they are published in non-BEC journals, such studies may be more powerfully impactful when published in BEC journals. (shrink)

Uses epistemic logic to clarify a number of possible interpretations of the principle, 'if you know you can't be wrong' and the deceptively similar principle 'if you may be wrong you don't know.' shows that on all plausible interpretation sceptical arguments beg the question at issue.