In the United States, physicians are Increasingly functioning In the consultative role. This change in role Is undoubtedly a result of a surge in the numbers of specialists, the relative decreasing number of primary care physicians, and the emergence of tertiary care centers as primary treatment providers. This change In the style of practicing medicine has led to role confusion In attending physician-patient-consultant relationships.

Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4-15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The audiotaped interviews (...) were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent-child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making. (shrink)

To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original research articles while (12) (...) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues. (shrink)

How are the demands of morality related to the needs, interests, and projects of people? Are they a burden, or are they good for us? Are they nothing but arbitrary impositions, or should we expect them to be justified? And will the answers to these questions tell us why and whether we should be moral? In this short, accessible text, William Nelson poses these questions in a form appropriate for beginning students and treats them in a way that (...) both they and their teachers will appreciate. In the company of major figures from the history of ethics, Nelson explores the key issues surrounding topics like egoism, altruism, the good life, and the requirements of morality. A special strength of his presentation is the way he demonstrates how the views of these historical figures prefigure the theories espoused by different schools of contemporary thought. Students get not only the historical positions in terms of which contemporary debates are framed but also up-to-date discussions of utilitarianism, contractualism, problems of collective action, and the relations between virtue and duty-based theories. Nelson's own view that morality is not a single subject matter enables him to show how each of the historical traditions has a role to play in a coherent and defensible pluralistic account of morality. At the core of this pluralism is a commitment to the democratic view that morality must not merely serve practical human purposes, but it must also be justified to the people it governs. Imaginative and insightful, intelligent and informed, this is an excellent first text for students of ethics and the history of ethics. (shrink)

In this manuscript, the author demonstrates how a new idea of the future came into being in eighteenth-century France with the development of modern biological, economic, and social engineering. With the emergence of these practices, the future transformed from something that was largely believed to be predetermined and beyond significant human intervention into something that could be significantly affected through actions in the present. Focusing on the second-half of the century, The author argues that specific mechanisms for constructing the future (...) first arose through the development of practices and instruments aimed at countering degeneration. In their attempts to regenerate a healthy natural state, Enlightenment philosophes created the means to exceed previously recognized limits and create a future that was not merely a recuperation of the past, but was fundamentally different from it. The new active orientation to the future that emerged from these practices was not something that was explicitly articulated during the Enlightenment. Instead this practical orientation must be seen as an implicit understanding of historical temporality. Historical actors often had a tacit knowledge of time--one that they worked with--without necessarily being fully aware of it or articulating it explicitly in their writing. The full articulation of the new idea of the future did not occur until the French Revolution, but the practical understanding of it that developed during the Enlightenment played an important role in making possible the French revolutionaries' unprecedented attempts to remake the world completely anew. (shrink)

Utilitarianism is subject to objections of at least three kinds: It is wrong about the nature of the fundamental property in virtue of which wrong acts are wrong. It is self-defeating in the sense that acting as it requires will actually undermine the goal of maximization. The acts it requires are, intuitively, wrong. In the book under review, Bailey replies to objections of all three kinds, but especially to the third.

This paper addresses two questions. First, how different is the ideal underlying deliberative democracy from the ideal expressed in contemporary liberal theory, especially contractualist theory and "political liberalism"? Second, what specific institutional prescriptions, if any, follow from deliberative democracy? It is argued that the deliberative ideal has become quite abstract and, in fact, does not differ significantly from many forms of contemporary liberalism. Moreover, it is something of an open question just what institutions best realize this ideal. Specifically, the ideal (...) does not necessarily require conventional, majoritarian institutions. (shrink)

The prelims comprise: Theories of Justice Political Liberalism and its Critics Notes Bibliography.

