Psychotherapy holds out the promise of help for people who are hurting and in need. It can save lives and change lives. In therapy, clients can find their strengths and sense of hope. They can change course toward a more meaningful and healthy life. They can confront loss, tragedy, hopelessness, and the end of life in ways that do not leave them numb or paralyzed. They can discover what brings them joy and what sustains them through hard times. They can (...) begin to trust, or to trust more wisely. They can learn new behaviors in therapy and how to teach themselves new behaviors after therapy ends. They can question what they always believed was a given. They can find out what matters most to them, and how to stop wasting time. They can become happier, or at least less miserable. They can become better able, as Freud noted, to love and to work. They can learn how to accept and love themselves just as they are and accept others who are different from them. Our ethics acknowledge and affirm our profession's responsibilities. This book was written to help strengthen, deepen, and inform ethical awareness and the sense of personal ethical responsibility. Its job is to help you hold onto the ideals-including ethical ideals-that called you into the profession to begin with, to help you develop and fulfill those ideals. There will be so much-trust us on this-that tends to dull ethical awareness, to make ethics drift out of focus, to create barriers between you and your ideals, to replace ethics with pseudo-ethics and ethics placebos. Fatigue, endless paperwork, unrealistic expectations, illness, family crises, not being able to make ends meet, burn out, threats of job loss, insurance coverage that doesn't come close to meeting the needs of our clients, biases that have not been addressed, and so many other forces can pressure us into cutting ethical corners. This book is intended to help you develop a strong and healthy resistance to such forces, to help you weather them without losing your ethical awareness and ideals. (shrink)

This issue’s “Legal Briefing” column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States.Healthcare providers’ own moral beliefs have been obstructing and are expected (...) to increasingly obstruct patients’ access to medical services. For example, some providers, on ethical or moral grounds, have denied: (1) sterilization procedures to pregnant patients, (2) pain medications in end-of-life situations, and (3) information about emergency contraception to rape victims. On the other hand, many healthcare providers have been forced to provide medical treatment that is inconsistent with their moral beliefs.There are two fundamental types of conscientious objection laws. First, there are laws that permit healthcare workers to refuse providing — on ethical, moral, or religious grounds — healthcare services that they might otherwise have a legal or employer-mandated obligation to provide. Second, there are laws directed at forcing healthcare workers to provide services to which they might have ethical, moral, or religious objections. Both types of laws are rarely comprehensive, but instead target: (1) certain types of healthcare providers, (2) specific categories of healthcare services, (3) specific patient circumstances, and (4) certain conditions under which a right or obligation is triggered. For the sake of clarity, I have grouped recent legal developments concerning conscientious refusal into eight categories: 1. Abortion: right to refuse2. Abortion: duty to provide3. Contraception: right to refuse4. Contraception: duty to provide5. Sterilization: right to refuse6. Fertility, HIV, vaccines, counseling7. End-of-life measures: right to refuse8. Comprehensive laws: right to refuse. (shrink)

The overwhelming weight of legal authority in the USA and Canada holds that consent is not required for brain death testing. The situation in England and Wales is similar but different. While clinicians in England and Wales may have a prima facie duty to obtain consent, lack of consent has not barred testing. In three recent cases where consent for brain death testing was formally presented to the court, lack of consent was not determinative, and in one case the court (...) questioned whether the clinicians were even required to seek consent from the parents of a child at all. (shrink)

The following represents excerpts from a transcription of the informal discussion that ensued after Stephen Pope and Philip Hefner delivered the preceding papers at the annual meeting of the American Association for the Advancement of Science in Washington, D.C., 20 February 2000. These excerpts are presented with a minimum of editing, to preserve the extemporaneous, informal, oral character of the conversation. The excerpts end with a fragmentary comment by E. O. Wilson, conveying the spirit of the actual conversation, which was (...) halted when the allotted time had elapsed and the sense of the group was that areas had been opened up for further conversation that could not be continued at this meeting. (shrink)

Creativity: Theory, History, Practice offers important new perspectives on creativity in the light of contemporary critical theory and cultural history. Innovative in approach as well as argument, the book crosses disciplinary boundaries and builds new bridges between the critical and the creative. It is organized in four parts: · Why creativity now? offers much-needed alternatives to both the Romantic stereotype of the creator as individual genius and the tendency of the modern creative industries to treat everything as a commodity. · (...) Defining creativity, creating definitions traces the changing meaning of "create" from religious ideas of divine creation from nothing to advertising notions of concept creation. It also examines the complex history and extraordinary versatility of terms such as imagination, invention, inspiration and originality. · Creation as myth, story, metaphor begins with modern re-telling of early African, American and Australian creation myths and -picking up Biblical and evolutionary accounts along the way - works round to scientific visions of the Big Bang, bubble universes and cosmic soup. · Creative practices, cultural processes is a critical anthology of materials, chosen to promote fresh thinking about everything from changing constructions of "literature" and "design" to artificial intelligence and genetic engineering. Rob Pope takes significant steps forward in the process of rethinking a vexed yet vital concept, all the while encouraging and equipping readers to continue the process in their own creative or "re-creative" ways. Creativity: Theory, History, Practice is invaluable for anyone with a live interest in exploring what creativity has been, is currently, and yet may be. (shrink)

Ariane Lewis offers a comprehensive and expert review of ethical issues raised by brain death in the United Kingdom and how they compare to management of those issues in the United States (Lewis 20...

