Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of the CE (...) chart note. The implementation of the “meaningful use” criteria for EHR, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, requires that health professionals meet certain standards for quality, efficiency, and safety, all of which overlap with the goals of standardization, peer review, and quality improvement within CE consultation. (shrink)

Obesity is the definitive epidemic of the modern era in the United States. Its well-documented public health impacts, especially related to children and adolescents, are horrific. Nearly one-third of American minors are overweight; over 50% of them are obese. Already, these kids suffer from multiple adverse physical and mental health conditions. Sadly, absent serious communal and individual interventions, their lives may be cut short compared to their own parents’ life expectancy. While recent surveillance suggests childhood obesity may be trending down (...) slightly in some populations, public health experts remain concerned about the threat obesity poses to the health of America's youth.The concurrent travesty underlying childhood obesity is the relative societal failure to slow and reverse its spread. (shrink)

Participatory and collaborative approaches in sustainability science and public health research contribute to co-producing evidence that can support interventions by involving diverse societal actors that range from individual citizens to entire communities. However, existing philosophical accounts of evidence are not adequate to deal with the kind of evidence generated and used in such approaches. In this paper, we present an account of evidence as clues for action through participatory and collaborative research inspired by philosopher Susan Haack’s theory of evidence. (...) Differently from most accounts of evidence for use in policies and interventions, our account combines action-oriented (the how) and actors-oriented (the who) considerations. We build on Haack’s theory and on the analysis of examples of participatory and collaborative research in sustainability science and public health research to flesh out six procedural criteria for the generation and mobilization of evidence in and from participatory research. Action-oriented criteria invite to look at evidence from a (a) foundherentist, (b) gradational and (c) quasi-holistic perspective. Actors-oriented criteria point out that evidence generation and utilization are (d) social, (e) personal, and (f) embedded. We suggest that these criteria may reinforce participatory and collaborative approaches to evidence co-production when addressing complex problems in sustainability science and public health allowing for the generation of a kind of practical objectivity. (shrink)

For four decades, research on the role and responsibilities of business in society has centered on the business case for corporate social responsibility (CSR) and an increasing number of studies on the corporate social performance (CSP)—corporate financial performance (CFP) link emerged leading to controversial results. Heeding the call for a deeper understanding of the mechanisms linking certain CSR efforts to certain performance outcomes, this study provides a stakeholder-based organizing framework rooted in an extensive review of existing literature on the link (...) between CSP and CFP. In so doing, we aim at guiding research and practice toward less simplistic understandings of the CSP–CFP connection, thus advancing the debate over the consequences of voluntary integrating CSR into business operations and into relationships with stakeholders. By disentangling specific drivers and outcomes of the CSP–CFP link, we underline the importance of setting clear boundaries and specifying levels of analysis to generate comparable results. (shrink)

A Teacher's Manual for this book will be available online at www.temple.edu/tempress.

Introduction: Moral responsibility and Aristotle's concerns -- 1. Moral responsibility and moral character -- 2. Voluntariness, praiseworthiness, and character -- 3. The dialectical inquiry into voluntariness -- 4. Force, compulsion, and the internal origin of action --5. Responsibility for character: its scope and significance --6. Moral agency and the origination of action -- App. I. Varieties of knowledge and ignorance -- App. II. "Up to us" and the internal origin.

The term conceptual simulation refers to a type of everyday reasoning strategy commonly called “what if” reasoning. It has been suggested in a number of contexts that this type of reasoning plays an important role in scientific discovery; however, little direct evidence exists to support this claim. This article proposes that conceptual simulation is likely to be used in situations of informational uncertainty, and may be used to help scientists resolve that uncertainty. We conducted two studies to investigate the relationship (...) between conceptual simulation and informational uncertainty. Study 1 was an in vivo study of expert scientists; the results suggest that scientists do use conceptual simulation in situations of informational uncertainty, and that they use conceptual simulation to make inferences from their data using the analogical reasoning process of alignment by similarity detection. Study 2 experimentally manipulated experts' level of uncertainty and provides further support for the hypothesis that conceptual simulation is more likely to be used in situations of informational uncertainty. Finally, we discuss the relationship between conceptual simulation and other types of reasoning using qualitative mental models. (shrink)

