Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education (...) since the widely used 1982 editions. This update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

Objective Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)—perceived psychological safety, ethical climate, patient safety—and healthcare professionals’ perception of moral distress.Design Cross-sectional surveySetting Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States.Participants Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study.Main outcome (...) measures Three dimensions of OCHC were measured using validated questionnaires: Olson’s Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality’s Patient Safety Culture Survey, and Edmondson’s Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM).Results Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (β= −0.357, p <.001) and patient safety culture (β = −0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (β = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82).Conclusions We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations. (shrink)

Using data on submitted and published manuscripts in Feminist Economics from 1995 to 2019, we examine differences in method and scope used by authors residing in the Global North and Global South. We specifically focus on research methods, intersectional analyses, region of analysis, and co-authorship status. Further, using logistic regression models, we examine the relationship between authors’ location and use of research methods. We find authors in the Global South are more likely to engage in empirical and mixed-methods (...) papers compared to Global North authors in our sample. Moreover, a greater share of Global South authors engage in intersectional analysis and exhibit geographical focus on developing countries. Drawing insights from the Feminist Economics manuscripts data, we argue that encouraging Global South research can contribute to the goals of the field of feminist economics – aimed at inclusivity, diversity of standpoints, and plurality in research methods, thereby improving overall economic research. (shrink)

Background: The Measure of Moral Distress – Healthcare Professionals (MMD-HP) is a 27-item survey that quantifies moral distress. The MMD-HP was distributed to healthcare professionals (HPs), and analysis of a free-text response item revealed information-rich descriptions of morally distressing situations. Research question: What are HPs’ perceptions of their experiences of morally distressing situations? Research design: A descriptive, qualitative approach explored respondents’ free-text responses to the following open-ended response item: “If there are other situations in which you (...) have felt moral distress, please write and score them here.” Participants and research context: Eligible participants were HPs ( N = 8206) working in a large, multi-site healthcare system located in a major, urban city in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information, and consent was presumed with survey completion. Findings: Three themes were identified from 282 free-text responses: Theme 1: Compromised Quality of Care, Theme 2: Hostile Work Environment, and Theme 3: Ineffective Leadership. Conclusions: This study is unique because it provided in-depth qualitative analysis of morally distressing situations in a free-text response item across a wide array of HPs within multiple settings. Responses revealed that moral distress impacted the quality of patient care and provided descriptions of powerlessness to act. (shrink)

More and more women are turning to egg freezing as a strategy for managing conflicting timelines related to professional goals and family formation aspirations. Drawing on critical realism, this article argues that vicious aspects of the reproductive marketplace and the workplace along with cultural ideals of motherhood and the nuclear family incentivize agents to freeze their eggs. While individual egg freezers help contribute to the maintenance of structures and cultures that perpetuate inequalities related to class, race, and gender and hinder (...) the flourishing of all women, ethical analysis should critique the structural and cultural forces that make egg freezing an attractive option for women balancing procreation and professional pursuits. (shrink)

The quality of doctoral-level biochemistry (N=139), botany (N=83), cellular/molecular biology (N=89), microbiology (N=134), physiology (N=101), and zoology (N=70) programs at United States universities was assessed, using 16 measures. These measures focused on variables related to: (1) program size; (2) characteristics of graduates; (3) reputational factors (scholarly quality of faculty, effectiveness of programs in educating research scholars/scientists, improvement in program quality during the last 5 years); (4) university library size; (5) research support; and (6) (...) publication records. Chapter I discusses prior attempts to assess quality in graduate education, development of the study plans, and the selection of disciplines and programs to be evaluated. Chapter II discusses the methodology used, focusing on each of the assessment measures. Chapters III to VIII present, respectively, findings from the analyses of the biochemistry, botany, cellular/molecular biology, microbiology, physiology, and zoology programs. Chapter IX includes a summary of results, correlations among measures, several additional analyses, and suggestions for future studies. Among the findings reported are those indicating that cellular/molecular biology programs had, on the average, the largest number of faculty and that students in cellular/molecular biology, biology, biochemistry, microbiology, and physiology received a relatively high fraction of financial support. (Survey instruments and supporting documentation are included in appendices.) (JN). (shrink)

Given the close relatedness of local issues, water scarcity, and sustainability, this research sought to investigate the factors affecting residents’ willingness to reuse direct and indirect potable water in the arid region. Utilizing the Bayesian Mindsponge Framework (BMF), an analysis was undertaken with a sample of 1,831 water consumers in the City of Albuquerque, the most populous city in New Mexico, United States. The primary analysis revealed positive associations between local concerns about drought or water scarcity and (...) population growth with residents' willingness to reuse direct and indirect potable water. Conversely, concerns about water quality and water bills were found to be negatively associated with the willingness to utilize directly and indirectly recycled water for drinking. In light of these findings, the study explores the potential of fostering an eco-surplus culture by cultivating a sense of environmental responsibility and acknowledging the relationship between local issues and environmental conditions. Simultaneously, the study proposes collaboration between the government and residents to promote water reuse programs to conserve water resources effectively. (shrink)

Background: Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives. Research hypothesis: We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage (...) was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth. Research design: The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable. Participants and research context: A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency. Ethical considerations: The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary. Findings: Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings. Discussion: Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service. Conclusion: Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes. (shrink)