Your Eminences,Dear Brother Bishops and Priests,Dear Brothers and Sisters,Good morning and welcome. I greet Cardinal Farrell and I thank him for his words of introduction. My greeting also goes to all taking part in this international Conference, “Yes to Life! Taking Care of the Precious Gift of Life in its Frailty,” organized by the Dicastery for Laity, Family and Life, and by the Foundation Il Cuore in una Goccia, one of the groups that work daily in our world to welcome (...) children born in conditions of extreme frailty. These are children that the throw-away culture sometimes describes as being “unfit for life,” and thus condemned to death.No human being can ever be unfit for life, whether due to age, state of... (shrink)

The determination of death by neurological criteria—“brain death”—has long been legally established as death in all U.S. jurisdictions. Moreover, the consequences of determining brain death have been clear. Except for organ donation and in a few rare and narrow cases, clinicians withdraw physiological support shortly after determining brain death. Until recently, there has been almost zero action in U.S. legislatures, courts, or agencies either to eliminate or to change the legal status of brain death. Despite ongoing academic debates, the law (...) concerning brain death has remained stable for decades. However, since the Jahi McMath case in 2013, this legal certainty has been increasingly challenged. Over the past five years, more families have been emboldened to translate their concerns into legal claims challenging traditional brain death rules. While novel, these claims are not frivolous. Therefore, it is important to understand them so that we can address them most effectively. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving futile or non-beneficial medical treatment. This topic has been the subject of recent articles in JCE. Indeed, it was the subject of a “Legal Briefing” in fall 2009. Accordingly, this column focuses on legal developments from the past two years. These developments are usefully grouped into the following 11 categories: 1. Texas Advance Directives Act2. Ontario Consent and Capacity Board3. Surrogate selection4. Ex post cases for damages5. Ex ante cases for (...) injunctions6. Coercion and duress7. Assent and transparency8. Brain-death cases9. Criminal and administrative sanctions10. Conscientious objection11. Penalties for providing futile treatment. (shrink)

The following note proposes a simple solution for an insufficiently considered difficulty in the much-debated dialogue between Mary and Joseph, the seventh of the extant lyrical divisions of the Old English Advent . In what follows I am assuming that the usual assignment of speeches, first set forth by Thorpe in the editio princeps of the Exeter Book, and accepted in all major editions up to and including that of Campbell, is to be preferred to the various alternatives that have (...) been proposed, notably the radically different assignment by Cosijn that has been tentatively adopted and defended by Robert B. Burlin. (shrink)

The purpose of this study is to investigate whether the availability of financial bounties and anonymous reporting channels impact individuals’ general reporting intentions of questionable acts and whether the availability of financial bounties will prompt people to reveal their identities. The recent passage of the Dodd–Frank Wall Street Reform and Consumer Protection Act of 2010 creates a financial bounty for whistle-blowers. In addition, SOX requires companies to provide employees with an anonymous reporting channel option. It is unclear of the effect (...) of these provisions as they relate to whistle-blowing. Our results indicate that a financial bounty has the potential to increase participants’ propensity to report questionable acts and their willingness to reveal their identities when reporting, but the availability of an anonymous reporting channel does not affect participants’ propensity to report questionable acts. These findings could potentially help corporate management, government policy makers and accounting researchers to assess the effectiveness of their internal compliance programs and help determine if financial bounties in the private sector could encourage whistle-blowing. (shrink)

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

This article outlines current safe harbors in the law for healthcare practitioners who work in a disaster setting. It reviews available legal protection in crisis situations with respect to the Emergency Medical Treatment and Labor Act (EMTALA), criminal liability, and licensure.

Bester offers powerful arguments for why the harm principle cannot replace the best interest standard (BIS) as a guide for, and limit on, surrogate healthcare decision making (Bester 2018). Since B...

