OBJECTIVES: To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics. DESIGN: Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals. SETTING: Two major London children's hospitals. RESULTS: Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and treatment; (...) lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting. CONCLUSION: Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees. (shrink)

Through discourse with international groups of physicians, we conducted a cross-cultural analysis of the types of ethical dilemmas physicians face. Qualitative analysis was used to categorise the dilemmas into seven themes, which we compared among the physicians by country of practice. These themes were a-theoretically-driven and grounded heavily within the text. We then subjected the dilemmas to an analysis of moral intensity, which represents an important theoretical perspective of ethical decision making. These constructs represent salient determinants of ethical behaviour and (...) our cross-cultural sample afforded us the opportunity to consider both the pragmatic aspects of culture, as they are perceived by physicians, as well as the theory-driven concept of moral intensity. By examining both culture and moral intensity, we hope to better elucidate the complexities of ethical decision-making determinants among physicians in their daily practice. Doing so may potentially have practical implications for ethics training of medical students and foreign physicians. (shrink)

This article investigates the use of favors by managers of BRIC firms to accomplish business goals, the ethicality of which should be determined by the moral reasoning in these countries rather than from a developed country perspective. We define a favor as an exchange of outcomes between individuals, typically utilizing one's connections, that is based on a commonly understood cultural tradition, with reciprocity by the receiver typically not being immediate, and its value being less than what would constitute bribery within (...) that cultural context. This exchange normally takes place between and among members of networks, and may involve a network outsider contacted by a network insider on behalf of another insider. We see the giver and receiver of the favor, as well as network insiders and outsiders, as stakeholders. Additionally, society could also be considered to be a stakeholder since the practice of using favors generally inhibits the development of legitimate, strong formal institutions, since the use of favors in emerging economies is rooted in cultural traditions that we view as informal institutions. Furthermore, we assert that the practice of using favors can lead to bribery which harms society as a stakeholder both morally and economically. We posit that BRIC-country managers' behaviors stem from informal, culturally based practices—jeito in Brazil, blat/sviazi in Russia, jaan-pehchaan in India, and guanxi in China. We utilize institutional theory to explain why favors are relied upon, and ISCT to support the argument that the use of favors in environments like the BRICs is generally considered ethical. (shrink)

We present an abstract social aggregation theorem. Society, and each individual, has a preorder that may be interpreted as expressing values or beliefs. The preorders are allowed to violate both completeness and continuity, and the population is allowed to be infinite. The preorders are only assumed to be represented by functions with values in partially ordered vector spaces, and whose product has convex range. This includes all preorders that satisfy strong independence. Any Pareto indifferent social preorder is then shown to (...) be represented by a linear transformation of the representations of the individual preorders. Further Pareto conditions on the social preorder correspond to positivity conditions on the transformation. When all the Pareto conditions hold and the population is finite, the social preorder is represented by a sum of individual preorder representations. We provide two applications. The first yields an extremely general version of Harsanyi's social aggregation theorem. The second generalizes a classic result about linear opinion pooling. (shrink)

Circadian rhythm abnormalities in bipolar disorder have led to a search for genetic abnormalities in circadian "clock genes" associated with BD. However, no significant clock gene findings have emerged from genome-wide association studies. At least three factors could account for this discrepancy: complex traits are polygenic, the organization of the clock is more complex than previously recognized, and/or genetic risk for BD may be shared across multiple illnesses. To investigate these issues, we considered the clock gene network at three levels: (...) essential "core" clock genes, upstream circadian clock modulators, and downstream clock controlled genes. Using relaxed thresholds for GWAS statistical significance, we determined the rates of clock vs. control genetic associations with BD, and four additional illnesses that share clinical features and/or genetic risk with BD. Then we compared the results to a set of lithium-responsive genes. Associations with BD-spectrum illnesses and lithium-responsiveness were both enriched among core clock genes but not among upstream clock modulators. Associations with BD-spectrum illnesses and lithium-responsiveness were also enriched among pervasively rhythmic clock-controlled genes but not among genes that were less pervasively rhythmic or non-rhythmic. Our analysis reveals previously unrecognized associations between clock genes and BD-spectrum illnesses, partly reconciling previously discordant results from past GWAS and candidate gene studies. (shrink)

Objective To determine the public's understanding of and views about a range of ethical issues in relation to death and dying. Design Random, digit-dialling, telephone interview Setting Ireland. Participants 667 adult individuals. Results The general public are unfamiliar with terms associated with end-of-life care. Although most want to be informed if they have a terminal illness, they also value family support in this regard. Most of the respondents believe that competent patients have the right to refuse life-saving treatment. Most also (...) (mistakenly) believe that families, either alone or with physicians, have the authority to make decisions about starting or stopping treatment for incompetent patients. Most Irish people are more concerned about the quality of their dying than death itself. Religious commitment is important to most Irish people, and this impacts on their views about medical treatment and care at the end of life. Conclusions The study paints a picture of a general public that is not very comfortable with or informed about the processes of dying and death. Great sensitivity is required of health professionals who must negotiate the timing and the context of breaking of bad news with patients and families. Educational interventions, public and organisational policies and legislation need to address the uncertainty that surrounds the role of professionals and families in making decisions for dying patients. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