A survey was conducted on the advertising practitioners in Taiwan concerning their experiences of ethical challenges at work. Among 120 respondents, while 32.5 percent responded that ethical problems did not exist, 67.5 percent admitted that ethical problem was a commonplace at work. According to these respondents, the most frequently mentioned ethical problems area representing unethical products or services, the message of advertisements, agency-client relationship, the creditability of research, undertable rebate, and the quality of service. Suggestions for international (...) advertising managers were also provided by comparing the finding from the present study with earlier studies in the United States. However, due to its preliminary nature, the present study should be considered exploratory and descriptive rather than conclusive, with the hope to inspire more research on advertising ethics in Taiwan as well as in other countries in the world. (shrink)

Background: Moral distress is the inability to do the right thing due to institutional constraints. The Measure of Moral Distress – Healthcare Professionals (MMD-HP) measures this phenomenon and has extensively explored moral distress among nurses. There are limited large-scale research studies using the MMD-HP to identify levels of moral distress across multiple healthcare professionals (HPs) and settings. Research question: What are the overall levels of moral distress among HPs? Research design: A quantitative, exploratory, cross-sectional study (...) of HPs in a healthcare system using the MMD-HP. Participants and research context: Eligible participants included HPs ( N = 8,206) working in all inpatient and outpatient units and centers in a multi-site healthcare system located in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information within the learning management system and consent was presumed with survey completion. Findings: A total of 3,561 HPs completed the MMD-HP. The top three morally distressing items included compromised patient care due to inadequate resources, caring for more patients than is safe, and low quality of patient care due to poor team communication. Intensive care unit (ICU) areas had significantly greater moral distress than all other areas ( p < 0.001). Formal leaders had the greatest moral distress ( p < 0.001). Mixed-acuity and medical-surgical HPs accounted for 22.8% of those who reported considering leaving their current position due to moral distress. Nurses represented 42.2% of those considering leaving their current position due to moral distress. Conclusions: This study uniquely identified that formal leaders and HP participants in the ICU setting had the greatest moral distress. Exploring moral distress is imperative for healthcare systems to decrease turnover, improve engagement, and the quality of patient care. (shrink)

Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance—primarily as a quality measure that increases patients’ safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence (...) presented in decision aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient’s decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved. (shrink)

In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide ; nearly 8% of the country's total emissions. The importance of sustainability in health care — as a business reliant on fossil fuels for transportation, energy, and operational functioning — is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care — not (...) the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery. (shrink)

Ellen Fox and collaborators have produced the most detailed description of healthcare ethics practices in the United States available. Some findings are shocking for anyone committed to promoting q...

This article begins with a review of the literature on the ethics of tax evasion and identifies the three main views that have emerged over the centuries, namely always ethical, sometimes ethical, and never or almost never ethical. It then reports on the results of a survey of HK and U.S. university business students who were asked to express their opinions on the 15 statements covering the three main views. The data are then analyzed to determine which of the three (...) viewpoints is dominant among the sample population. Although it was found that HK scores were significantly different from the U.S. scores, both HK and U.S. respondents were opposed to the view that tax evasion is always or almost always ethical. The strongest arguments justifying tax evasion were in cases where the government was corrupt, the tax system was unfair and unaffordable. The weakest arguments for justifying tax evasion were in cases where there was a selfish motive. The underlying cultural differences are further explored in hope of accounting for differing perceptions of ethics of tax evasion. Policy implications for increasing people’s awareness of ethics on tax evasion are also highlighted. (shrink)

During the first years of organized agricultural research in Mexico in the 1940s, two agencies ran separate programs for corn improvement. The Rockefeller Foundation's Office of Special Studies and the Mexican government's Office of Experiment Stations carried out research on corn with distinct aims and methods. That they differed strongly is well established in the literature. Many authors have discussed a Rockefeller Foundation program that reportedly emphasized hybrid corn, a technical choice that embodied a preference for assisting wealthy (...) farmers who could afford hybrid corn and the necessary agricultural inputs. Conversely, these authors attribute to the Mexican program a focus on open-pollinated corn, which presumably manifested its concern for Mexico's small farmers who saved seed. This article argues that the reverse was true. The Rockefeller Foundation program initially was committed to a type of improved open-pollinated corn while the Mexican program proceeded with a strict, U.S.-style hybrid program. I try to illuminate each group's priority on yield, as well as additional significant, and complicating, breeding priorities that precluded any collaboration between the two. (shrink)

Objectives: The corona virus disease-2019 pandemic spread globally, and we aimed to investigate the psychosocial impact on healthcare workers in China during the pandemic.Methods: In this systematic review and meta-analysis, we searched seven electronic databases for cross-sectional studies on psychosocial impact on HWs in relation to COVID-19 from January 1, 2020 to October 7, 2020. We included primary studies involving Chinese HWs during the pandemic, and data were extracted from the published articles. Our primary outcome was prevalence of anxiety, (...) depression, and stress disorders. We pooled prevalence value with their 95% confidence interval using random effect models and assessed study quality on the basis of an 11-item checklist recommended by the Agency for Healthcare Research and Quality. The study protocol was registered in PROSPERO.Results: We identified 25 articles comprising a total of 30,841 completed questionnaires and 22 studies for meta-analysis. The prevalence of anxiety, depression, and stress disorders was 34.4%, 31.1%, and 29.1% for HWs. The pooled prevalence of anxiety disorders for HWs from late January to early February was 46.4%, significantly higher than those in mid-term February and after late February. The pooled prevalence of depression disorders for HWs from late January to early February was 46.5%, significantly higher than those in mid-term February and after late February. HWs working in Hubei Province had a higher prevalence of anxiety and a lower prevalence of depression than those working in other regions. Nurses had a higher prevalence of anxiety and depression than other HWs.Conclusions: About one-third of HWs in China suffered anxiety, depression, and stress at the early epidemic of COVID-19. HWs in Hubei Province, especially nurses, had a higher prevalence of psychological disorders. During the pandemic, a negative psychological state may persist in a proportion of Chinese HWs, fluctuating with the control of the pandemic. The long-term impact should continue to be observed. Attention should be paid to HWs for their psychological impact due to the pandemic.Systematic Review Registration: The study protocol was registered with PROSPERO. (shrink)

In speculating on the motives for government, English philosopher Thomas Hobbes identified the pervasive role of fear and the danger of violent death, holding famously that where no government prevails to secure physical safety and property, there can also be no enduring knowledge, art, or civilization—leaving human lives “solitary, poore [sic], nasty, brutish and short.”.

