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)

Volume 24, Issue 8, August 2024, Page 90-93.

After 100+ years of studying syllogistic reasoning, what have we learned? Well, Riesterer and colleagues suggest that we have learned to throw away most of the data! If that seems like a bad idea to you then, be assured, that the authors agree with you. The sad fact is that the conclusion of “No Valid Conclusion” (NVC) is one of the most frequently selected responses in syllogistic reasoning but these “majority data” have been ignored by most researchers. Riesterer and colleagues (...) introduce heuristic rules for predicting NVC and provide directions to modelers on how to up their game. (shrink)

Background: In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions. Objectives: We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these (...) decisions ought to be made. Research design: This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made. Participants and research context: We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders. Ethical considerations: The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient. Findings: As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress. Discussion: We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care. Conclusions: One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

Rule violations have usually been studied from a third-person perspective, identifying situational factors that render violations more or less likely. A first-person perspective of the agent that actively violates the rules, on the other hand, is only just beginning to emerge. Here we show that committing a rule violation sensitises towards subsequent negative stimuli as well as subsequent authority-related stimuli. In a Prime-Probe design, we used an instructed rule-violation task as the Prime and a word categorisation task as the Probe. (...) Also, we employed a control condition that used a rule inversion task as the Prime. Probe targets were categorised faster after a violation relative to after a rule-based response if they related to either, negative valence or authority. Inversions, however, primed only negative stimuli and did not accelerate the categorisation of authority-related stimuli. A heightened sensitivity towards authority-related targets thus seems to be specific to rule violations. A control experiment showed that these effects cannot be explained in terms of semantic priming. Therefore, we propose that rule violations necessarily activate authority-related representations that make rule violations qualitatively different from simple rule inversions. (shrink)

Attention-Deficit Hyperactivity Disorder (ADHD) and Tourette Syndrome (TS) present as distinct conditions clinically; however, comorbidity and inhibitory control deficits have been proposed for both. Whilst such deficits have been studied widely within clinical populations, findings are mixed—partly due to comorbidity and/or medication effects—and studies have rarely distinguished between subtypes of the disorders. Studies in the general population are sparse. Using a continuity approach, the present study examined (i) the relationships between inattentive and hyperactive/impulsive aspects of ADHD and TS-like behaviors in (...) the general population, and (ii) their unique associations with automatic and executive inhibitory control, as well as (iii) yawning (a proposed behavioral model of TS). One hundred and thirty-eight participants completed self-report measures for ADHD and TS-like behaviors as well as yawning, and a conditioned inhibition task to assess automatic inhibition. A sub-sample of fifty-four participants completed three executive inhibition tasks. An exploratory factor analysis of the TS behavior checklist supported a distinction between phonic and motor like pure TS behaviors. Whilst hyperactive/impulsive aspects of ADHD were associated with increased pure and compulsive TS-like behaviors, inattention in isolation was related to reduced obsessive-compulsive TS-like behaviors. TS-like behaviors were associated with yawning during situations of inactivity, and specifically motor TS was related to yawning during stress. Phonic TS and inattention aspects of ADHD were associated with yawning during concentration/activity. Whilst executive interference control deficits were linked to hyperactive/impulsive ADHD-like behaviors, this was not the case for inattentive ADHD or TS-like behaviors, which instead related to increased performance on some measures. No associations were observed for automatic conditioned inhibition. (shrink)

This special issue of AVANT is all about Cognitive Innovation. It is not about CogNovo, the interdisciplinary and international doctoral training programme that produced three different Off the Lip events. It is not about Off the Lip 2017, the novel symposium format we developed to collaboratively create a publication resulting in this special issue of AVANT. It is not about the seemingly heterogeneous collection of papers that follow this preface. Collaborative Approaches to Cognitive Innovation required something else, something we are (...) starting to capture in the four GIFT principles. While this special issue is not solely about CogNovo, Off the Lip events, or the content of the following submissions, all these aforementioned elements were necessary to shape our current understanding of Cognitive Innovation, the very process which led to numerous publications, exhibitions, and events during the past three years. In a sense, all of our previous endeavours have culminated in this collection of 26 distinct pieces of work, yet we hope and believe that this special issue also marks a beginning. Let us explain. [...]. (shrink)