These studies examined whether having thoughts related to an event before it occurs leads people to infer that they caused the event— even when such causation might otherwise seem magical. In Study 1, people perceived that they had harmed another person via a voodoo hex. These perceptions were more likely among those who had first been induced to harbor evil thoughts about their victim. In Study 2, spectators of a peer’s basketball-shooting performance were more likely to perceive that they had (...) influenced his success if they had first generated positive visualizations consistent with that success. Observers privy to those spectators’ visualizations made similar attributions about the spectators’ influence. Finally, addi- tional studies suggested that these results occur even when the thought-about outcome is viewed as unwanted by the thinker and even in field settings where the relevant outcome is occurring as part of a live athletic competition. (shrink)

“That is no country for old men” is the famous first line of Yeats’s “Sailing to Byzantium,” which reflects upon aging, art, and immortality. Yeats sug­gests in his poem that the aged ought to move from the sensual, physical world of their youth to a world of intellect and timeless beauty. We em­ploy this poem and that line to explore the aging male protagonists in two recent novels: Cormac McCarthy’s No Country For Old Men, and J.M. Coetzee’s Disgrace. We (...) suggest that though both of the novel’s pro­tagonists have aspirations to ’sail to Byzantium’, various factors ranging from their characters to the problematic realities of contemporary south­west America and South Africa make such a wholesale, successful journey impossible even though some progress is made. (shrink)

Nel Noddings claims that there is an important normative element in happiness. For support, she points to the Aristotelian idea of the eudaimonic life, a concept that is often translated into English as ‘the happy life’. However, in light of the wide divergence between the Aristotelian view of eudaimonia as a life of virtuous activity and most contemporary psychologists’ and lay people’s view of happiness as subjective wellbeing, the authors of this article believe that Noddings’s merging of the two has (...) several shortcomings. Aside from ambiguity and confusion, it encourages us to deny that, given the human condition, we must sometimes choose between happiness as pursuit of positive emotion and personal satisfaction and happiness as pursuit of the common good and the virtuous life. (shrink)

Dewey's theory of happiness goes against the grain of much contemporary psychologic and popular thought by identifying the highest form of human happiness with moral behavior. Such happiness, according to Dewey, avoids being at the mercy of circumstances because it is independent of the pleasures and successes we take from experience and, instead, is dependent upon the disposition we bring to experience. It accompanies a disposition characterized by an abiding interest in objects in which all can share, one founded upon (...) a dynamic inner harmony and evolving adjustment to the world. The marks of such an expansive disposition are "stability of character, braveness of soul, and equanimity of soul," and the key to the development of these traits is what Dewey calls "ethical love." We conclude with consideration of three potential criticisms of Dewey's view of happiness and possible Deweyan rejoinders. (shrink)

This interdisciplinary collection of essays highlights the relevance of Buddhist doctrine and practice to issues of globalization. From philosophical, religious, historical, and political perspectives, the authors show that Buddhism—arguably the world’s first transnational religion—is a rich resource for navigating todays interconnected world.

Animals and War: Confronting the Military-Animal Industrial Complex is the first book to examine how nonhuman animals are used in war and the military. Animals and War contributes significantly to the fields of social justice, animal rights, and anti-war/peace activist communities. This book also will be read by peace, conflict, social justice, and critical animal studies scholars, students, and practitioners.

The intent of ethics is to establish a set of standards that will provide a framework to modify, regulate, and possibly enhance moral behaviour. Eleven focus groups were conducted with physicians from six culturally distinct countries to explore their perception of formalized, written ethical guidelines (i.e., codes of ethics, credos, value and mission statements) that attempt to direct their ethical practice. Six themes emerged from the data: lack of awareness, no impact, marginal impact, other codes or value statements supersede, personal (...) codes or values dictate, and ethical guidelines are useful. Overall, codes were valued only when they were congruent with existing personal morality. The findings suggest the need to re-evaluate the purpose, content, and delivery of codes for them to improve their function in promoting ethical conduct. (shrink)

The study examined the influence of the Pond Report on the teaching of medical ethics in the London medical schools. A questionnaire was given to both medical students and college officers. All medical colleges reported that ethics was included in the curriculum. However, from students' replies, it seems that attendance of optional courses is low and that not all current final year medical students have had any formal teaching in medical ethics. Stronger guidelines are necessary to ensure appropriate ethical training (...) in London medical schools. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

Catholic health care has long been a key place where the Church embodies its social doctrine. However, the moral methodology that shapes Catholic bioethics relies on an act-based approach to decision making, which is rooted in the pre–Vatican II manualist tradition, focusing primarily on clinical issues related to the beginning and end of life. This essay argues that given the doctrinal status of Catholic social thought, Catholic bioethics must revisit its scope and methodology. It proceeds in three steps: a meta-analysis (...) of traditional Catholic bioethics, validating the claim made above; an overview of the limited literature published since 1980 engaging Catholic bioethics and CST; and a map of a Catholic bioethics informed by CST generated from a dual starting point. The essay concludes by focusing on both the places where marginalized persons encounter Catholic health care and the ethical issues presented, including race, health care disparities, immigration status, and gender inequality, as well as the interrelated perspective of the common good, expanding the array of issues to include environmental degradation, unions, health care financing, and more. (shrink)