Erdelyi's account of thought suppression, which he equates with the Freudian construct of repression, is that it is mostly successful, and that it undermines memory for the suppressed material. Erdelyi has neglected to consider evidence from two decades of research on suppression which renders both these claims invalid. Contrary to Erdelyi's thesis, suppression often enhances the accessibility of unwanted material.

In lieu of an abstract, here is a brief excerpt of the content:More Than Words:Communicating for the Quality of CareElaine HsiehMy first experience as a healthcare interpreter was in the summer of 1998. I just completed the first year of a two-year graduate program in one of the top MA programs for conference interpreters—many of the graduates ended up working at the United Nations and international agencies. Many of my classmates chose to work in top business or (...) government agencies for their summer internships. I wanted to do something different. Something that I may never cross paths with again if I miss the opportunity. So, I chose to work as a healthcare interpreter intern at a large healthcare system. The summer internship was supposed to be a refreshing break from the drudgery of rigorous training to be a conference interpreter at an international level.As a graduate student who has received one year of intensive practicum training, I was proud of my "overqualification." At that time and to this day, the norm for most training programs for professional healthcare interpreters is a 40-hour short course (e.g., Bridging the Gap). With my advanced training and language proficiency, I thought this would be a fun, easy detour in my career development. I was excited to work with real people, no longer trapped in the isolating interpreting booths with headphones in conference rooms.Little did I know that the summer internship would change my life and career trajectory. The first big jolt that challenged my confidence as an interpreter was also one of the first assignments I received. I was taking an elderly man to his first physical therapy session. The man had such severe scoliosis that he was essentially looking backward as he walked forward. As we walked into the clinic, a medical resident saw my patient and jumped up in excitement. With a great smile on his face, he exclaimed, "Wow! This is the worst case I have ever seen." I felt startled. I could see that the patient was unsure about the resident's excitement. Normally, I would just go ahead and interpret what the physician said. I would then introduce the patient to the physician, explain my role as an interpreter (e.g., "I will interpret everything you and the patient say so you understand each other"), and proceed to interpret what other speakers said.However, all my training as an interpreter failed me at that moment. It's not because I was unsure about the linguistic equivalences of the resident's comment in Chinese. Rather, I was unsure how to best convey the information in a faithful, neutral, and accurate way without risking the provider-patient relationship and the quality of care. I explained to the physician, "Hi, my name is Elaine, and I am the healthcare interpreter. I am responsible for helping the patient understand what others are saying." Then, I asked, "How would you like me to interpret what you just said? You appeared very excited." The resident was taken aback, paused for a moment, and said, "Please tell him that I'm very happy to meet him." I interpreted that and proceeded to my regular routines.Another memorable moment took place at the end of a long shift near the end of my summer internship. I was already packing up to head home when I received a call to assist a 90-year-old patient who had just been admitted to a mental health ward after a failed suicide attempt a few hours ago. As an interpreter, I was required to interpret everything in the first-person style. For example, instead of saying, "The patient is sad," I say, "I am sad." Whenever possible, I also embody the speaker's nonverbals, including attitudes and emotions, through my interpretation. During the intake, the physician asked, "From 1 to 10, 1 being the least happy day in your life and 10 being the happiest, what number do you feel right now?" With the emptiest stare and the most soulless voice, the patient said, "If I have never experienced happiness in my life, how [End Page 159] do I know which number to give?" Throughout the hour-long session, I spoke in the... (shrink)

Prevention and control of chronic conditions are global healthcare challenges. Patient self-management has been deemed essential for treating chronic conditions and improving the quality of patient life. However, the current Japanese system for supporting patient self-management of chronic conditions has received little ethical assessment. The first aim of this article is to provide an ethical analysis of current Japanese support for self-management of chronic conditions with reference to international discussions concerning self-management, developed mainly in western societies such as (...) Europe, the United States. The second aim is to clarify the challenges faced by Japanese biomedical ethics concerning selfmanagement support by focusing on the ethical concepts of quality of life and autonomy. This article identifies the following two challenges: [1] dispelling conceptual confusion concerning basic ethical concepts such as quality of life and autonomy, and [2] exploring the conceptual relationship between these ethical concepts, as they relate to providing support for chronically ill patients. By addressing these challenges and constructing a theoretical basis for radical change in support mechanisms, bioethics in Japan could contribute to efforts to construct a comprehensive support system for patients with chronic conditions, which organize variety kinds of supports, such as medical professional supports, supports from patient’s groups, local community supports, familial supports, support in patients’ workplace, and supports for patients’ family members as well. (shrink)