Whether one should accept a principle like DDE cannot be settled independent of one's more general moral theory. In this, I take it, I agree with Professor Boyle, though I do not think he has shown that DDE has a role only in his particular form of absolutism. Still, since his theory does require DDE, an important question is what the alternatives are – whether we must choose between this absolutism and either utilitarianism or intuitionism. A form of contractualism, the (...) requirements of which derive to a large extent from institutionally or conventionally established rights, is sketched here as an attractive alternative. It does not lead, so far as I can see, to DDE. Keywords: authority, contractualism, rights CiteULike Connotea Del.icio.us What's this? (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

Appellate Court Modifications Extraction consists of, given an Appellate Court decision, identifying the proposed modifications by the upper Court of the lower Court judge’s decision. In this work, we propose a system to extract Appellate Court Modifications for Portuguese. Information extraction for legal texts has been previously addressed using different techniques and for several languages. Our proposal differs from previous work in two ways: our corpus is composed of Brazilian Appellate Court decisions, in which we look for a set of (...) modifications provided by the Court; and to automatically extract the modifications, we use a traditional Machine Learning approach and a Deep Learning approach, both as alternative solutions and as a combined solution. We tackle the Appellate Court Modifications Extraction task, experimenting with a wide variety of methods. In order to train and evaluate the system, we have built the KauaneJunior corpus, using public data disclosed by the Appellate State Court of Rio de Janeiro jurisprudence database. Our best method, which is a Bidirectional Long Short-Term Memory network combined with Conditional Random Fields, obtained an \ score of 94.79%. (shrink)

The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of ‘rural hospital’ and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined by (...) the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals’ community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural–urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant. (shrink)

This paper is concerned with the normative content of Kant's formula of humanity (FH). More specifically, does FH, as some seem to think, imply the specific and rigid prescriptions in 'standard' deontological theories? To this latter question, I argue, the answer is 'no'. I propose reading FH largely through the formula of autonomy and the formula of the kingdom of ends, where I understand FA to describe the nature of the capacity of humanity-a capacity for self-governance. The latter, I suggest, (...) is akin to the capacity for planning and intentional action described in Michael Bratman's work. A significant part of what FH requires, I then propose, is that we exercise these capacities for planning in such a way that we accommodate and coordinate with the (permissible) plans and intentions of others. Kant himself, as do many commentators, emphasizes the idea that our human capacities give us a distinctive kind of value. On my interpretation, by contrast, what is fundamentally important is not the value of the capacities but rather what they make possible: distinctive ways of mistreating (using) persons, but also a distinctive kind of morally desirable relationship. CiteULike Connotea Del.icio.us What's this? (shrink)

Abstract:The mission and value statements of healthcare organizations serve as the foundational philosophy that informs all aspects of the organization. The ultimate goal is seamless alignment of values to mission in a way that colors the overall life and culture of the organization. However, full alignment between healthcare organizational values and mission in a fashion that influences the daily life and culture of healthcare organizations does not always occur. Grounded in the belief that a lack of organizational alignment to explicit (...) organizational mission and value statements often stems from the failure to develop processes that enable realization of the leadership’s good intentions, the authors propose an organizational ethics dashboard to empower leaders of healthcare organizations to assess the adequacy of systems in place to support alignment with the stated ethical mission. (shrink)

I will give a broad overview of what has become the standard paradigm in cosmology. I will describe the relational notion of time that is often used in cosmological calculations and discuss how the local nature of Einstein's equations allows us to translate this notion into statements about `initial' data. Classically this relates our local definition of time to a quasi-local region of a particular spatial slice, however incorporating quantum theory comes at the expense of losing this locality entirely. This (...) occurs due to the presence of two, apparently distinct, issues: Seemingly classical issues to do with the infinite spatial volume of the universe and Quantum field theory issues, which revolve around trying to apply renormalization in cosmology. Following the ‘cosmological principle’ - an extension of the ‘Copernicus principle’ - that physics at every point in our universe should look the same, we are lead to the modern view of cosmology. This procedure is reasonably well understood for an exactly homogeneous universe, however the inclusions of small perturbations over this homogeneity leads to many interpretational/ conceptual difficulties. For example, in an infinite universe perturbations can be arbitrarily close to homogeneous. To any observer, such a perturbation would appear to be a simple rescaling of the homogenous background and hence, physically, would not be considered an inhomogeneous perturbation at all. However, any attempt to choose the physically relevant scale at which perturbations should be considered homogeneous will break the cosmological principle i.e. it will make the resulting physics observer dependent. It amounts to `putting the perturbations in a box' and a delicate practical issue is that the universe is not static, hence the scale of the box will be time dependent. Thus what appears ‘physically homogeneous’ to an observer at one time will not appear so at another. This issue is brought to the forefront by considering the canonical version of the theory. The phase space formulation of General Relativity, just as for any other theory, contains the shadow of the underlying quantum theory. This means that, although the formulation is still classical, many of the subtleties that are present in the quantum theory are already apparent. In the cosmological context the infinite spatial volume renders almost all expressions formal or ill-defined. In order to proceed, we must restrict our attention to a cosmology that has some finite spatial extent, on which our relational notion of time is everywhere definable. In particular, this would constrain the permissible data outside our `observable universe'. This difficulty is an IR or large scale issues in cosmology, however in addition there are UV or short scale problems that need to be tackled. There are the usual problems of renormalization, which are further complicated by the fact that the universe is not static. In the cosmological setting this leads to new IR problems which again prevent one from taking the spatial extent of the universe to infinity. The physical relevance of this problem, the consequence for defining a time variable, and the distinction of homogeneous and inhomogeneous IR issues will be discussed. (shrink)

