Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of the CE (...) chart note. The implementation of the “meaningful use” criteria for EHR, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, requires that health professionals meet certain standards for quality, efficiency, and safety, all of which overlap with the goals of standardization, peer review, and quality improvement within CE consultation. (shrink)

Obesity is the definitive epidemic of the modern era in the United States. Its well-documented public health impacts, especially related to children and adolescents, are horrific. Nearly one-third of American minors are overweight; over 50% of them are obese. Already, these kids suffer from multiple adverse physical and mental health conditions. Sadly, absent serious communal and individual interventions, their lives may be cut short compared to their own parents’ life expectancy. While recent surveillance suggests childhood obesity may be trending down (...) slightly in some populations, public health experts remain concerned about the threat obesity poses to the health of America's youth.The concurrent travesty underlying childhood obesity is the relative societal failure to slow and reverse its spread. (shrink)

Participatory and collaborative approaches in sustainability science and public health research contribute to co-producing evidence that can support interventions by involving diverse societal actors that range from individual citizens to entire communities. However, existing philosophical accounts of evidence are not adequate to deal with the kind of evidence generated and used in such approaches. In this paper, we present an account of evidence as clues for action through participatory and collaborative research inspired by philosopher Susan Haack’s theory of evidence. (...) Differently from most accounts of evidence for use in policies and interventions, our account combines action-oriented (the how) and actors-oriented (the who) considerations. We build on Haack’s theory and on the analysis of examples of participatory and collaborative research in sustainability science and public health research to flesh out six procedural criteria for the generation and mobilization of evidence in and from participatory research. Action-oriented criteria invite to look at evidence from a (a) foundherentist, (b) gradational and (c) quasi-holistic perspective. Actors-oriented criteria point out that evidence generation and utilization are (d) social, (e) personal, and (f) embedded. We suggest that these criteria may reinforce participatory and collaborative approaches to evidence co-production when addressing complex problems in sustainability science and public health allowing for the generation of a kind of practical objectivity. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Philosophising, as Spinoza conceives it, is the project of learning to live joyfully. This in turn is a matter of learning to live together, and the most obvious test of philosophical insight is our capacity to sustain a harmonious way of life. Susan James defends this interpretation and explores Spinoza's influence on contemporary debates.

Human beings are strange animals. Although evolutionary theory has brilliantly accounted for the features we share with other creatures—from the genetic code that directs the construction of our bodies to the details of how our muscles and neurons work—we still stand out in countless ways. Our brains are exceptionally large, we alone have truly grammatical language, and we alone compose symphonies, drive cars, eat spaghetti with a fork and wonder about the origins of the universe.

Many philosophers have been persuaded that if we don’t create our own characters, we cannot be responsible for acts that flow from our characters; they also raise doubts about whether acts that do not flow from our characters can fairly be attributed to us. Both these concerns, however, reflect a simplistic and implausible conception of character and of its relation to our actions and our selves. I suggest a different relationship between character and responsibility: We can be responsible for acts (...) that are in character and also for acts that are out of character, but to be capable of being responsible at all is closely related to the capacity to have a character. I relate this capacity to the exercise of active intelligence—a capacity that is manifested in actions in or out of character, but not in the display of many psychological conditions or disorders. (shrink)

Background Dynamic consent has been proposed as a process through which participants and patients can gain more control over how their data and samples, donated for biomedical research, are used, resulting in greater trust in researchers. It is also a way to respond to evolving data protection frameworks and new legislation. Others argue that the broad consent currently used in biobank research is ethically robust. Little empirical research with cohort study participants has been published. This research investigated the participants’ opinions (...) of adding a dynamic consent interface to their existing study. Methods Adult participants in the Extended Cohort for E-health, Environment and DNA longitudinal cohort study who are members of the EXCEED Public and Participant Engagement Group were recruited. Four focus groups were conducted and analysed for thematic content. Discussion topics were derived from a review of the current literature on dynamic consent. Results Participants were in favour of many aspects of a dynamic consent interface, such as being able to update their information, add additional data to their records and choose withdrawal options. They were supportive provided it was simple to use and not intrusive. Participants expressed a markedly high level of trust in the study and its investigators and were unanimously happy with their current participation. No strong support was found for adding a dynamic consent interface to EXCEED. Conclusions Trust in the study researchers was the strongest theme found. Openness and good data security were needed to retain their trust. While happy to discuss dynamic consent, participants were satisfied with the current study arrangements. There were indications that changing the study might unnecessarily disturb their trust. This raised the question of whether there are contexts where dynamic consent is more appropriate than others. This study was limited by the small number of participants who were committed to the study and biased towards it. More research is needed to fully understand the potential impact of adding a dynamic consent interface to an existing cohort study. (shrink)