This article examines how skilled middle-class Tamil women—an Indian regional group—negotiate with gender to strategize immigration to and settlement in the United States by drawing on life-history interviews with 33 first-generation professional women, most of whom entered the United States as family migrants. I find that the women negotiate with gender to configure Tamil Brahminical relations of subordination, thereby asserting their subjectivity through “strident embedded agency” in immigration. In this way, they realize gender non-normative desires (...) for immigration, engage in gender non-normative actions, and perform normative actions in reconstituted ways. Even as their strident embedded agency facilitates their embodiment of configured Tamil womanhood, it produces Tamil Brahmin relations of subordination. This article delineates the complexity of women’s subjectivities and agency and Tamil women’s agential strategizing of immigration as emergent from their gendered and caste/classed social locations. (shrink)

In the United States 46 million people are uninsured and it is from within this population that many ‘normal, healthy’ research participants are selected. Research institutions and sponsors are not required to compensate or provide free treatment to participants when they incur research-related harm, and most studies do not stipulate the provision of free medical care to treat research-related adverse events. The consequence for uninsured participants is that they must assume these medical costs unless (...) they successfully sue the study sponsor or research institution. This article discusses the matter of healthy volunteers becoming ‘the sick’ as a result of research participation, and proposes guidance for the informed consent process in order to optimize awareness about injury potential and injury compensation. Guidance regarding health screening for these volunteers is also presented. (shrink)

Good communication between healthcare providers and patients is vital to effective healthcare. In order to understand patients’ complaints, make accurate diagnoses, obtain informed consent and explain treatment regimens, clinicians must communicate well with their patients. This can be challenging when treating patients from unfamiliar cultural backgrounds, such as the Deaf. Not only are they a linguistic and cultural minority, they are also members of the world’s largest and oft-forgotten minority group: the disability community. Under Article 25 of the (...) United Nations Convention on the Rights of Persons with Disabilities, persons with disabilities have rights to the same range, quality and standard of free or affordable healthcare and programmes as provided to other people. Yet communication barriers and healthcare providers’ lack of familiarity with Deaf culture can impair the quality and accessibility of healthcare for the Deaf. This essay analyses the scope of this issue in Singapore: a state party to the CRPD which has a vibrant Deaf community, and yet no legislative or constitutional guarantees of the rights of persons with disabilities. In addition to exploring the communication barriers faced by Deaf patients in Singapore, this essay highlights ways in which healthcare providers and the state can support community-based initiatives to overcome these barriers. (shrink)

Fossil fuel divestment movements have gained momentum since 2011, aimed at ending fossil fuel use and a move toward a cleaner, affordable, and sustainable energy system, for business and society. The present study investigates the direct impact of fossil fuel divestment announcements on stock prices of firms listed on the United States' stock exchanges. Using an event study and guided by the United Nation's sustainable development goals (SDGs), we test the effects of 116 divestments announcements between 2014 (...) and 2019 on 51 publicly traded fossil fuel companies. Our results suggest that there is a negative effect of these announcements on fossil fuel firm stock prices. Also, we find that the type of fossil fuel firm (coal or oil and gas), the type of divestment (partial, coal only, or full), the timing of the announcement, and the size of the divesting investor have some explanatory power in relation to the (cumulative) abnormal returns following the divestment announcements. While the negative impact on stock prices is not surprising, the reaction from the divested firms after such large divestitures is not consistent with what may be expected, given past reactions to divestitures seeking to achieve different social goals. Given the SDGs, it seems clear why investors are divesting themselves from fossil fuel firms, but why has the reaction to the 116 divestments led to very little change in the way these publicly traded fossil fuel firms do business given their direct and growing impacts on society? We conclude the study with some suggestions for future research. (shrink)

The objective of this paper is to examine the ‘Code of Ethics Quality’ (CEQ) in the largest companies of Australia, Canada and the United States. For this purpose, a proposed CEQ construct has been applied. It appears from the empirical findings that while Australia, Canada and the United States are extremely similar in their economic and social development, there may well be distinct cultural mores and issues that are forming their business ethics practices. A (...) class='Hi'>research implication derived from the performed research is that the construct provides a selection of observable and measurable elements in the context of CEQ. The construct of CEQ consists of nine measures divided into two dimensions (i.e. staff support and regulation). They should not be seen as a complete list. On the contrary, it is encouraged that others propose and elaborate revisions and extensions. A practical implication of this paper is a structure of what and how to examine the CEQ in a managerial setting. It may assist companies in their efforts to establish, maintain and improve their ethical culture, norms and beliefs within the organization and supporting them in their ethical business practices with different stakeholders in the marketplace and society. The dimensions and measures of the construct may be used as a frame of reference for further research. They may be useful and applicable across contexts and over time using similar samples when it comes to large companies, as small‐ or medium‐sized ones may not have considered all areas nor have the elements in place. This is a research limitation, but it provides an opportunity for further research. (shrink)

The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what (...) procedures must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible. (shrink)

Gene editing techniques, such as CRISPR, are being heralded as powerful new tools for delivering agricultural products and foods with a variety of beneficial traits quickly, easily, and cheaply. Proponents are concerned, however, about whether the public will accept the new technology and that excessive regulatory oversight could limit the technology’s potential. In this paper, we draw on the sociotechnical imaginaries literature to examine how proponents are imagining the potential benefits and risks of gene editing technologies within agriculture. We derive (...) our data from a content analysis of public comments submitted to the Food and Drug Administration’s 2017 docket titled “Genome Editing in New Plant Varieties Used for Food.” Our sample frame consists of 26 comments representing 30 agriculture and biotech companies, organizations, and trade associations. Our findings reveal three key sociotechnical imaginaries, including that gene editing technologies in agriculture: are not GMO but instead equivalent to traditional plant breeding; have the potential to usher in a new Green Revolution; and could facilitate the democratization of agricultural biotechnologies. We argue that forming and projecting these collective interpretations of the potential of gene editing technologies for crops and foods plays an important role in efforts by proponents to influence regulatory oversight, modes of governance, and build public acceptance. This research contributes to calls by science and technology studies scholars to investigate emergent concerns and imaginaries for novel technoscientific advances to help inform upstream models of public engagement and governance decisions. (shrink)

