The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

Integrated information systems are increasingly used in schools, and the advent of the technology-rich classroom requires a new degree of ongoing classroom assessment. Able to track web searches, resources used, task completion time, and a variety of other classroom behaviors, technology-rich classrooms offer a wealth of potential information about teaching and learning. This information can be used to track student progress in languages, STEM, and in 21st Century skills, for instance. However, despite these changes, there has been little change in (...) the kind of data made available to teachers, administrators, students, and parents. Measuring and Visualizing Learning in the Information-Rich Classroom collects research on the implementation of classroom assessment techniques in technology-enhanced learning environments. Building on research conducted by a multinational and multidisciplinary team of learning technology experts, and specialists from around the globe, this book addresses these discrepancies. With contributions from major researchers in education technology, testing and assessment, and education psychology, this book contributes to a holistic approach for building the information infrastructure of the 21st Century school. (shrink)

This paper responds to the contributions by Alexander Bird, Nathan Wildman, David Yates, Jennifer McKitrick, Giacomo Giannini & Matthew Tugby, and Jennifer Wang. I react to their comments on my 2015 book Potentiality: From Dispositions to Modality, and in doing so expands on some of the arguments and ideas of the book.

Dispositionalism about modality is the view that metaphysical modality is a matter of the dispositions possessed by actual objects. In a recent paper, David Yates has raised an important worry about the formal adequacy of dispositionalism. This paper responds to Yates’s worry by developing a reply that Yates discusses briefly but dismisses as ad hoc: an appeal to a ’plenitude of powers’ including such powers as the necessarily always manifested power for 2+2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} (...) \begin{document}$$2+2$$\end{document} to be 4. I argue that the reply is not ad hoc at all, by defending the metaphysics of dispositions that should underly it. I then argue, first, that a proper understanding of dispositions’ degrees provides us with an argument for such necessarily always manifested dispositions; second, that all the natural attempts to block that argument can be resisted without being ad hoc; and third, that pragmatic considerations explain our intuitive resistance to the ascription of necessarily always manifested dispositions. Dispositionalism can be formally adequate after all. (shrink)

This paper explores the prospects for dispositional accounts of abilities. According to so-called new dispositionalists, an agent has the ability to Φ iff they have a disposition to Φ when trying to Φ. We show that the new dispositionalism is beset by some problems that also beset its predecessor, the conditional analysis of abilities, and bring up some further problems. We then turn to a different approach, which links abilities not to motivational states but to the notion of success, and (...) consider ways of implementing that approach. Our results suggest that there are principled disanalogies between abilities and disposition which prevent any dispositional account of abilities from succeeding. (shrink)

The book introduces young researchers to phenomenology and the two primary philosophical approaches along with the vocabulary of phenomenology including how to set up the research design and execute the study to include data collection, data analysis, and presentation of findings.

Some of the series' finest lectures have been lost for many years, unavailable to the public in any form -- until now.

This paper aims to determine whether extended human-machine cognitive systems and group systems can be regarded as autonomous agents. For this purpose, I compare two notions of agency: one developed within analytical philosophy of action and based on the concept of intention, and the other introduced by enactivists via the concepts of autopoiesis and sensorimotor autonomy. I argue that only the latter approach can be used to demonstrate autonomous agency in respect of systems that are not humans as such, though (...) they contain humans as their elements. After introducing Maturana and Varela’s conception of minimal autonomy as a kind of generalization of autopoiesis, I present the three conditions of agency put forward by Barandiaran, Di Paolo and Rohde, noting that they do not invoke the property of being alive as necessary in that respect. I argue that both extended and group systems can satisfy these conditions of agency, even though they are not alive as such. The fulfillment of these conditions, however, is ensured by the autopoietic nature of the living components of these systems. That being said, an autonomous system itself does not need to be alive in the biological sense. Sensorimotor, adaptive agency could emerge out of other processes than those responsible for biological life. The article concludes with a suggestion that this is exactly what will happen if an autonomous system is ever artificially created. It would be functionally indistinguishable from a living organism, though not alive in a biological sense. (shrink)

The American Society for Bioethics and Humanities has created a quality attestation process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (...) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described. (shrink)

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted (...) a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)

The field of clinical ethics consultation has matured into a multidisciplinary profession, with clinical ethics consultants (CECs) being trained in bioethics, philosophy, theology, law, medicine, n...

The stories in this volume shed light on the potential of narrative inquiry to fill gaps in knowledge, particularly given the mixed results of quantitative research on patient views of and experiences with genetic and genomic testing. Published studies investigate predictors of testing (particularly risk perceptions and worry); psychological and behavioral responses to testing; and potential impact on the health care system (e.g., when patients bring DTC genetic test results to their primary care provider). Interestingly, these themes did not dominate (...) the narratives published in this issue. Rather, these narratives included consistent themes of expectations and looking for answers; complex emotions; areas of contradiction and conflict; and family impact. More narrative research on patient experiences with genetic testing may fill gaps in knowledge regarding how patients define the benefits of testing, changes in psychological and emotional reactions to test results over time, and the impact of testing on families. (shrink)

Volume 20, Issue 3, March 2020, Page 27-29.

This article offers a critical examination of the notion of the common good in Catholic social ethical teaching, comparing this concept with utilitarianism and examining parallels between them and common critiques of both. Rather than focusing on the common good and trying to reach agreement on its content as a maximum standard for persons and communities in society, we argue that it is preferable to focus on the common harm. The common harm serves as a minimum standard of what causes (...) harm to individuals and communities in society and should be avoided. The common harm provides both a conceptually sound and practically achievable construct for contributing positively to the social ethical discussion in an increasingly secular society. National Catholic Bioethics Quarterly 13.4 : 617–623. (shrink)

Volume 19, Issue 11, November 2019, Page 69-70.

