The idea of patient advocacy as a function of clinical ethics consultation (CEC) has been debated in the bioethics literature. In particular, opinion is divided as to whether patient advocacy inherently is in conflict with the other duties of the ethics consultant, especially that of impartial mediator. The debate is complicated, however, because patient advocacy is not uniformly conceptualized. This article examines two literatures that are crucial to understanding patient advocacy in the context of bioethical deliberations: the CEC literature and (...) the literature on advocacy in the social work profession. A review of this literature identifies four distinct approaches to patient advocacy that are relevant to CEC: (1) the best interest approach, (2) the patient rights approach, (3) the representational approach, and (4) the empowerment approach. After providing a clearer understanding of the varied meanings of patient advocacy in the context of CEC, we assert that patient advocacy is not inherently inconsistent with the function of the ethics consultant and the CEC process. Finally, we provide a framework to help consultants determine if they should adopt an advocacy role. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bedside VoicesJacqueline J. GloverThis issue of Narrative Inquiry in Bioethics features ten stories of Certified Nursing Assistants (CNAs) who work primarily in long-term care. This is a voice of direct care at the bedside that is not often heard. The addition of these stories in the literature is long overdue and I am honored to be asked to comment. There is much to learn from these bedside caregivers. All (...) of these stories reflect the deep struggle to be respected as a member of the health care team. But I also hear the pain of being caught in the tension between the desire to be skilled, qualified, and professional and the desire to be present in a way that emphasizes service, caring and common human touch. My commentary is informed by my experience in Rural Bioethics and my work at the Center for Bioethics and Humanities at the University of Colorado which has a commitment to Interprofessional Education. The CNAs' stories reveal much that they share with other health care professionals, but also some unique features that can teach us much.CommonalitiesSelf Care and Being Cared ForThe voice of the CNA is a voice that is echoed in a way by all health care professionals. Each of the stories bears witness to the need to take care of yourself and to be cared for in order to be able to continue to care for others. Leilani Roseberry writes "This unresolved grief and constant exposure to dying and death had me looking at every day, even every moment, through the eyes of a dying person. This is an emotion that is very difficult to put into words." She continues elsewhere, "I believe that if I had grief support opportunities available to me in my professional life, my level of care and compassion would have been much more resilient from the very beginning of my work as a CNA. Instead, only after sorting through emotions affecting my personal life and learning they were a compilation of what I experienced professionally, only then have I become much more resilient in the face of grief and mourning." Danny Reed writes, "Caregivers benefit from the same thing patients and residents do: genuine kindness. Take care of the caregivers because one day they will be all you have left in the world." And from James Bradley, "The work itself can be very draining, but to beat the stress of it, you can follow all the usual stuff like going for walks, playing with your kids, watch TV etc. The best advice though is to, as far as possible, leave the work behind when you walk off at the end of your shift. That may be the hardest thing to do but it is the only way to retain the correct professional approach."Self care can certainly be about boundaries and stress management. Health care institutions, including professional schools, increasingly have wellness programs (Johnson, 2000). It was once thought that [End Page 159] professional and emotional distance was necessary to maintain healthy relationships and avoid burn out. But current thinking seems to indicate the opposite. If a health care professional views his or her work only in terms of tasks to be performed without some connection to the meaning of what he or she is doing for the patient as a human being, that person is more likely to burn out (Halpern, 2003). Bradley's use of "correct professional approach" prompted me to think beyond wellness and health to the need to nurture meaning in one's work. The CNAs' essays are filled with the call to recognize the deeper meaning of their work. Tracy Dudzinski writes, "Most people think anyone can do this job. I thought that myself, twelve years ago. But now I know that it takes someone special. Direct care workers do not do this work because they are getting rich. They do it because they love the work and because it is the right thing to do. This is the hardest job I have ever done but it is also the most rewarding job I have ever done."There is increasing attention to the use of reflective writing in... (shrink)

Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We (...) present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical “authorization,” for cadaveric organ donation using TA-NRP. (shrink)

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a (...) nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID. (shrink)