Firearm violence in the United States produces over 36,000 deaths and 74,000 sustained firearm-related injuries yearly. The paper describes the burden of firearm violence with emphasis on the disproportionate burden on children, racial/ethnic minorities, women and the healthcare system. Second, this paper identifies factors that could mitigate the burden of firearm violence by applying a blend of key ethical theories to support population level interventions and recommendations that may restrict individual rights. Such recommendations can further support targeted (...) research to inform and implement interventions, policies and laws related to firearm access and use, in order to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and society-at-large. By incorporating a blended public health ethics to address firearm violence, we propose a balance between societal obligations and individual rights and privileges. (shrink)

Today, health systems around the world are under pressure to create greater value for patients and society [81, p. 1, 119]; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher (...) value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system’s customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery. (shrink)

BackgroundAs the population of the United States ages, chronic diseases increase and treatment options become technologically more complicated. As such, patients’ autonomy, or the right of patients to accept or refuse a medical treatment, may become a more pressing and complicated issue. This autonomy rests upon a patient’s capacity to make a decision. As more older, cognitively and functionally impaired individuals enter healthcare systems, quality assessments of decision-making capacity must be made. These assessments should be done (...) in a time-efficient manner at a patient’s bedside by the patient’s own physician. Thus, a clinically practical tool to assist in decision-making capacity assessments could help guide physicians in making more accurate judgments.ObjectivesTo create a clinically relevant Bedside Capacity Assessment Tool (BCAT) to help physicians make timely and accurate clinical assessments of a patient’s decision-making capacity for a specific decision.SettingThe Department of Medicine, Division of Geriatrics and Palliative Medicine, Zucker School of Medicine at Hofstra/northwell.ParticipantsGeriatric medicine fellows, palliative medicine fellows, and internal medicine residents (n = 30).MeasurementsSubjects used the BCAT to assess the decision-making capacity of patients described in 10 written, clinically complex capacity assessment vignettes. Subjects’ conclusions were compared to those of experts.ResultsThe subjects’ and experts’ assessments of capacity had a 76.1 percent rate of agreement, with a range of 50 percent to 100 percent. With removal of three complex outlier vignettes, the agreement rate reached 83.2 percent.ConclusionThe strong correlation between the two groups—one of physicians in training utilizing the BCAT and the other of specialists in this area—suggests that the BCAT may be a useful adjunct for clinicians who assess decision-making capacity in routine practice. The range indicates that further refinement and testing of this tool is necessary. The potential exists for this tool to improve capacity assessment skills for physicians in clinical practice. (shrink)

Background: Hospitalized children have the right to “partake in practices related to their treatment and care.” Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children. Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes. Methods: This descriptive cross-sectional study included 122 midwives (...) and nurses in total. The data were collected through a questionnaire. Ethical considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted. Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child’s consent about the treatment by looking at the child’s facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child’s consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher. Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children’s rights make a difference in terms of children’s rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs. (shrink)

Education in the responsible conduct of research (RCR) in the United States has evolved over the past decade from targeting trainees to including educational efforts aimed at faculty and staff. In addition RCR education has become more focused as federal agencies have moved to recommend specific content and to mandate education in certain areas. RCR education has therefore become a research-compliance issue necessitating the development of policies and the commitment of resources to develop or expand systems (...) for educating faculty and staff and for assuring compliance. These changes implied the need to develop a program evaluation model that could be applied to institutional RCR education programs, which were expected to differ from traditional academic credit-bearing courses targeting trainees. Information gleaned from the examination of corporate compliance models was analyzed in order to create a program evaluation module that could be used to document and assess educational programs focused on teaching RCR. A programmed series of questions for each of the nine RCR content areas identified by the United States Office of Research Integrity was created based on a performance-monitoring evaluation model. The questions focus on educational goals, resources provided to support the educational efforts, educational content, content delivery, educational outcomes, compliance requirements and feedback. Answers collected in response to the questions could be used to both document and continually improve the quality of RCR educational programs through on-going formative assessment and feedback. (shrink)