Smartphone acceptance could improve instruction, increase accessibility, and foster student involvement, which is a fundamental element in the development and application of m-learning in the classroom. This process reflects continuing advancements and versions in educational methods. The effect of mobile technology adoption in classrooms is examined in this study, focusing on its effects on student engagement, educational outcomes, and the associated infrastructure and support. The study comprised qualitative and quantitative data collected from 300 students using a mixed-method approach. Five key (...) variables related to mobile technology use were integrated, and SPSS software was employed for analysis. Descriptive statistics were used to compute an adoption index, highlighting positive student feedback and assessing technological integration, despite, to assess variations in student satisfaction and academic achievement; a one-sample t-test was used. Results revealed significant positive impacts on engagement and outcomes, though challenges in infrastructure and cost price. The findings highlight how mobile technology could transform education, but they also highlight how much additional resources and encouragement are required to ensure that it is as sustainable and effective as possible. (shrink)

Cultural effects can influence the results of causal genetic analyses, such as Mendelian randomisation, but the potential influences of culture on genotype–phenotype associations are not currently well understood. Different genetic variants could be associated with different phenotypes in different populations, or culture could confound or influence the direction of the association between genotypes and phenotypes in different populations.

SOCREAL 2013 : 3rd International Workshop on Philosophy and Ethics of Social Reality 2013. Hokkaido University, Sapporo, Japan, 25-27 October 2013. Session 4 : Agency, Responsibility, and Intentionality.

The main purpose of this study was to map school leaders? perceptions concerning the cooperation of the leadership team, the distribution of leadership functions and participative decision?making, and to asses their relative weight in terms of predicting school leaders? job satisfaction. Also, the effect of demographical and structural school variables (i.e. seniority, job experience, school size, size of the leadership team, school type) on school leaders? job satisfaction was examined. A sample of 130 school leaders of 46 large secondary schools (...) completed a self?report questionnaire. The study results indicated that school leaders are highly satisfied with their job. Multiple regression analysis revealed that job satisfaction was significantly related to the cooperation of the leadership team and the school type. The amount of formal distribution of leadership functions and participative decision?making of teachers in the school policy did not have a significant influence on school leaders? job satisfaction. (shrink)

I defend the normativity of meaning against recent objections by arguing for a new interpretation of the ‘ought’ relevant to meaning. Both critics and defenders of the normativity thesis have understood statements about how an expression ought to be used as either prescriptive or semantic. I propose an alternative view of the ‘ought’ as conveying the primitively normative attitudes speakers must adopt towards their uses if they are to use the expression with understanding.

Although there are many different moral arguments concerning the use of Best Interests in neonatal decision-making, there seems in practice a firm commitment to application of the concept. And yet, there is still little reflection given by practitioners about what employing a Best Interest determination means in infant care. The following lays out a comprehensive taxonomy of interest-sources in order to provide for more robust considerations of what constitutes best interests of/for neonates.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Die medizinischen Interventionen bei Intersexualität basieren auf den vorherrschenden gesellschaftlichen Geschlechtsnormen, die das intersexuelle Kind als behandlungsbedürftige Abweichung sehen. Aus diesem Blickwinkel wird unter „Heilung“ die erfolgreiche Integration des intersexuellen Individuums in ein eindeutig abgegrenztes Geschlecht verstanden, das durch eine medizinische Behandlung hergestellt wird. Dabei wird einerseits vorausgesetzt, dass unbehandelte intersexuelle Individuen nicht erfolgreich „heilen“ können, und andererseits, dass behandelte Individuen medizinische Interventionen als „Heilungsmaßnahmen“ erleben. Die Exploration der medizinischen Fachliteratur und der Berichte aus erster Hand sowohl von behandelten als (...) auch von unbehandelten Menschen mit Intersexualität lassen diese Vorannahmen fragwürdig erscheinen. In der Literatur wird nämlich belegt, dass als grundlegende Mittel, die tatsächlich bei diesen Menschen zu einer „Heilung“ führen, zentrale Werte wie Selbstakzeptanz der Andersartigkeit, Überwindung der Isolation durch Austausch mit anderen in ähnlichen Situationen und Wahrhaftigkeit von Bedeutung sind. Dies würde bedeuten, dass eine medizinische Intervention zur Überwindung der sozialen Ausgrenzung in Fällen von Intersexualität möglicherweise nicht die effektivste „Heilungsmaßnahme“ ist. Die medizinische Behandlung muss vielmehr darauf ausgerichtet werden, die Reaktion auf Intersexualität zu überwinden, als diesen Zustand selbst als pathologisch anzusehen. (shrink)