This article tracks how group egotists disavow their hate group identity. Group egotists are individuals born and raised in hate groups. The well-documented exit cases of Megan Phelps-Roper (Westboro Baptist Church) and Derek Black (White Nationalism) prove that hate group indoctrination can be undermined. A predominantly epistemic approach, which focuses on argument and conversational virtues, falls short in capturing the complexity of their apostasies. I turn to pragmatism for conceptual support. Using the work of Richard Rorty and William James, I (...) explain how redemptive relationships and alternative lifeworlds participate in weakening belief-systems, leading to the disavowal of the hate group. (shrink)

The book makes a new contribution to the contemporary debates on nihilism and the sacred. Drawing on an original interpretation of Richard Rorty’s writings, it challenges the orthodox treatment of nihilism as a malaise that human beings must overcome. Instead, nihilism should be framed as a problem for human culture to outgrow through pragmatism.

In an ongoing class action suit against large tobacco companies, including Philip Morris, Inc., and R.J. Reynolds Tobacco Co., Judge Jack B. Weinstein of the U.S. District Court for the Eastern District of New York issued an opinion on October 15, 2002 making statistical proof available to address plaintiffs’ common questions and prove required elements of consumer fraud.The dilemmas inherent in tobacco litigation as a mass tort action include overcoming the collective action problem, mobilizing appropriate and persuasive legal theories for (...) recovery, and meeting the standards of proof, all in a timely and cost-effective manner. While some tobacco cases have proceeded on products liability theories of defective or negligent design, many recent cases are grounded in consumer fraud laws. (shrink)

Artykuł stanowi próbę kulturowej analizy powieści kryminalnej Jerzego Putramenta Strachy w Biesalu (1958). Utwór osadzony został w literackim i społecznym kontekście epoki, co pozwoliło na scharakteryzowanie jego genezy, formy oraz recepcji. W toku analizy omówione zostały trzy główne aspekty dzieła Putramenta. W pierwszej części tekstu autor opisuje, w jaki sposób powieść wpisywała się w charakterystyczny dla okresu postalinowskiej odwilży proces przemiany oficjalnego stosunku do literatury sensacyjnej. Zaakceptowano wówczas powieść kryminalną jako gatunek rozrywkowy i oczekiwano, że sięgną po niego cieszący się (...) uznaniem pisarze – wierzono bowiem, że zapewni to wysoki poziom powstającym w ten sposób utworów. W drugiej części artykułu analizie poddano metafikcjonalny i pastiszowy charakter powieści Putramenta, która dzięki licznym odwołaniom do metaforyki teatralnej ujawnia i tematyzuje mechanizmy rządzące konwencją kryminalną. W części ostatniej zrekonstruowany został społeczny kontekst Strachów w Biesalu – powieść odnosi się bowiem do charakterystycznych dla drugiej połowy lat 50. procesów emancypacji kobiet i wykorzystuje genderowe stereotypy związane z tymi procesami. Powieść Putramenta stanowi zatem także satyrę wykpiwającą środowisko artystyczne oraz młode, zafascynowane modą i kulturą Zachodu kobiety. Autor artykułu dowodzi jednak, że krytycznemu tonowi powieści towarzyszy także mimowolna fascynacja wyemancypowaną kobiecością. (shrink)

In this paper we consider the prospects for an account of good argument that takes the character of the arguer into consideration. We conclude that although there is much to be gained by identifying the virtues of the good arguer and by considering the ways in which these virtues can be developed in ourselves and in others, virtue argumentation theory does not offer a plausible alternative definition of good argument.

Jean Dominique Bauby, former editor of Elle, suffereda stroke to his brain stem that left him with locked-in syndrome. Subsequently, through blinking his left eye, he writes his memoirof this experience, The Diving Bell and the Butterfly. Thispaper explores the meaning of embodiment, especially as one'sbody bears upon one's personal identity. It explores the variouschallenges and threats to selfhood that result from Bauby'sexperience and recounts how Bauby rises to the challenge throughhis memory and imagination.

Ethics consultants and critical care clinicians reflect on Seattle’s early experience as the United States’ first epicenter of COVID-19. We discuss ethically salient issues confronted at UW Medicin...

Although many of the congenital syndromes that used to be lethal no longer are, they are still routinely referred to as “lethal anomalies.” But the label is not only inaccurate, it is also dangerous: by portraying as a medical determination what is in fact a judgment about the child's quality of life, it wrests from the parents a decision that only the parents can make.