Introduction Paul Boshears The following excerpt from Paul Amitai's In Between States: Field notes and speculations on postwar landscapes (2012) confounds its reader. Presenting an alternate history of the State of Israel as a space station orbiting Earth, the excitement of possibilities crackles across the texts and images. Like Chris Marker's La Jeteé , the accompanying static images distort the viewer's temporality: are these archaeological items, images from a past, or a future? Why isn't this our future? In Between (...) States can also be seen as complementing Larissa Sansour's provocative science fiction works, Space Exodus (2009) which "documents" the Palestinian space program, and her Nation Estate (2012), in which Palestine is relocated into a skyscraper. Amitai's vision opens onto an intergalactic diaspora, wherein the refugees of World War II are given the stars as Western Europe continues to fight over terrestial colonies. —PFB Auditorium, Hoechst AG headquarters, Industriepark-Höchst, 2011. In 1941 an investigation by the US Justice Department exposed a marriage cartel between John D. Rockefeller’s Standard Oil (now ExxonMobil) and I.G. Farben. The two corporations had formed a joint operation in 1927 called Standard IG Farben. It was revealed that the two had shared patents in order to control prices and markets in their respective regions. Standard was accused of hiding patents from the US Navy and supplying fuel to German submarines, which lead to charges of criminal conspiracy. The Pentagon intervened, requesting that President Roosevelt stop the investigation in order to protect war production and oil supply. Roosevelt agreed, and the Senate committee investigating the matter, headed by Senator Harry Truman, was halted. Standard Oil paid a fine of $5000 and promised to stop supplying fuel to the enemies. Auditorium, Hoechst AG headquarters, Industriepark-Höchst, 2011. Furious at the decision to terminate the investigation of acts he considered treason, Truman initiated a new inquiry into Standard Oil’s war-time practices after succeeding Roosevelt as president in 1945. With the chief executives of I.G Farben simultaneously on trial at Nuremburg, Truman brokered a deal with the Allies that reduced or withdrew criminal charges leveled against both corporations in exchange for Standard Oil and I.G. Farben’s sponsorship of one of Truman’s most ambitious postwar projects—the relocation of the Jewish people. Detail, Sanofi-Aventis advertisement, 2011. The third critical player in this bold experiment was the nascent North Atlantic Space Agency. Formed by Allied forces using the seized assets and engineering expertise of Hitler’s hitherto classified space program (conquer Earth, then the stars), the North Atlantic Space Agency was a pre-NATO foray into interstellar nation building, with orbital occupation as the first point of order. By 1947, NASA was nearly ready to deploy the first manned space station. Standard Oil and I.G. Farben’s advanced fuel refinement capacities and deep, war-enriched financial resources allowed NASA to speed up their launch schedule significantly. Detail, Sanofi-Aventis advertisement, 2011. Diplomatic efforts to establish a Jewish homeland in Palestine were failing to gain traction, while post-colonial England held its ground on immigration restrictions and bands of Jews and Arabs battled over territory on the ground. More immediate was the issue of temporarily housing Holocaust survivors and refugees across scorched Europe. Leaders of the continental nations demonstrated, at best, reluctance to accommodate the Jews, who in turn were, at the least, resistant to returning to the same bloody cocktail from which they had fled. Truman used the impasse to advance a plan for NASA’s space station to be put to use as a temporary Jewish outpost, an orbital displaced persons camp, to be operated by the US Army. Detail, Infaserv Höchst advertisement, 2011. Final preparations advanced rapidly. Viewing the orbital displaced persons (ODP) camp as a solution to their immigration problem both at home and abroad, England came on board as a willing partner. Spaceship Exodus was positioned for takeoff on German farmland 20 kilometers southwest of Frankfurt. On December 30, 1947, one month after the UN General Assembly voted down the separation plan for Palestine, Exodus rocketed into the atmosphere hauling the first module of barracks designed to house 1,500 refugees. Transport vehicles arrived shortly thereafter, loaded down with leftover wartime military rations and 3,000 Jews of Russian and Polish origin. Detail, Infaserv Höchst advertisement, 2011. "The camp is the space that is opened when the state of exception begins to become the rule."—Giorgio Agamben, Homo Sacer , trans. Daniel Heller-Roazen, (Stanford: Stanford University Press, 1995), 96. Detail, Infaserv Höchst advertisement, 2011. The ODP camp proved to be a longer-term solution than originally envisioned. Additional installations were positioned to form swollen clusters of interlocking units – sleeping quarters, schools, clinics, canteens. The UN was brought in to monitor the camp following two chaotic years of US Army control in which food shortages, pandemic diseases, and rampant black market trade had brought the camp to near total collapse. No less bureaucratic or ineffectual, the UN relief agency at least had prior experience facilitating contexts of a similar magnitude and could potentially predict outcomes. Detail, Infaserv Höchst advertisement, 2011. What had been unexpected was the degree to which the camp would evolve into its own self-regulated, hive-like ecosystem where previously accepted rules of conduct were not applicable. The ODP camp was an exceptional space, a riverboat casino, an offshore research lab of social experimentation and entrepreneurial innovation. No longer Earth-bound, touching soil knotted by prescripts of Talmudic law, the camp residents were able to rationalize loopholes and detonate barriers standing in the way of absolute production. The Jewish archipelago was renamed Israel after the ancient homeland. If the temple couldn’t be rebuilt in the motherland, a post-national rhizome would sprout up in its stead. Eyes everywhere, beyond all borders. More information on the project at the author's site. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Walking the Bodhisattva Path/Walking the Christ PathU.S. Conference of Catholic BishopsCatholics and Buddhists brought together by Dharma Realm Buddhist Association, the San Francisco Zen Center, and the United States Conference of Catholic Bishops (USCCB) met 20-23 March 2003 in the first of an anticipated series of four annual dialogues. Abbot Heng Lyu, the monks and nuns, and members of the Dharma Realm Buddhist Association hosted the dialogue (...) at the City of Ten Thousand Buddhas in Talmage, California. The community had transformed their Confucius Hall into a chapel, with a large, newly constructed wooden cross on a wall above an altar facing out from a raised platform, so the Catholic delegation would have a space for worship. A special poster announcing the theme of the conference, "Walking the Bodhisattva Path/Walking the Christ Path," showing a Buddhist dharma wheel at one foot of a bridge and a Celtic cross at the other foot, had been created by the hosting community.The daily schedule for the dialogue did not interfere with the monastic routine at the City of Ten Thousand Buddhas, which included early morning chanting (4:00-5:00 am), daily rituals in the Buddha Hall, and the single large meal for monastics before noon to which all participants were invited. Catholics and Buddhists meeting in the dialogue began each day with an optional forty-five minutes of quiet sitting together in the monastery meditation hall, each following their own form of meditation and prayer. There was a Eucharist on Friday and Saturday evenings for the Catholics and to which the Buddhists were invited, and additional meals of breakfast and supper throughout the meeting at the City's Jyun Kang Restaurant.Fourteen Buddhists and fourteen Catholics participated in the formal discussions. Each participant spoke on what it means to them to follow Christ or the way of the Bodhisattvas or enlightened beings. In addition to speaking, each participant distributed a short passage, usually from a traditional text, on this topic. Several passages from Master Dogen's Shobogenzo and the Gospel of John were among those shared by the group. Other passages shared were taken from the Avatamsaka Sutra and the Shurangama Sutra and from the other gospels and the writings of Zen master HakuinZenji, the Dalai Lama, Korean Zen Master I-sahn Hye-yeon, the teachings of Master [End Page 247] Hsuan Hua, Shantideva, Origen, St. Ignatius, St. Benedict, the author of The Cloud of Unknowing, St. John of the Cross, and Chiara Lubich. A minute of silence separated the fifteen-minute segments for each presentation. With so large a group, most of the time in the formal sessions involved listening to series of presentations; however, during discussion periods the participants asked several challenging questions of one another.Some participants noted the tension they felt between belonging to a particular religious group and the need to let go of any consequential narrowness. The goal of the discussion was to promote understanding of the differences and similarities between Christianity and Buddhism. At one point, the participants noted several concerns about mutual enrichment: whether Buddhist methods can be separated from Buddhism and Christian methods from Christianity, and what specific aspects of Christian practice truly enrich Buddhists and which Buddhist practices likewise enrich Christians. Several times participants discussed their understanding of terms such as transformation, grace, the incarnation and the passion of Jesus, discernment of spirits, prayer, Buddha-nature, and related terms. There was consensus that Buddhists and Catholics can practically help one another regarding mental cultivation and religious precepts. They expressed this consensus in their choice of the topic forthe next dialogue, "Transformation of Hearts and Minds: Chan/Zen-Catholic Approaches to Precepts."The group agreed to reconvene in 2004 to respond to six presentations, three from each side, on different aspects of this topic.Chairing the sessions were Rev. Heng Sure for the Dharma Realm Buddhist Association, Rev. Taigen Dan Leighton for the San Francisco Zen Center, and Bishop John Webster for the United States Conference of Catholic Bishops. Their three organizations are the sponsors of the Northern California Chan/Zen-Catholic Dialogue. Chan and Zen are respectively the Chinese and Japanese terms for the meditation school... (shrink)

