Volume 25, Issue 2, February 2025, Page 149-150.

Volume 24, Issue 7, July 2024, Page 132-134.

The success of fecal microbiota transplantation as a treatment for Clostrioides difficile infection has stirred excitement about the potential for microbiota transplantation as a therapy for a wide range of diseases and conditions. In this article, we discuss vaginal microbiota transplantation as “the next frontier” in microbiota transplantation and identify the medical, regulatory, and ethical challenges related to this nascent field. We further discuss what we anticipate will be the first context for testing VMT in clinical trials, prevention of the (...) recurrence of a condition referred to as bacterial vaginosis. We also compare clinical aspects of VMT with FMT and comment on how VMT may be similar to or different from FMT in ways that may affect research design and regulatory decisions. (shrink)

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

The COVID-19 pandemic has triggered much-needed reflection on family caregiver burden. This is unsurprising, given U.S. dependence on acute health care delivery and long-standing t...

As national and state health care policy -making becomes contentious and complex, there is a need for a forum to debate and explore public concerns and values in health care, give voice to local citizens, to facilitate consensus among various stakeholders, and provide feedback and direction to health care institutions and policy makers. This paper explores the role that regional health care ethics committees can play and provides two contrasting examples of Networks involved in facilitation of public input into and (...) the development of health care policies and adoption of state-wide practices. (shrink)

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”Genesis 3:16There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their (...) pain.One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men. (shrink)

Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids. Surveys have shown that physicians fear potential disciplinary acrion for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in (...) some cases, disciplined physicians for such prescribing. While in virtually all of these cases the disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment. (shrink)

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland (...) Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)

Healthcare ethics consultants in the Veterans Health Administration (VHA) document consults in an enterprise-wide web-based database entitled IEWeb, serving as a system of record for healthcare ethics documentation at 1300 VA facilities. The need arose to evolve the database from an ethics process training resource into a more streamlined documentation repository that captures essential consult elements. A VHA National Center for Ethics in Health Care (NCEHC) Improvement Team convened for three tasks: (1) Specify and prioritize IEWeb changes (occurred via six (...) focus groups composed of “new user” and “super user” cohorts with analysis of existing documentation patterns); (2) Pilot the changes regionally (via regional communication, training, and reviews of pre-post use patterns); and (3) Measure the impact of national change implementation on user perspectives (via pre-and post-change implementation polls). Focus groups identified six implementable priority areas for ethics consult documentation improvement, including the development of a usable consult summary note for ready conversion from IEWeb fields into the electronic health record. Post-IEWeb updates showed an increased number of consults documented, a reduction in “time to consult documentation closure” by a mean of 4.5 days, and a clinically-meaningful improvement in the quality of documentation (78% of ethics questions scored “above-bar” on the validation tool pre- vs. 89% scored “above-bar” post-IEWeb changes, n = 140). According to national survey findings, the number of consultants documenting “all” consults in IEWeb increased, satisfaction increased, and perception of documentation difficulty decreased. IEWeb simplification enabled ethics consultants to re-focus their documentation completion efforts by decreasing perception of documentation burden while improving documentation frequency and quality in a clinically-meaningful way. (shrink)

The quality of end-of-life care in this country is often poor. There is abundant literature indicating that dying individuals do not receive adequate pain medication or palliative care, are tethered to machines and tubes in a way that challenges their dignity and autonomy, and are not helped to deal with the emotional grief and psychological angst that may accompany the dying process. While this is true for individuals in many settings, it seems to be especially true for individuals in nursing (...) homes. This is somewhat puzzling given that considerable resources have been devoted to bringing public attention to this problem, we have the knowledge and expertise to provide such care, and we have a government-financed benefit that covers this type of care - the Medicare hospice benefit.While utilization of hospice care has increased during the last decade, there is considerable evidence that hospice care remains underutilized particularly in the long term care setting. (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)

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute (...) a consult. As one bioethicist commented:if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics. (shrink)

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...) distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

It has become increasingly difficult for individuals to exercise meaningful control over the personal data they disclose to companies or to understand and track the ways in which that data is exchanged and used. These developments have led to an emerging consensus that existing privacy and data protection laws offer individuals insufficient protections against harms stemming from current data practices. However, an effective and ethically justified way forward remains elusive. To inform policy in this area, we propose the Ethical Data (...) Practices framework. The framework outlines six principles relevant to the collection and use of personal data—minimizing harm, fairly distributing benefits and burdens, respecting autonomy, transparency, accountability, and inclusion—and translates these principles into action-guiding practical imperatives for companies that process personal data. In addition to informing policy, the practical imperatives can be voluntarily adopted by companies to promote ethical data practices. (shrink)