Intentional collective action -- Collective moral responsibility -- Collective guilt -- Individual responsibility for (and in) collective wrongs -- Collective obligation, individual obligation, and individual moral responsibility -- Individual moral responsibility in wrongful social practice.

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

Wrestling with the Angel is a meditation on contemporary political, legal, and social theory from a psychoanalytic perspective. It argues for the enabling function of formal and symbolic constraints in sustaining desire as a source of creativity, innovation, and social change. The book begins by calling for a richer understanding of the psychoanalytic concept of the symbolic and the resources it might offer for an examination of the social link and the political sphere. The symbolic is a crucial dimension of (...) social coexistence but cannot be reduced to the social norms, rules, and practices with which it is so often collapsed. As a dimension of human life that is introduced by language--and thus inescapably "other" with respect to the laws of nature--the symbolic is an undeniable fact of human existence. Yet the same cannot be said of the forms and practices that represent and sustain it. In designating these laws, structures, and practices as "fictions," Jacques Lacan makes clear that the symbolic is a dimension of social life that has to be created and maintained and that can also be displaced, eradicated, or rendered dysfunctional. The symbolic fictions that structure and support the social tie are therefore historicizable, emerging at specific times and in particular contexts and losing their efficacy when circumstances change. They are also fragile and ephemeral, needing to be renewed and reinvented if they are not to become outmoded or ridiculous. Therefore the aim of this study is not to call for a return to traditional symbolic laws but to reflect on the relationship between the symbolic in its most elementary or structural form and the function of constraints and limits. McNulty analyzes examples of "experimental" (as opposed to "normative") articulations of the symbolic and their creative use of formal limits and constraints not as mere prohibitions or rules but as "enabling constraints" that favor the exercise of freedom. The first part examines practices that conceive of subjective freedom as enabled by the struggle with constraints or limits, from the transference that structures the "minimal social link" of psychoanalysis to constrained relationships between two or more people in the context of political and social movements. Examples discussed range from the spiritual practices and social legacies of Moses, Jesus, and Teresa of Avila to the political philosophy of Hannah Arendt and Jacques Rancière. The second part is devoted to legal and political debates surrounding the function of the written law. It isolates the law's function as a symbolic limit or constraint as distinct from its content and representational character. The analysis draws on Mosaic law traditions, the political theology of Paul, and twentieth-century treatments of written law in the work of Carl Schmitt, Walter Benjamin, Sigmund Freud, Pierre Legendre, and Alain Badiou. In conclusion, the study considers the relationship between will and constraint in Kant's aesthetic philosophy and in the experimental literary works of the collective Oulipo. (shrink)

“The Innsmouth Look: H. P. Lovecraft’s Ambivalent Modernism” explores how horror writing responds to the anxieties and possibilities presented by historical modernity. Lovecraft, in his short story “The Shadow Over Innsmouth,” translated contemporary concerns about immigration, industrialization and racial difference into a plot about a young traveler encountering a terrifying alien population in a small New England town. The essay examines the ways that this story both demonstrates how the dehumanization of the racialized “other” operated during the modern period, and (...) exposes the inherent fallacy in such objectification. Though the aliens in the story are physically distinct, and the visual difference provokes disgust and withdrawal in the narrator, this “Innsmouth look” also reveals the way the objectified other is always looking back, a subject in his or her own right. (shrink)

The motivations for rural and agricultural development in the twenty-first century are not different from previous centuries, but evolving technologies in the late twentieth century have altered many methods and institutional arrangements for accomplishing development. The internet has facilitated initiatives that in earlier decades would have required large, complex organizations in both donor and developing countries. We will compare the ethical and institutional strengths and weaknesses of two such initiatives in Malawi: a smallholder farmers organization involved in fair trade and (...) the Millennium Village Project. These are two of a large array of institutions which are currently being used to benefit smallholder agricultural producers. We will examine their relative merits through the lenses of various ethical paradigms and show that the institutional arrangements of the two programs are complimentary in the evolution of agricultural trading systems linking the global north and south. (shrink)

Leonard Norman Primiano (1957–2021), esteemed folklorist and ethnographer of religion, relied for 16 years on assistive technology to speak. Described by an anonymous reviewer as “our ever-vanguard of thought, work, and ethics, not to mention creativity, funkiness, and joy,” Primiano brought a reverential delight to his vocation and inspired a reverential delight in return. This essay reflects on Primiano as a radiant example of the capacity for wonder.