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from (...) within and outside of VA. During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

What people value today can differ from what they have valued. But what does this value variability mean in the context of healthcare? We ethically analyze the current state of research on the change of embedded values in healthcare systems and the driving processes behind it. Starting with a systematic literature review and a content analysis, we subject the selected articles to an ethical analysis through three ethical theories: principlism, value ethics, and utilitarianism. The included papers demonstrated (...) how moral dissonance between individual values and behavior leads to moral distress. The occurrence of moral distress was related to current healthcare practices. Beneficence and non-maleficence played a central role where principlism was considered, virtue ethics was criticized for not addressing the structural problems in the healthcare system, and consequences of value change for healthcare professionals and the society were analyzed. Further, principlism cannot fully cover the value change in medical care with its top-down and bottom-up processes leading to consequences for the patients, healthcare professionals, and society as a whole. We found correlations between top-down value change processes in the healthcare system and the quality of care. Health professionals are forced to develop an attitude that does not adhere to traditional medical values any longer and eventually leads to low-value care. Accompanying phenomena like moral distress cause dropout of healthcare workers. These can be hardly slowed down from the bottom-up by the development of resilience and moral courage. More effectively, structural changes through value interventions have the potential to improve working conditions and the quality of care. (shrink)

This paper presents a preliminary analysis of the first participatory budgeting experiment in the United States, in Chicago's 49th Ward. There are two avenues of inquiry: First, does participatory budgeting result in different budgetary priorities than standard practices? Second, do projects meet normative social justice outcomes? It is clear that allowing citizens to determine municipal budget projects results in very different outcomes than standard procedures. Importantly, citizens in the 49th Ward consistently choose projects that the research literature (...) classifies as low priority. The results are mixed, however, when it comes to social justice outcomes. While there is no clear pattern in which projects are located only in affluent sections of the ward, there is evidence of geographic clustering. Select areas are awarded projects like community gardens, dog parks, and playgrounds, while others are limited to street resurfacing, sidewalk repairs, bike racks, and bike lanes. Based on our findings, we offer suggestions for future programmatic changes. (shrink)

Ageism is a pan-cultural problem, and correspondingly, increased research attention worldwide has focused on how a person’s age drives prejudice against them. Nevertheless, recent work argues that chronological age alone is a limited predictor of prejudice—particularly in the workplace, where age conflates intertwined elements, and across cultures, in which the nature of ageism can substantially differ. A recent organizational behavior framework advocates for extending beyond numerical age alone, focusing instead on prejudice arising from workers’ perceived Generation, Age, Tenure, and (...) Experience. In addition to clarifying the multifaceted nature of workplace ageism, GATE helps uncover potential cultural ageism differences. Using the United States and China as focal Western and Eastern prototypes, the current paper compares Eastern and Western cultures through a GATE Lens. Eastern and Western cultures adopt different perceptions of generations, elder life stages, organizational tenure expectations, and desired experience levels. Moreover, existing research offers clues for how workplace GATE-ism likely differs between cultures, but more research is needed. Future research should adopt a nuanced GATE conception of “age”-ism, toward enhanced ageism understanding and the ability to utilize a globally aging workforce. (shrink)