In Daubert v. Merrell Dow Pharmaceuticals, Inc., the U.S. Supreme Court made its first major pronouncement on the evaluation of scientific evidence, calling on judges to act as gatekeepers for scientific knowledge and validity, despite lack of scientific training among judges. Daubert offers the science studies community a case study for examining how judges engage in boundary-work and construct scientific validity. In constructing scientific validity under Daubert, judges must evaluate the scientific method behind a particular scientific claim, and will look (...) to the parties' experts and the relevant scientific community for assistance. To combat the oft-cited problem of the battle of the experts, judges may be tempted to obtain assistance from court-appointed neutral experts, an inquisitorial system in the civil law tradition of many European countries. The judicial evaluation of scientific evidence, the resulting construction of scientific validity, and the push for a greater use of court-appointed experts reveal judges' desire to segregate "objective" scientific facts from aspects of the legal process that are infused with adversaries' values. Yet the scientific and judicial construction of validity mixes empirical results and research methods with the personal, political, and institutional values of judges and scientists. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Seasoned clinical ethics consultants are likely familiar with concerns brought to them about the home environment for a vulnerable patient not meeting criteria for a “safe discharge.” For some pati...

As ambient assisted living technologies continue to evolve, ethics consultants should be prepared to address questions about their proper use. In this issue, we address a scenario in a dementia car...

Responding to the impact of prior trauma on mental and physical health and disease/injury recovery is decades-old. In the 1970s, healthcare providers and researchers expanded our understanding of h...

Medical councils increasingly require graduates to understand law and to practise medicine mindful of the legal rules. In the UK a revised curriculum for medical law and ethics has been published. However, coverage of law in medical education remains variable and doubts exist about how far students acquire legal knowledge and skills in its implementation. This survey of students in two UK medical schools measured their law learning and their confidence in using this knowledge. Concept maps and a self-audit questionnaire (...) were used to capture students' understanding and perceptions of this knowledge domain and self-assessments of their legal knowledge and skills. A large sample was achieved across first, second and final year students. Students agree that a sound understanding of law is essential to being a good doctor. Their perceptions of law are generally positive but the interface between the legal rules and codes of medical ethics creates difficulty. In some areas students offer relatively confident self-assessments of their legal knowledge and skills for practising law. However, levels of confidence in other areas of their law learning raise doubts about the degree to which they can advocate for and protect their patients. Conclusions are drawn about the effectiveness of students' law learning and recommendations made for further research. (shrink)

On January, 27, 2017, U.S. President Donald J. Trump issued Executive Order 13769 on immigration and travel, which restricted entry into the U.S. of the citizens of seven primarily Muslim countries. Many academics reacted with outrage, including me and other members of the Academy of Management, of which I was President at the time. Some scholarly associations condemned EO 13769 as immoral, but the AOM did not immediately issue such a condemnation because the AOM’s Constitution included a policy of no-political-stands (...) and a principle that nobody, including the AOM President, could represent personal views as those of the organization. Within a few weeks, the AOM Constitution was changed, and in October, 2017, the AOM joined other associations in issuing a condemnation. An article was published in this journal on this situation that was subsequently amended through a published Correction, but the Correction only partially addressed the problems in the original. The main contribution of this commentary is to take up the invitation in Tsoukas to examine the case for insights on theoretical and conceptual questions raised in the literature on prototypicality and moral imagination. It also briefly outlines the most significant omitted errors of fact in Tsoukas that were not corrected in Tsoukas, and describes the most important methodological problems in Tsoukas. The conclusion suggests that the complex, nuanced, and evolving interactions that unfolded at the AOM are not fully addressed theoretically or conceptually in this literature. (shrink)

The present study is the first to empirically test a hierarchical, positive-oriented model of self and its relationship to the second language (L2) achievement motivation, and compare it in three different cultural contexts of Japan, U.S. and Taiwan. Based on the L2 self model (Lake, 2016), three levels of constructs were developed: Global Self (i.e., Flourishing, Curiosity, and Hope); Positive L2 domain self (i.e., interested-in-L2 self, harmonious passion for L2 learning, and mastery L2 goal orientation); and L2 Motivational Variables (i.e., (...) reading, speaking and listening self-efficacy). A total of 667 students participated in this study, including 181 first-year college students in Japan, 159 high school students in Taiwan, and 327 college students in the U.S. All the participants were learning a L2 in school. Results showed that the measures of positive global self, L2 domain self, and L2 motivational self all had a stronger relationship within their respective levels, and progressively weaker relationships as level of generality/specificity became more distal. Furthermore, the relationships among measures varied in the differing cultural contexts with the Japan-based student participants relatively lower on all measures. (shrink)