Re-consent in research, the asking for a new consent if there is a change in protocol or to confirm the expectations of participants in case of change, is an under-explored issue. There is little clarity as to what changes should trigger re-consent and what impact a re-consent exercise has on participants and the research project. This article examines applicable policy statements and literature for the prevailing arguments for and against re-consent in relation to longitudinal cohort studies, tissue banks and biobanks. (...) Examples of re-consent exercises are presented, triggers and non-triggers for re-consent discussed and the conflicting attitudes of commentators, participants and researchers highlighted. We acknowledge current practice and argue for a greater emphasis on ‘responsive autonomy,’ that goes beyond a one-time consent and encourages greater communication between the parties involved. A balance is needed between respecting participants' wishes on how they want their data and samples used and enabling effective research to proceed. (shrink)

Miranda Fricker?s research carefully negotiates the fields of ethics and epistemology, and the places and points where they overlap and intersect. Her 2007 text Epistemic injustice: Power and the ethics of knowing is particularly noteworthy in this regard. It seamlessly integrates these research areas and, in so doing, turns a critical eye on the common assumption that feminist epistemology, characterized by its focus on the role of gender oppression within knowledge practices, is a marginal field of social epistemology. Fricker challenges (...) her readers to consider the thesis that social and feminist epistemologies are more thoroughly interconnected than is traditionally assumed. (shrink)

I offer a novel interdisciplinary approach to understanding the communicative task of listening, which is under-theorised compared to its more conspicuous counterpart, speech. By correlating a Rylean view of mental actions with a virtue ethical framework, I show listeners’ internal activity as a morally relevant feature of how they treat people. The listener employs a policy of responsiveness in managing the extent to which they allow a speaker's voice to be centred within their more effortful, engaged attention. A just listener's (...) policy of responsiveness avoids unwarrantedly dismissing speakers’ messages on the basis of peripheral attention alone. (shrink)

The primary aim of this essay is to present a case for a heavily revised notion of heterophenomenology. l will refer to the revised notion as ‘enkinaesthesia’ because of its dependence on the experiential entanglement of our own and the other’s felt action as the sensory background within which all other experience is possible. Enkinaesthesia2 emphasizes two things: (i) the neuromuscular dynamics of the agent, including the givenness and ownership of its experience, and (ii) the entwined, blended and situated co-affective (...) feeling of the presence of the other(s), agential (for example, human, horse, cat, beetle) and non-agential (for example, cup, bed, apple, paper) and, where appropriate, the anticipated arc of the other’s action or movement, including, again where appropriate, the other’s intentionality. When the ‘other’ is also a sensing and experiencing agent it is their - in this case, the pair’s - affective intentional reciprocity, their folding, enfolding, and unfolding, which co-constitutes the conscious relation and the experientially recursive temporal dynamics that lead to the formation and maintenance of the deep integral enkinaesthetic structures and melodies which bind us together, even when they pull us apart. Such deeply felt enkinaesthetic melodies emphasise the dialogical nature of the backgrounded feeling of being. (shrink)

Background: Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse—an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future. Research objective: The purpose of the study was (...) to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system. Research design: A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted. Participants and research context: A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents. Ethical considerations: Institutional Review Board approval was obtained from both the university and hospital system. Findings: Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention. Discussion: Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future. Conclusion: Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities. (shrink)

This paper looks at a range of metaphors used within HIV/AIDS discussions and research in support of the claim that bioethicists should pay serious attention to metaphors. Metaphors shape the ways we think about problems and the types of solutions we investigate. HIV/AIDS is an especially rich field for the investigation of metaphor, since the struggles for dominance among different metaphorical options has been very evident. In the field of medical resarch as well as in the area of public policy, (...) different metaphors support different strategies and, therefore, the choice of metaphor has ethical significance. I argue that feminists should engage in these debates since they have an interest in the metaphors selected. They can also learn to be more self-conscious in choosing politically liberating metaphors in other bioethics contexts. (shrink)

Volume 20, Issue 7, July 2020, Page 6-8.