This book examines both the personal and the political sides of Nietzsche's writings to show how his writings can expand notions of democratic politics and democratic understanding.

Rorty uses the private–public distinction as a conceptual tool to uphold the ideal of self–creation (Romanticism) simultaneously to the ideal of solidarity (Enlightenment liberalism). The difficulty of accommodating these two apparently opposing ideals has led Rorty to make inconsistent and contradictory claims about the private–public distinction. This article suggests a way of easing the tension that exists around Rorty’s formulations of the distinction. It does so by turning to the thematic of “self–enlargement” to be found in Rorty’s later writings. By (...) presenting self–enlargement as a common feature of self–creation and solidarity, this reading opens up a way of reconciling these two ideals and mitigating some of the difficulties in Rorty’s private–public distinction. (shrink)

Cross-species comparisons are benefited by compatible datasets; conclusions related to phylogenetic comparisons, questions on convergent and divergent evolution, or homologs versus analogs can only be made when the behaviors being measured are comparable. A direct comparison of the social function of physical contact across two disparate taxa is possible only if data collection and analyses methodologies are analogous. We identify and discuss the parameters, assumptions and measurement schemes applicable to multiple taxa and species that facilitate cross-species comparisons. To illustrate our (...) proposed guidelines for evaluating the role played by tactile contact in social behavior across disparate taxa, this paper presents data on mother-offspring relationships in the two species studied by the authors: chimpanzees (Pan troglodytes schweinfurthii) and dolphins (bottlenose and spotted, Tursiops truncatus and Stenella frontalis, respectively). Cross-species comparative studies allow for a more comprehensive assessment of the similarities and differences with respect to how animals traverse the relationships that form their social groups and societies. (shrink)

The aim of this study was to understand how incivility is viewed across multiple academic programs and respondent subgroups where different institutional and cultural power dynamics may influence the way students and faculty perceive uncivil behaviors. This study used the Conceptual Model for Fostering Civility in Nursing Education as its guiding framework. The Incivility in Higher Education Revised (IHE-R) Survey and a detailed demographic questionnaire were used to gather self-assessment and personal perspective data regarding incivility in the higher education setting. (...) This approach aspired to collect a comprehensive perspective of incivility in higher education. With data from 400 students and 69 faculty, there was limited agreement between faculty and student participants about perceptions and experiences with incivility. Faculty and students did agree that the solution to incivility may be found with the creation of a code of conduct that defines acceptable and unacceptable behavior, role-modeling professionalism and civility, and taking personal responsibility and standing accountable for actions. Despite significant differences in participants’ perceptions of incivility, they shared common solutions. With a shared goal, faculty and students can work toward cultivating civility in higher education. (shrink)

Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on (...) the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)

Volume 20, Issue 3, March 2020, Page 6-8.

Tacitus traces a series of conflicts between Agrippina the Elder and her father-in-law Tiberius. After the death of her husband Germanicus in Syria, Agrippina returned to Rome with their children. Germanicus' lingering popularity with the armies and people meant that his widow Agrippina and their children enjoyed a level of popular support as well—one that eventually became a threat in Tiberius' mind. Agrippina, moreover, refused to embrace the modest, retiring role that her father-in-law expected of her. Tiberius was, moreover, ‘never (...) gentle toward the house of Germanicus’ and his concerns were augmented by the machinations of Sejanus, who reported that the people were dividing themselves into factions, some even calling themselves members of the partes Agrippinae. The combination of Agrippina's high birth—the only still-living grandchild of Augustus—and her status as widowed daughter-in-law of the emperor, therefore mother of the emperor's probable heir, along with her persistent independence and sometimes unfeminine strength of character made her seem an intolerable political threat. This paper examines the culmination of these conflicts, when Agrippina is subjected to criminal prosecution and penalty in a.d. 27 and 29 at the instigation of Sejanus, with the overt approval of Tiberius. Of primary concern is the timing and the order of the charges brought against Agrippina. (shrink)