I defend a form of preventive detention through the creation of an offence of ‘being a persistent violent dangerous offender’. This differs from alternative proposals and actual habitual offender laws that impose extra periods of incarceration on offenders after they have completed the sentence for their most recent crime or as a result of a certain number of prior convictions. I, instead, would make ‘being a persistent violent dangerous offender’ an offence itself. Persons to be preventively detained would be tried (...) and convicted of this offence. My approach would then have one significant advantage: provided the elements of being a PVDO could be rendered sufficiently determinate, punishing persons under such an offence would comport with central rule of law values, most importantly legality and fair notice, as well as principles of proportionality in sentencing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to much feminist (...) bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

Whether the mind is thought to be physical or non-physical, philosophers generally agree that there is an intimate connection between the mind and the self. Dualists have always maintained that the person is his mind and that he just happens to have a particular body. There has also been support for this in classical and contemporary literature on personal identity in the discussions of numerous hypothetical cases involving the transfer of “mental contents” from one body to another, often in the (...) form of “brain transplants”. In connection with each case the following question was raised: Does mental continuity guarantee that one will be the same person or is spatio-temporal continuity necessary? Most philosophers have thought that spatio-temporal continuity is not necessary, but that mental continuity is. Finally, very recently there has been much interest in two types of abnormal phenomena—the “split-brain” and multiple personalities—which give indications of there being more than one mental stream associated with a single body and, as a result, philosophers discussing these phenomena have thought that there is good reason to think of there being more than one self involved in such cases. (shrink)

Both bioethics and law have governed human genomics by distinguishing research from clinical practice. Yet the rise of translational genomics now makes this traditional dichotomy inadequate. This paper pioneers a new approach to the ethics of translational genomics. It maps the full range of ethical approaches needed, proposes a “layered” approach to determining the ethics framework for projects combining research and clinical care, and clarifies the key role that return of results can play in advancing translation.

Lingering skepticism about climate change might be due in part to the way climate projections are perceived by members of the public. Variability between scientists’ estimates might give the impression that scientists disagree about the fact of climate change rather than about details concerning the extent or timing. Providing uncertainty estimates might clarify that the variability is due in part to quantifiable uncertainty inherent in the prediction process, thereby increasing people's trust in climate projections. This hypothesis was tested in two (...) experiments. Results suggest that including uncertainty estimates along with climate projections leads to an increase in participants’ trust in the information. Analyses explored the roles of time, place, demographic differences, and initial belief in climate change. Implications are discussed in terms of the potential benefit of adding uncertainty estimates to public climate projections. (shrink)

While parents have traditionally provided proxy consent for minors to participate in research, this has proven inadequate for adolescents who are mentally and emotionally capable of making their own decisions. Research has proven that even young children, and certainly most adolescents, are developmentally prepared to make such decisions for themselves. The author challenges the assumption that both consent and assent are static concepts, and proposes that a sliding scale of competence be created to ascertain the adolescent's comprehension of the proposed (...) research by shifting the burden of proof to those who believe a particular adolescent is unable to provide informed consent. (shrink)

Among the thousands of Hellenistic hemispherical relief bowls found on Delos is a small collection of Athenian bowls, isolated by Alfred Laumonier in the course of his work on the much larger corpus of Ionian bowls. All major decorative types are present, with long‑petal bowls in the majority. The imagery largely matches that of bowls found in Athens, but some new stamps are documented. Many fragments can be attributed to specific workshops. The fragments throw new light on the production process, (...) documenting a previously unsuspected step in that process and offering evidence for the export of molds for the production of “Attic” bowls elsewhere. Although some of the bowls arrived on the island before 167, most were imported later, and the opening of this new market may have had an impact on the development of the Athenian industry. (shrink)