Volume 19, Issue 1, February 2020, Page 78-88.

The Covid‐19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success (...) or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake‐up call, and bioethics must rise to the challenge. (shrink)

This article is a critique, first, of the theory of identity advanced by Judith Butler and many of the feminist critics of identity politics, and, second, of identity politics itself. I argue that Butler's rejection of the modernist subject for its opposite, the fictional, substanceless subject, is untenable. Looking to object relations theory, I argue instead for a concept of the subject as an ungrounded ground, occupying a middle ground between the postmodern and the modern subject. With regard to identity (...) politics I argue that instead of populating the political realm with multiple identities, we should instead remove identity entirely from the political realm. (shrink)

Successful preimplantation genetic diagnosis to avoid creating a child affected by a genetically-based disorder was reported in 1989. Since then PGD has been used to biopsy and analyze embryos created through in viuo fertilization to avoid transferring to the mother’s uterus an embryo affected by a mutation or chromosomal abnormality associated with serious illness. PGD to avoid serious and early-onset illness in the child-to-be is widely accepted. PGD prevents gestation of an affected embryo and reduces the chance that the parents (...) will be faced with a difficult decision of whether to terminate the pregnancy. More controversial have been PGD to select the sex of the child-to-be for “family balancing”, PGD for mere susceptibility to disease and for late-onset disorders such as Alzheimer diseas, and most controversially, PGD to create a donor child who is Human Leukocyte Antigen (HLA-matched with a preexisting sibling in need of stem cell transplant. (shrink)

The Mind Doesn’t Work That Way is an expose of certain theoretical problems in cognitive science, and in particular, problems that concern the Classical Computational Theory of Mind (CTM). The problems that Fodor worries plague CTM divide into two kinds, and both purport to show that the success of cognitive science will likely be limited to the modules. The first sort of problem concerns what Fodor has called “global properties”; features that a mental sentence has which depend on how the (...) sentence interacts with a larger plan (i.e., set of sentences), rather than the type identity of the sentence alone. The second problem concerns what many have called, “The Relevance Problem”: the problem of whether and how humans determine what is relevant in a computational manner. However, I argue that the problem that Fodor believes global properties pose for CTM is a non-problem, and that further, while the relevance problem is a serious research issue, it does not justify the grim view that cognitive science, and CTM in particular, will likely fail to explain cognition. (shrink)

The second volume of companion books on comparative student discipline identifies the best practices in dealing with student misconduct, on six continents, in a legally sound manner.

Through our hands we construct our world and through our construction of our world we construct ourselves. We reach with our hands and touch with our hands, and with this reaching and touching we come to understand how things feel and are. It is not an utterable knowledge, yet it is knowing the world in a dynamically-engaged affective, effective way. Through affective feedback our reaching and touching becomes a prehensive grasping which leads, through the enkinaesthetic givenness of the agent with (...) its world, to a situated and embodied knowing, and the rudiments of apprehension. With each fresh comprehension a new enkinaesthetic enquiry is engendered; with each enquiry we have afresh the anticipatory dynamics of reaching, touching and feeling, with the hand-to-object of world-investigation, the hand-to-body of auto-investigation and investigating the Other. (shrink)

To say that man is made up of strength and weakness, pettiness and grandeur, is not to draw up an indictment against him: it is to define him.Denis Diderot Introduction Not long ago, I was startled to read in my morning paper that legislators in North Carolina were nearing consensus on how to compensate roughly 3,000 people who had been involuntarily sterilized under the state’s eugenics laws – the first of which was enacted in 1919, and the most recent of (...) which wasn’t repealed until 2003. Un... (shrink)

This book takes us on a fascinating journey through the world of thought of Miki Kiyoshi, one of Japan s pre-eminent philosophers before the Pacific War, and thus makes us discover the man behind the philosopher.