Contemporary approaches to adolescent development are framed by positive youth development models. A key outcome of these models is that healthy and positively developing youth are more likely to contribute to their family, schools, and communities. However, little work on contribution and its antecedents has been conducted with youth of color. As high achieving youth of color often become leaders in their communities, it is important to consider malleable predictors of contribution within this population. Therefore, through a cross-sectional design, we (...) examined the relations between youth critical reflection, hopeful future expectations, and mentoring relationship quality and youth contribution in a sample of 177 youth of color (60% Black, 40% Latinx) attending an afterschool college preparation program at six sites around the U.S. Results indicated that youth critical reflection, hopeful future expectations, and mentoring relationship quality significantly predicted contribution. Exploratory analyses suggested that these relations were significant for Black youth but not Latinx youth. Implications of these findings for future scholarship are discussed. (shrink)

Purpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) (...) were deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical schools are responding to the preparation (...) of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training. (shrink)

Physical activity and sedentary behaviour have been linked to the mental health of children and adolescents, yet the timing of behaviours may play a role in this relationship and clarifying this could inform interventions. We explored cross-sectional associations of PA and SED in varying time segments throughout the school day with the mental health of school-aged children and adolescents from rural Northeastern Ontario, Canada. A total of 161 students wore accelerometers for 8 days and completed a self-report survey. (...) Mental health was measured using the Strengths and Difficulties Questionnaire. Accelerometer-measured SED, light PA, and moderate and vigorous PA were estimated in the time-segments before school, school time, after school, and evenings. Associations were tested with multilevel linear regressions while adjusting for confounding factors. Students spent 72.6 min in MVPA, 209.0 min in LPA, and 621.0 min in SED per day. Daily SED was associated with less conduct problems. Evening LPA was inversely associated with hyperactivity, while SED was associated with hyperactivity and with peer problems before school, and during school. No associations were observed for MVPA, emotional symptoms, or prosocial behaviour. In conclusion, displacing SED with LPA in some specific periods of the day may benefit the mental health of students; taking this into account could strengthen interventions. (shrink)

Einstein’s razor, a corollary of Ockham’s razor, is often paraphrased as follows: make everything as simple as possible, but not simpler. This rule of thumb describes the challenge that designers of a legal system face—to craft simple laws that produce desired ends, but not to pursue simplicity so far as to undermine those ends. Complexity, simplicity’s inverse, taxes cognition and increases the likelihood of suboptimal decisions. In addition, unnecessary legal complexity can drive a misallocation of human capital toward comprehending and (...) complying with legal rules and away from other productive ends. While many scholars have offered descriptive accounts or theoretical models of legal complexity, most empirical research to date has been limited to simple measures of size, such as the number of pages in a bill. No extant research rigorously applies a meaningful model to real data. As a consequence, we have no reliable means to determine whether a new bill, regulation, order, or precedent substantially effects legal complexity. In this paper, we begin to address this need by developing a proposed empirical framework for measuring relative legal complexity. This framework is based on “knowledge acquisition”, an approach at the intersection of psychology and computer science, which can take into account the structure, language, and interdependence of law. We then demonstrate the descriptive value of this framework by applying it to the U.S. Code’s Titles, scoring and ranking them by their relative complexity. We measure various features of a title including its structural size, the net flow of its intra-title citations and its linguistic entropy. Our framework is flexible, intuitive, and transparent, and we offer this approach as a first step in developing a practical methodology for assessing legal complexity. (shrink)

Background: The field of clinical ethics is examining ways of determining competency. The Assessing Clinical Ethics Skills (ACES) tool offers a new approach that identifies a range of skills necessary in the conduct of clinical ethics consultation and provides a consistent framework for evaluating these skills. Through a training website, users learn to apply the ACES tool to clinical ethics consultants (CECs) in simulated ethics consultation videos. The aim is to recognize competent and incompetent clinical ethics consultation skills by watching (...) and evaluating a videotaped CEC performance. We report how we set a criterion cut score (i.e., minimally acceptable score) for judging the ability of users of the ACES tool to evaluate simulated CEC performances.Methods: A modified Angoff standard-setting procedure was used to establish the cut score for an end-of-life case included on the ACES training website. The standard-setting committee viewed the Futility Case and estimated the probability that a minimally competent CEC would correctly answer each item on the ACES tool. The committee further adjusted these estimates by reviewing data from 31 pilot users of the Futility Case before determining the cut score.Results: Averaging over all 31 items, the proposed proportion correct score for minimal competency was 80%, corresponding to a cut score that is between 24 and 25 points out of 31 possible points. The standard-setting committee subsequently set the minimal competency cut score to 24 points.Conclusions: The cut score for the ACES tool identifies the number of correct responses a user of the ACES tool training website must attain to “pass” and reach minimal competency in recognizing competent and incompetent skills of the CECs in the simulated ethics consultation videos. The application of the cut score to live training of CECs and other areas of practice requires further investigation. (shrink)