Heroism is apparently nonadaptive in Darwinian terms, so why does it exist at all? Risk-taking and heroic behavior are predominantly male tendencies, and literature and legend reflect this. This study explores the possibility that heroism persists in many human cultures owing to a female preference for risk-prone rather than risk-averse males as sexual partners, and it suggests that such a preference may be exploited as a male mating strategy. It also attempts to quantify the relative influences of altruism and bravery (...) in the evolution of heroism. Our study found that females do prefer risk-prone brave males to risk-averse non-brave males, and that men are aware of this preference. Bravery in a male was shown to be the stronger factor influencing female choice of short-term partners, long-term partners, and male friends, with altruism playing a lesser part in their choice. Altruism was deemed important in long-term relationships and friendships, but for short-term liaisons, non-altruists were preferred to altruists. Heroism may therefore have evolved owing to a female preference for brave, risk-prone males because risk-taking acts as an honest cue for "good genes." Altruism was judged to be a less influential factor in the evolution of heroism than bravery and a demonstrated willingness to take risks. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Can They Do This?” Dealing with Moral Distress after Third–Party Termination of the Doctor–Patient RelationshipSusan McCammonNot so long ago, a storm badly damaged the tertiary care hospital in which I practice surgical oncology. In the aftermath of the storm, the institution determined it was no longer able to provide unreimbursed cancer care, and many of my patients were terminated by a form letter from the hospital. The helplessness and (...) outrage that I experienced when I was first handed one of these letters, crumpled from the damp fist of one of my patients, was immense, and frightening in its unfamiliarity: “Can they do this?” I asked repeatedly, ascending a hierarchy of authority, which was increasingly reticent and then elusive. In short, the answer was “yes.”While this decision was made by the administration, its enactment was delegated to the physicians. Thus, not only were the physicians not involved in the decision to terminate their patients, they shouldered the burden of telling their patients that they would no longer be treated. The reason given—storm devastation—was contradicted by the orderly flow of insured patients in and out of unaffected clinics and hospitals.In those months, when the operating rooms were closed, I took to the road and learned about hospice and palliative care medicine on the ground. I drove from city to smaller city to the devastated countryside, locating my patients and providing all the care that I could with only my hands and mind and heart. I struggled with the limitations of the health care system and worked to rebuild a sustainable infrastructure at my own institution, all while trying to come to terms with bioethicist Haavi Morreim’s (1995) caution that “... it is not the physician who owes the resources at all. He cannot owe what others own and control, because moral obligations can only be assigned to those capable of fulfilling them” (p. 87).In considering my experience of moral distress over this period of time, I have reflected on the different connotations of the word, “practice.” I grappled with the philosophical terms “practice,” “praxis,” and “phronesis,” and I questioned their relevance to the word, as used in my professional life. However, in struggling to understand my moral obligations after the storm, when I was learning to do what I could, even when I couldn’t do what I felt like I should, I reconsidered. The elements of immersion, repetition, particularity, and utility that pervade this language of philosophers and artists turned out to be what preserved my ability [End Page 109] to practice medicine in a space holding only patient and practitioner.Many of the patients that I take care of are very poor. Many more are working but uninsured. This is a result of both their risk factors and the demographics and resources in my geographic catchment area. Their access to care was disrupted after a natural disaster and concerted efforts to reestablish it have not succeeded. Since then, I have learned how to tell people that they will die of cancer because they don’t have enough money. This is not a skill I was taught in medical school. I can talk about death, imminent or not, feared or anticipated. I can talk about unresectable tumors, treatments that have more risk than benefit (or no benefit at all), suffering beyond what has yet been experienced or imagined, helplessness, futility and grief. I could be neither surgeon nor oncologist without some facility with these. But I was unprepared for this move from medical to economic “can’t,” the nexus where an institutional “won’t” becomes a personal “can’t.”I should say here that I was not blind to the expense and technological hype of the American medico–industrial complex or our systematic marginalization of public health or the ever–present cries for health care reform. I understood that I was a steward and that I served both the individual and the society and had at my disposal what I was told were limited resources. These values, however, were only just being incorporated into the training of medical professionals; certainly they played no role in my own education. Morreim’s (1995) conclusion... (shrink)

Kristina Rolin (2002), in her article in Social Epistemology, asks the question, “Is ‘the social’ a feminist insight?” Rolin then goes on to examine this observation further in the context of femin...

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

The revised classic on the professional and legal standards of school psychology This completely updated edition of the leading ethics and law guide provides ...