Ideal for survey courses in social and political philosophy, this volume is a substantially abridged and slightly altered version of Steven M. Cahn's Classics of Political and Moral Philosophy (OUP, 2001). Offering coverage from antiquity to the present, Political Philosophy: The Essential Texts is a historically organized collection of the most significant works from nearly 2,500 years of political philosophy. It moves from classical thought (Plato, Aristotle) through the medieval period (Aquinas) to modern perspectives (Machiavelli, Hobbes, Locke, Rousseau, Hume, Adam (...) Smith, Hamilton and Madison, Kant). The book includes work from major nineteenth-century thinkers (Hegel, Marx and Engels, Mill) and twentieth-century theorists (Rawls, Nozick, Foucault, Habermas, Nussbaum) and also presents a variety of notable documents and addresses, including the Declaration of Independence, the Bill of Rights, and speeches by Abraham Lincoln and Martin Luther King, Jr. The readings are substantial or complete texts, not fragments. An especially valuable feature of this volume is that the works of each author are introduced with an engaging essay by a leading contemporary authority. These introductions include Richard Kraut on Plato and Aristotle; Paul J. Weithman on Aquinas; Roger D. Masters on Machiavelli; Jean Hampton on Hobbes; A. John Simmons on Locke; Joshua Cohen on Rousseau and Rawls; Donald W. Livingston on Hume; Charles L. Griswold, Jr., on Adam Smith; Bernard E. Brown on Hamilton and Madison; Paul Guyer on Kant; Steven B. Smith on Hegel; Richard Miller on Marx and Engels; Jeremy Waldron on Mill; Thomas Christiano on Nozick; Thomas A. McCarthy on Foucault and Habermas; and Eva Feder Kittay on Nussbaum. (shrink)

Classics of Political and Moral Philosophy provides in one volume the major writings from nearly 2,500 years of political and moral philosophy. The most comprehensive collection of its kind, it moves from classical thought (Plato, Aristotle, Epicurus, Cicero) through medieval views (Augustine, Aquinas) to modern perspectives (Machiavelli, Hobbes, Spinoza, Locke, Rousseau, Hume, Adam Smith, Kant). It includes major nineteenth-century thinkers (Hegel, Bentham, Mill, Nietzsche) as well as twentieth-century theorists (Rawls, Nozick, Nagel, Foucault, Habermas, Nussbaum). Also included are numerous essays from (...) The Federalist Papers and a variety of notable documents and addresses, among them Pericles' Funeral Oration, the Declaration of Independence, the Constitution of the United States, and speeches by Edmund Burke, Abraham Lincoln, Elizabeth Cady Stanton, John Dewey, and Martin Luther King, Jr. The readings are substantial or complete texts, not fragments. An especially valuable feature of this volume is that the works of each author are introduced with a substantive and engaging essay by a leading contemporary authority. These introductions include Richard Kraut on Plato, Aristotle, Epicurus, and Cicero; Paul J. Weithman on Augustine and Aquinas; Roger D. Masters on Machiavelli; Jean Hampton on Hobbes; Steven B. Smith on Spinoza and Hegel; A. John Simmons on Locke; Joshua Cohen on Rousseau and Rawls; Donald W. Livingston on Hume; Charles L. Griswold, Jr., on Smith; Bernard E. Brown on Hamilton and Madison; Jeremy Waldron on Bentham and Mill; Paul Guyer on Kant; Richard Miller on Marx and Engels; Richard Schacht on Nietzsche; Thomas Christiano on Nozick; John Deigh on Nagel; Thomas A. McCarthy on Foucault and Habermas; and Eva Feder Kittay on Nussbaum. Offering unprecedented breadth of coverage, Classics of Political and Moral Philosophy is an ideal text for courses in social and political philosophy, moral philosophy, or surveys in Western civilization. (shrink)

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

The ontological foundation of the modern world view based on irreconcilable dichotomies has held hegemonic status since the dawn of the scientific revolution. The post‐modern critique has exposed the inadequacies of the modern perspective and challenged the potential for any narrative to adequately ground a vision for the future. This paper proposes that the philosophy of Beatrice Bruteau can support a foundation for a visionary world view consistent with nursing's respect for human dignity and societal health. The author discusses the (...) key concepts of Bruteau's perspective on societal evolution based on an integrated study of science, mathematics, religion, and philosophy. This perspective is discussed as a foundation to move beyond the dichotomous influence of the modern world view and the deconstructive critique of the post‐modern perspective. The author suggests spiritual evolution and a participatory consciousness as an ontological foundation for a cosmology congruent with nursing's social mandate. (shrink)

The kingship has been integrated into the fundamental relationship between Yahweh and the people and that relationship reaffirmed. A crisis has been described and resolved in narrative and theological terms, and a new era can begin.