In this book, a dozen distinguished scholars in the field of the history of philosophy and science investigate aspects of the commentary tradition on Aristotle's De generatione et corruptione, one of the least studied among Aristotle's treatises in natural philosophy. Many famous thinkers such as Johannes Philoponus, Albert the Great, Thomas Aquinas, John Buridan, Nicole Oresme, Francesco Piccolomini, Jacopo Zabarella, and Galileo Galilei wrote commentaries on it. The distinctive feature of the present book is that it approaches this commentary tradition (...) as a coherent whole, thereby ignoring the usual historiographical distinctions between the Middle Ages, the Renaissance, and the seventeenth century. Frans de Haas and Henk Kubbinga address the Greek commentary tradition on De generatione et corruptione. Simone van Riet's essay is devoted to the Latin version of Avicenna's third treatise of his Kitab al Shifa, which discusses Aristotle's De generatione et corruptione. James Otte traces the intricate history of the identification of the Latin translator of Aristotle's treatise as Burgundio of Pisa. The essay by John Murdoch explores the fortuna of atomistic arguments in the Latin commentary tradition. Jurgen Sarnowsky, Henk Braakhuis, and Stefano Caroti examine various themes in the commentaries that were produced by the so-called Buridan School, that is, John Buridan, Albert of Saxony, Nicholas Oresme, and Marsilius of Inghen. The article by Silvia Donati focuses on the influential commentary by the Expositor, Giles of Rome. The final essay, written by Anita Guerrini, tackles Robert Boyle's attitude in the Origin of Forms and Qualities toward such Aristotelian key concepts as forms, matter, qualities, and mixture. These essays are prefaced by a preliminary survey by Hans Thijssen of Aristotle's text, its Latin translations and its Greek, Arabic and Latin commentaries. (shrink)

There is an increasing interest in how managers describe and respond to what they regard as moral versus nonmoral problems in organizations. In this study, forty managers described a moral problem and a nonmoral problem that they had encountered in their organization, each of which had been resolved. Analyses indicated that: (1) the two types of problems could be significantly differentiated using four of Jones' (1991) components of moral intensity; (2) the labels managers used to describe problems varied systematically between (...) the two types of problems and according to the problem's moral intensity; and (3) problem management processes varied according to the problem's type and moral intensity. (shrink)

Background Informed consent confers upon participants the right to decline or accept participation in a study in equal measure. Consent declines can be used as a potential metric to assess the adequacy of the informed consent process. Limited literature is available on the reporting of consent declines in Clinical Research. We evaluated randomized controlled trials published in three high-impact factor journals for consent declines (four-year period) to assess the extent of exertion of autonomy by research participants. Methods CONSORT flow charts (...) in RCTs published in New England Journal of Medicine (NEJM), The Lancet and Journal of the American Medical Association (JAMA) between 2012 and 2015 were evaluated. The total and per journal proportion of RCTs reporting consent declines was calculated. Percentage of consent declines was also compared based on number of centers (single centric vs. multicentric) and type of setting (developed vs. developing). Between-groups analysis was done using Chi Square, Chi Square for trend and a Crude odds ratio [95% C.I] (cOR) were calculated. Results Only 3.7% (1103/29,825) of the published articles were RCTs. Of the 1103 RCTs, only 532 (48.2%) reported consent declines. JAMA had the highest RCTs reporting consent declines (171/267.64%), the Lancet [129,150/781,924, 16.5%] had the most participants declining consent. Difference was significant using Chi square for linear trend [ p < 0.00001]. Consent decline rate was higher in developed countries relative to developing countries [cOR(95% C.I): 2.27(2.23,2.32), p < 0.000001] and in single centric versus multicentric studies [cOR (95% C.I): 3.63(3.56,3.71), p < 0.0000001]. Conclusion Both authors and journal editors need to ensure better reporting of consent declines. (shrink)