The form of Western mainstream film is the crux of its ideological efficiency: by using established formal techniques, films ensure audiences un- derstand that aesthetic decisions support and clarify the narrative to ensure maximum spectatorial satisfaction. However, some films exploit their formal aesthetics in order to prevent clarification, thwarting satisfaction in favour of viewing practices that can be considered perverse in that they withhold, suspend or obstruct immediate pleasure. Contemporary Western filmmaking in the mid-1990s witnessed the emergence of a distinct (...) group of filmmakers and films that, in the popular discourse of cinematic criticism, were together coded as “difficult” or “perverse.” These films were, as a result of the characteristics we identify below, situated obliquely in relation to the larger economic and artistic struc- tures of a commercially oriented “mainstream” cinema. Included in this new form of cinematic production were films from directors such as Tim Burton: Edward Scissorhands ; David Cronenberg: eXistenZ ; David Fincher: Se7en ; Peter Greenaway: The Baby of Maçon ; David Lynch: Lost Highway ; Quentin Tarantino: Pulp Fiction and Lars von Trier: Breaking the Waves . Whilst Western cinema as a whole has a long history of exploring “difficult” or “perverse” material within the overt or covert content of narrative, plot and story, such films demonstrate a particular relationship between the content being explored and the specific formal characteristics utilised in the delivery of that content. Thus where previous examples would utilise standardised formal techniques as a way of both delivering and containing the difficult or objectionable material, the films instead offer instances where the material of the narrative content seems to bleed backwards, affecting the form and rendering the very materiality of the film itself suspect and problematic. (shrink)

Originally published in 1773 in two volumes, and now reissued here together in one, this work by the writer Hester Chapone, a renowned proponent of female education, contains advice delivered in the form of letters to her niece. The first volume deals primarily with matters of religion and morality, while the second volume addresses questions of behaviour and schooling. Unusually for self-improvement books of this era, Chapone recommends that a young woman should have a rigorous education in a wide (...) variety of subjects, including ancient history and geography, as well as instruction in ladylike deportment and mastery of household matters. She exhorts young ladies to avoid vanity and other vices through devoted study of scripture, and writes of the importance of choosing worthy and sensible friends who can be trusted to offer good advice. Chapone's posthumously published works, in two volumes, are also reissued in this series. (shrink)

Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn (...) more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable. (shrink)

Although Hannah Arendt is considered one of the major contributors to social and political thought in the twentieth century, this is the first general anthology ...

The behavior of some nightlife-setting patrons would be unacceptable in workplaces or public settings and could cause distress to other patrons. This quantitative study determined 381 young Australian’s descriptive and personal norms regarding four types of sexual behavior. Participants’ personal norms were that these behaviors are wrong, but they reported that the behaviors are common in a nightlife setting. Behaviors such as these could theoretically be prevented by modifying patrons’ descriptive norms with evidence that their beliefs are contrary to individuals’ (...) personal norms of acceptable behavior in nightlife settings. (shrink)

Several months ago, I was walking down the hallway outside our medical school faculty offices and a colleague stopped me to ask a question. He phrased his query in the context of a case that raised ethical issues for him, and he asked me to respond. I obligingly offered my opinion given the details he presented, ending my comments with the phrase, To this he kindly shot back, To be honest, this question caught me off guard. Though his particular dilemma (...) was relatively well-trod territory for many bioethicists, I had done little research on the issue and could not immediately render a response to his latter query. (shrink)

Scholars have explored the influence of the field of cybernetics on scientific thought and disciplines. However, from the inception of the field, ‘‘cyberneticians’’ had explicitly envisioned applications reaching beyond the purview of scientific disciplines; cybernetics was remarkable for its portability and potential application in a wide variety of contexts. This article explores connections between cybernetics and experimental music from 1950-1980, which was a period of experimentation with electronic techniques in recording, composition, and sound production and manipulation. Examples include musicians, engineers, (...) instrument builders, composers, and scientists in collaboration with musicians who invoked cybernetic themes in their work. These uses of cybernetics were more diverse than accounts of cybernetics within the sciences suggest, presenting a major difficulty in addressing cybernetics as a homogeneous or monolithic discourse. In particular, cybernetic discourse in music often exhibited themes of openness and indeterminacy, rather than the ‘‘command and control’’ of the ‘‘closed world.’’. (shrink)

A K-12 curriculum guide for philosophy and ethics.

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.