In this issue of JCE, Douglas Diekema argues that the best interest standard (BIS) has been misemployed to serve two materially different functions. On the one hand, clinicians and parents use the BIS to recommend and to make treatment decisions on behalf of children. On the other hand, clinicians and state authorities use the BIS to determine when the government should interfere with parental decision-making authority. Diekema concedes that the BIS is appropriately used to “guide” parents in making medical treatment (...) decisions for their children. But he argues that the BIS is inappropriately used as a “limiting” standard to determine when to override those decisions. Specifically, Diekema contends that the BIS “does not represent the best means for determining when one must turn to the state to limit parental action.” He argues that this limiting function should be served by the harm principle instead of by the BIS.I contend that we should not reassign the BIS’s limiting function to the harm principle. In this article I make two arguments to support my position. First, the BIS has effectively served, and can serve, both guiding and limiting functions. Second, the harm principle would be an inadequate substitute. It cannot serve the limiting function as well as the more robust BIS. (shrink)

Considerable evidence shows that people with limited english proficiency (LEP) are at increased risk of experiencing lower quality and disparate care. Chipman and colleagues rightly call on policym...

Pullman argues that when it comes to medical aid in dying (MAID), “Canada … has much to learn from California” (Pullman 2023). Canada and California have similar populations: each about 40 million...

Growth in CSR-washing claims in recent decades has been dramatic in numerous academic and activist contexts. The discourse, however, has been fragmented, and still lacks an integrated framework of the conditions necessary for successful CSR-washing. Theorizing successful CSR-washing as the joint occurrence of five conditions, this paper undertakes a literature review of the empirical evidence for and against each condition. The literature review finds that many of the conditions are either highly contingent, rendering CSR-washing as a complex and fragile outcome. (...) This finding runs counter to the dominant perception in the general public, among activists, and among a vocal contingent of academics that successful CSR-washing is rampant. (shrink)

Like the authors of some of the other responses to Schneiderman, Jecker, and Jonsen, I too was one of the group that produced “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Futile and Potentially Inappropriate Treatments in Intensive Care Units”. Furthermore, ethical and legal issues surrounding futile and potentially inappropriate medical treatment have been a primary focus of my scholarship for more than a decade. Schneiderman, Jecker, and Jonsen offer a strong critique of the Multiorganization Statement, but they do (...) not describe it with sufficient precision. There are points of true normative disagreement between the... (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the “single greatest category of problems” encountered in bioethics consultation. Moreover, the scope of the problem continues (...) to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia.Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. “Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform.” Most providers are “muddling through on an ad hoc basis.” Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two define the problem of medical decision making for the unbefriended. The remaining 12 categories describe different solutions to the problem. The first six of these solutions are discussed in this article (Part 1). The last eight solutions will be covered in the Summer 2012 issue of JCE (Part 2). 1. Who are the unbefriended?2. Risks and problems of the unbefriended3. Prevention: advance care planning, diligent searching, and careful capacity assessment4. Decision-making mechanisms and standards5. Emergency exception to informed consent6. Expanded default surrogate lists: close friends7. Private guardians8. Volunteer guardians9. Public guardians10. Temporary and emergency guardians11. Attending physicians12. Other clinicians, individuals, and entities13. Institutional committees14. External committees. (shrink)

The comprehensive guide to ethics "An excellent blend of case law, research evidence, down-to-earth principles, and practical examples from two authors with outstanding expertise. Promotes valuable understanding through case illustrations, self-directed exercises, and thoughtful discussion of such issues as cultural diversity."--Dick Suinn, president-elect 1998, American Psychological Association "The scenarios and accompanying questions will prove especially helpful to those who offer courses and workshops concerned with ethics in psychology."--Charles D. Spielberger, former president, American Psychological Association; distinguished research professor of psychology, University (...) of South Florida The authors draw on their professional experience, empirical studies, and case examples to examine the ethical responsibilities that confront psychotherapists and counselors in their day-to-day practice. They offer insights into contending with the sometimes competing demands of clients' needs, formal ethical principles, personal values, and evolving legal standards in a range of areas--including fees, informed consent, sexual concerns, confidentiality, documentation, and supervision. (shrink)

This issue’s “Legal Briefing” column continues coverage of recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the “single greatest category of problems” encountered in bioethics consultation. Moreover, the scope of the (...) problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia.Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. “Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform.” Most providers are “muddling through on an ad hoc basis.” Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two categories define the problem of medical decision making for the unbefriended. The remaining 12 describe different solutions to the problem. The first six categories were covered in Part 1 of this article; the last eight categories are covered in this issue (Part 2). 1. Who are the unbefriended?2. Risks and problems of the unbefriended3. Prevention: advance care planning, diligent searching, and careful capacity assessment4. Decision-making mechanisms and standards5. Emergency exception to informed consent6. Expanded default surrogate lists: close friends7. Private guardians8. Volunteer guardians9. Public guardians10. Temporary and emergency guardians11. Attending physicians12. Other clinicians, individuals, and entities13. Institutional committees14. External committees. (shrink)

Volume 19, Issue 5, May 2019, Page 27-28.