An epistemic theory of democracy, I assume, is meant to provide on answer to the question of why democracy is desirable. It does so by trying to show how the democratic process can have epistemic value. I begin by describing a couple of examples of epistemic theories in the literature and bringing out what they presuppose. I then examine a particular type of theory, worked out most thoroughly by Joshua Cohen, which seems to imply that democracy has epistemic value. The (...) key idea in this theory is that its conception of political right is itself a democratic conception – roughly, what is right is constituted by a consensus among ideal democratic agents. If democratic procedures are modeled on this conception of right, the theory proposes, the fact that we follow these procedures in decision-making will give us reason to believe that the outcomes are themselves right. I do not reject the democratic conception of the right, but I argue that the theory breaks down when we try to extend its conclusions to real-world democratic procedures. While it invites interesting speculation about possible reforms, it gives us little reason to accept the outcomes of actual democratic politics. (shrink)

The rural health context in the United States presents unique ethical challenges to its approximately 60 million residents, who represent about one quarter of the overall population and are distributed over three-quarters of the country’s land mass. The rural context is not only identified by the small population density and distance to an urban setting but also by a combination of social, religious, geographical, and cultural factors. Living in a rural setting fosters a sense of shared values and beliefs, a (...) strong work ethic, self-reliance, and a tendency for close-knit extended social structures where overlapping relationships are commonplace. (shrink)

The ethical standard for informed consent is fostered within a shared decision-making process. SDM has become a recognized and needed approach in health care decision-making. Based on an ethical foundation, the approach fosters the active engagement of patients, where the clinician presents evidence-based treatment information and options and openly elicits the patient’s values and preferences. The SDM process is affected by the context in which the information exchange occurs. Rural settings are one context that impacts the delivery of health care (...) and SDM. Rural health care is significantly influenced by economic, geographical and social characteristics. Several specific distinctive features influence rural health care decision-making—poverty, access to health care, isolation, over-lapping relationships, and a shared culture. The rural context creates challenges as well as fosters opportunities for the application of SDM as a natural dynamic within the rural provider–patient relationship. To fulfill the ethical requirements of informed consent through SDM, it is necessary to understand its inherent challenges and opportunities. Therefore, rural clinicians and ethicists need to be cognizant of the impact of the rural setting on SDM and use the insights as an opportunity to achieve SDM. (shrink)

Since children are considered incapable ofgiving informed consent to participate inresearch, regulations require that bothparental permission and the assent of thepotential child subject be obtained. Assent andpermission are uniquely bound together, eachserving a different purpose. Parentalpermission protects the child from assumingunreasonable risks. Assent demonstrates respectfor the child and his developing autonomy. Inorder to give meaningful assent, the child mustunderstand that procedures will be performed,voluntarily choose to undergo the procedures,and communicate this choice. Understanding theelements of informed consent has been theparadigm for (...) assessing capacity to give assent.This method leaves the youngest, leastcognitively mature children vulnerable towaiver of assent and forced researchparticipation. Voluntariness can also becompromised by the influence of authorityfigures who can exert undue influence andcoerce children to participate in research. This paper discusses factors that may influencethe decision to give assent/permission,potential parent-child conflict in theassent/permission process and how it isresolved, and potential parental undueinfluence on research participation. Theseissues are illustrated with quotations drawnfrom a larger qualitative study of parentalpermission and child assent (data notpresented). We suggest a developmentalapproach, viewing assent as a continuum rangingfrom mere affirmation in the youngest childrento the equivalent of the informed consentprocess in the mature adolescent. (shrink)