How does thinking affect doing? There is a widely held view that thinking about what you are doing, as you are doing it, hinders performance. Once you have acquired the ability to putt a golf ball, play an arpeggio on the piano, or parallel-park, reflecting on your actions leads to inaccuracies, blunders, and sometimes even utter paralysis--that's what is widely believed. But is it true? After exploring some of the contemporary and historical manifestations of the idea, Barbara Gail Montero (...) develops a theory of expertise which emphasizes the role of the conscious mind in expert action. She aims to dispel various myths about experts who proceed without any understanding of what guides their action, and she analyzes research in both philosophy and psychology that is taken to show that conscious control and explicit monitoring of one's movements impedes well practiced skills. Montero explores a wide range of real-life examples of optimal performance, in sports, the performing arts, healthcare, the military, and other fields, and draws from psychology, neuroscience, and literature to offer a refreshing and persuasive view of expertise, according to which expert action generally is and ought to be thoughtful, effortful, and reflective. (shrink)

A shift from top-down, hierarchical decision-making toward collaborative, consensus-oriented decision-making is taking place across many settings, leading to meetings in which diverse participants seek to reach agreement on issues of significance. This article proposes a new approach to analyzing such meetings that integrates conversation analysis and issue framing. While CA and IF have both been applied to collaborative decision-making, each approach, on its own, suffers from significant limitations. Combined, they allow negotiation talk in meetings to be examined holistically, integrating a (...) consideration of both process and content. New relationships among interactional sequences and framing processes are revealed, leading to the discovery of patterns across the decision-making activity as a whole. These patterns, in turn, can be situated in the context of the institutions within which the negotiations take place. This novel integrative approach is illuminated through application to a 162-turn decision-making activity. (shrink)

Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co–curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus (...) on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three–year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co–curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician’s Vocation Program (PVP). (shrink)

This book presents the most important problems of reference and considers their solution. It presupposes no technical knowledge, presents analyses from first principles, illustrates every stage with examples, and is written with verve and clarity. This is the ideal introduction to reference for students of linguistics and philosophy of language.

Catholic ethical teaching has increasingly relied on a concept of the common good for making and evaluating social decisions. The authors have argued that the common good is a maximal and ideal concept about which people and communities differ fundamentally. In practice, it does not resolve moral and social disagreements. The concept of the common harm is preferable because it is a minimal standard that can be more clearly identified and agreed for individuals and society, providing a basis for legislative (...) and social action. Bioethics and public health both have strong roots in doing no harm and preventing harm to both individuals and communities in society. The authors argue that the application of the concept of the common harm from these disciplines into wider use in the health professions and public policy would be beneficial. National Catholic Bioethics Quarterly 14.3 : 449–455. (shrink)

We argue that dominant research approaches concerning mental illness, which are centered on traditional categories of psychiatric classification as codified in the DSM-IV, have serious empirical, conceptual, and foundational problems. These problems have led to a classification scheme and body of research findings that provide a very poor map of the domain of mental illness, a map that, in turn, undermines clinical and research pursuits. We discuss some current efforts to respond to these problems and argue that the DSM-5 revision (...) process is not very promising, whereas the NIMH Research Domain Criteria initiative and some recent research in cognitive neuroscience fares better, although the latter remains potentially compromised by residual influences of the DSM-based approach. We conclude with some lessons and suggestions for the pursuit of alternative research pathways. (shrink)

Combining knowledge of social policy and practice with insights from poststructural and feminist theory, the text demonstrates how democratic citizens and the political are continually recreated.

At a time of increasing interest and advocacy in integrated and policy-oriented research, this paper offers an empirically-based view of the intellectual and practical challenges of undertaking such research. It analyses the experience of a long-standing university research and postgraduate training centre from 1973-2004: the Centre for Resource and Environmental Studies at The Australian National University. The paper discusses staff development issues, cross-disciplinary understanding, organisational requirements for collaborative research, postgraduate and early career considerations, a range of integrative frameworks, and the (...) tensions that arise for interdisciplinary research in the political and economic operating environments of modern universities. (shrink)

The Code of Ethics for Health Care Ethics Consultation (HCEC) is a pivotal step in the process of identifying and clarifying standards in our field. It draws on the Core Competencies articulated by...

Background: Direct–to–consumer genetic testing (DTCGT) offers risk estimates for a variety of complex diseases and conditions, yet little is known about its impact on actual users, including their decisions about sharing the information gleaned from testing. Ethical considerations include the impact of unsolicited genetic information with variable validity and clinical utility on relatives, and the possible burden to the health care system if revealed to physicians. Aims: The qualitative study explored primary care patients’ views, attitudes, and decision making considerations regarding (...) DTCGT. This article focuses on the disclosure decisions participants made regarding participation, testing, and results of DTCGT, a topic which arose as a secondary aim of the study. Methods: Through four longitudinal interviews (pre–test, results, 3 and 12 months post–test) we examined twenty primary care patients’ decisions, expressed intentions, and actions regarding disclosure to immediate and extended family, friends and coworkers, and physicians about participation in and results of DTCGT. Individual interviews were analyzed using qualitative content analysis and a summative approach to describe the global themes. Results: Most participants disclosed to some immediate family; less than half disclosed to extended family; approximately half talked to friends. Most participants stated they would or might disclose to physicians about DTCGT and a few did. Conceptual themes that emerged from the data analysis include ambivalence about disclosure, consistency between intention and actual disclosure behavior and decisions, and conditional information sharing. Conclusions: Participants’ intentional and actual disclosure patterns offer insight into how they view DTCGT, weigh results, and the potential impact of DTCGT. (shrink)