During the 1970s and 1980s, legal precedent, governmental recommendations, and professional society guidelines drove the formation of hospital ethics committees (HECs). The Joint Commission on Accreditation of Health Care Organization’s requirements in the early 1990s solidified the role of HECs as the primary mechanism to address ethical issues in patient care. Because external factors drove the rapid growth of HECs on an institution-byinstitution basis, however, no initial consensus formed around the structure and function of these committees. There are now almost (...) 40 years of empirical studies on the composition, administration, and activities of HECs in the United States. We conducted a systematic review of the available empirical literature on HECs to describe their evolution. As HECs changed over time, they increased their total number of members and percentage of members from nursing and the community. Although physicians increasingly chaired these committees, their presence as a percentage of overall members declined. The percentage of administrative members remained steady, although committees became increasingly likely to have at least one administrative member. HECs were also increasingly likely to report to an administrative body or to the board of trustees or directors rather than to the medical staff. Finally, consultation volume increased steadily over time. There has not, however, been a national survey of the composition of ethics committees, their administration, or volume of consultation in more than 10 years, despite increasing calls for professional standards and quality improvement assessments among HECs. (shrink)

This paper explores how current United States policies for funding nonreproductive cloning are justified and argues against that justification. I show that a common conceptual framework underlies the national prohibition on the use of public funds for cloning research, which I call the simple argument. This argument rests on two premises: that research harming human embryos is unethical and that embryos produced via fertilization are identical to those produced via cloning. In response to the simple argument, (...) I challenge the latter premise. I demonstrate there are important ontological differences between human embryos (produced via fertilization) and clone embryos (produced via cloning). After considering the implications my argument has for the morality of publicly funding cloning for potential therapeutic purposes and potential responses to my position, I conclude that such funding is not only ethically permissible, but also humane national policy. (shrink)

This article examines the topic of protest mapping during the rise of Occupy Wall Street in the United States in 2011–2012. It focuses on various practices of protest mapping, including a con­sideration of how space (public, urban, or of the protest camp) is represented in the visual sources discussed. It also addresses the qualitative difference between protest mapping and other mapping practices, as well as the categorization of protest mapping terms. Using the method of source analysis and online (...) research, the article adopts, as its key concept for studying protest as a multi-threaded phenomenon, the notion of détournement. This concept was first described in 1957 by Gil Wolman and Guy Debord, and from the early 1960s was used as a creative method and also a revolutionary strategy by the avant-garde artistic group, the Situationist International. The categories of stasis, dynamism, and spatiality will also be important points of reference. (shrink)

BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” who self-identified (...) as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

There is an increasing need for quality in ethics consultations, though there have been significant achievements in the United States and Europe. However, fundamental concerns that place the profession in jeopardy are discussed from the perspective of the U.S. in a manner that will be helpful for other countries. The descriptive component of the essay (the first two points) explains the achievements in ethics quality (illustrated by the IntegratedEthics program of the Veterans Health Administration) and the (...) progress on standards and competencies for ethics consultations (represented by the Core Competencies of the American Society for Bioethics and Humanities). Based on these achievements, the analytical component of the essay (the final three points) identifies and seeks to resolve three fundamental concerns (with increasing levels of importance) that compromise quality in ethics consultations: standards of quality; professionalism; and credentialing. The analysis argues for clearer standards of quality in ethics consultation and urges further professionalism by explaining the need for the following: interpreting the ASBH core competencies in a normative manner, developing a Code of Ethics, and clarifying the meaning of best practices. However, the most serious concern that threatens quality in ethics consultations is the lack of a credentialing process. This concern can be resolved effectively by developing an independent Ethics Consultation Accreditation Council to accredit and standardize graduate degree programs, fellowship experiences, and qualifying examinations. This credentialing process is indispensable if we are to strategically enhance quality in ethics consultations. (shrink)

Historians have emphasized the appearance of a productive research program in genetics after 1910, and philosophers and biologists have considered endorsement of genetics as a progressive move, indeed as a starting point for modern experimental biology. These efforts focus on what biology had changed to. This paper examines the condition from which biology moved, stressing the way in which Americans held heredity and development as a natural, intimately intertwined couple. Heredity accounts for likenesses, development for variation, and the two (...) act together throughout an individual's life. This discussion establishes the antecedent conditions necessary to explain the split of genetics and embryology and addresses the reasons for the split. (shrink)

Interfaith prejudice continues to be an understudied challenge in the United States. In three studies, the present research focused on prejudice between atheists and Christians and assessed the role that social identity complexity (SIC), the degree of overlap that an individual perceives between their various social identities, plays in these biases, as well as tested a novel intervention method using SIC to reduce bias. Study 1 assessed the relationship between SIC and prejudice for atheists and Christians and (...) found that higher SIC in Christians was associated with lower levels of prejudice, but SIC was unrelated to prejudice for atheists. Study 2 tested the utility of an SIC intervention for reducing prejudice in Christians and showed a small increase in SIC but no reduction in prejudice towards atheists. A mini meta-analysis in Study 3 assessed the relationship between SIC and prejudice across all three studies and fully replicated Study 1. This line of work was an important first step in uncovering the relationship between SIC and interfaith intolerance for atheists and Christians in the United States. The findings suggest that SIC interventions may have potential for reducing prejudice in Christians, but future researchers will need to use methods that can be tested longitudinally for greater impact. (shrink)