Adverse events that harm patients can also have a harmful impact on health care workers. A few health care organizations have begun to provide psychological support to these Second Victims, but there is uncertainty over whether these discussions are admissible as evidence in malpractice litigation or disciplinary proceedings. We examined the laws governing the admissibility of these communications in 5 states, and address how the laws might affect participation in programs designed to support health care workers involved in adverse events. (...) We found that privilege is uneven from stateto- state, and also unclear. Ambiguity alone could have a chilling effect on Second Victim programs. We propose legislation to protect volunteer and health care worker communications provided by peer counselors, or failing this, updating of statutory provisions to explicitly include these communications within the ambit of existing protections. Enhancing protections could help to foster an environment of healing for both patients and caregivers. (shrink)

The harmful impact of an adverse event ripples beyond injured patients and their families to affect physicians, nurses, and other health care staff that are involved. These “Second Victims” may experience intense feelings of anxiety, guilt, and fear. They may doubt their clinical competence or ability to continue working at all. Some go on to suffer post-traumatic stress disorder and depression.Medical institutions long ignored this problem, preferring to believe that adverse events, or “errors,” occur due to incompetence — the unfortunate (...) work of a few “bad” practitioners who deserve, if anything, a reprimand for their negligence. Study after study has rejected this attribution and shown that adverse events in health care stem primarily from systemic flaws, not “bad apples.” Devastating errors, in other words, can, do, and always will happen in the care of competent, well-trained, and caring practitioners. (shrink)

It has been proposed that inferring personal authorship for an event gives rise to intentional binding, a perceptual illusion in which one’s action and inferred effect seem closer in time than they otherwise would . Using a novel, naturalistic paradigm, we conducted two experiments to test this hypothesis and examine the relationship between binding and self-reported authorship. In both experiments, an important authorship indicator – consistency between one’s action and a subsequent event – was manipulated, and its effects on binding (...) and self-reported authorship were measured. Results showed that action-event consistency enhanced both binding and self-reported authorship, supporting the hypothesis that binding arises from an inference of authorship. At the same time, evidence for a dissociation emerged, with consistency having a more robust effect on self-reports than on binding. Taken together, these results suggest that binding and self-reports reveal different aspects of the sense of authorship. (shrink)

The year 2013 may someday be seen as the year a new profession was born. Clinical ethics consultation has been practiced in different ways for roughly 30 years, originally initiated by a group of h...

This book investigates the chaotic end of the Bronze Age in the Aegean and Eastern Mediterranean through the lens of Homeric poetry, with an emphasis on the description of piratical activities described in the Odyssey’s “Second Cretan Lie,” and on the impact of revolutionary seafaring technology in this watershed period in Mediterranean history.

A fourteen year old is diagnosed with aplastic anemia. The teen and his parents are Jehovah’s Witnesses. An ethics consult is called on the day of admission by an ethically sophisticated social worker and attending. The patient and his parents see this diagnosis as “a test of their faith.” The ethical analysis focuses on the mature minor doctrine, i.e. whether the teen has the capacity to make this decision. The hospital chooses to take the case to court, with a result (...) that is at odds with the ethics consultation recommendations. Ethics was never deposed or otherwise invited to be involved with the hearing. Thus the larger question of the relation of ethics and law was brought into stark relief. (shrink)

Beyond Consent examines the concept of justice, and its application to human subject research, through the different lenses of various research populations: children, the vulnerable sick, captive and convenient populations, women, people of colour, and subjects in international settings. Separate chapters address the evolution of research policies, implications of the concept of justice for the future of human subject research, and the ramifications of this concept throughout the research enterprise.

How can one be trained to enter the evolving field of clinical ethics consultation? The classroom is not the proper place to teach clinical ethics consultation; it is best done in a clinical setting. The author maps the elements that might be included in an apprenticeship, and sets out propositions for debate regarding the training needed for clinical ethics consultants and directors of clinical ethics consultation services.

Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment.Returning the locus of capacity assessment to the attending, the primary care doctor, and (...) even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation. (shrink)

In this paper, a new method of quantitatively assessing continuity and discontinuity of visual attention is developed. The method is based on representing narrative information using graph theory. It is applicable to any type of narrative report. Since dream reports are often described as bizarre, and since bizarreness is partially characterized by discontinuities in plot, we chose to test our method on a set of dream data. Using specific criteria for identifying and arranging objects of visual attention, dream narratives from (...) 10 subjects were obtained and mapped onto graphs. The interrater reliabilities were 76% and 91% . Discontinuities in visual attention were quantified by plotting transitions from one part of a graph to another, which provided a spatiotemporal map of attention shifts within a narrative. This procedure was compared with other approaches to discontinuity and also applied to a set of 10 fantasy reports from the same subjects. The results showed that our method includes but transcends other approaches and has the capability to distinguish dream and fantasy reports. To our knowledge, the method provides the most rigorous and reliable measure to date of continuity and discontinuity of attention in narrative reports. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 13-15, August 2012.

The process-dissociation procedure was used to estimate the influence of spatial and form-based processing in the Simon task. Subjects made manual responses to the direction of arrows . The results provide evidence that the form and spatial location of a single stimulus can have functionally independent effects on performance. They also indicate the existence of two kinds of automaticity—an associative component that reflects prior S-R mappings and a nonassociative component that reflects the correspondence between stimulus and response codes.

The COVID-19 pandemic has had an impact on every aspect of our social, cultural and commercial lives, including the world of sport. This book examines the ethical and philosophical dimensions of the intersection of COVID-19 and sport. The book goes beyond simple description of the impact of the pandemic on sport to offer normative judgments about how the sporting world responded to challenges posed by COVID-19, as well as philosophical speculation as to how COVID-19 will change our understanding and appreciation (...) of sport in the long term. It examines the considerations that either influenced - or arguably should have influenced - decisions to continue or to resume the playing of organized sport in the midst of a pandemic. As a part of this analysis, a spotlight is shone on how sport intersected with political issues surrounding COVID-19. It also explores the configuration and meaning of sport in the COVID-19 era, touching on themes such as the nature of sport, and its integrity, and sport's relationship to technology. Other themes include the changed nature of spectatorship, suffering in sport during pandemic times, and the impact of COVID-19 on the Olympic and Paralympic Games. A final chapter looks ahead and asks what sport might look like in a post-COVID world. This is fascinating reading for anybody with an interest in the ethics and philosophy of sport, the sociology of sport, event studies, politics or public health. (shrink)

The Heythrop Journal, Volume 63, Issue 3, Page 333-348, May 2022.

Of Goals and Goods and Floundering About: A Dissensus Report on Clinical Ethics Consultation Content Type Journal Article Pages 275-291 DOI 10.1007/s10730-009-9101-1 Authors Jeffrey P. Bishop, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Mark J. Bliton, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, (...) Suite 400 Nashville Tennessee 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 3. (shrink)

Erratum to: Echo Calling Narcissus: What Exceeds the Gaze of Clinical Ethics Consultation? Content Type Journal Article Pages 171-171 DOI 10.1007/s10730-010-9132-7 Authors Jeffrey P. Bishop, Saint Louis University Tenet Chair of Health Care Ethics, Albert Gnaegi Center for Health Care Ethics Salus Center, Room 527, 3545 Lafayette Ave St. Louis MO 63104-1314 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Ave., 4th Floor, Suite 400 Nashville TN 37203 USA Mark J. Bliton, Vanderbilt (...) University Center for Biomedical Ethics and Society 2525 West End Ave., 4th Floor, Suite 400 Nashville TN 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 22 Journal Issue Volume 22, Number 2. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Philosophy of George Engel and the Philosophy of MedicineJeffrey P. Spike (bio)KeywordsGeorge Engel, psychosocial medicine, medical education, medical humanities, interviewing skills, philosophy of medicine, scientific methodDoctor Brad Lewis has encouraged us to consider George Engel’s philosophy with his excellent essay on Engel and Pragmatism. As a philosopher teaching full time in a medical school, it is refreshing to have an opportunity to analyze the work of two physicians (...) at this level of reflection and abstraction. It is even more of a pleasure because I knew Dr. Engel personally while I was teaching at the University of Rochester School of Medicine. I will make some observations of the philosophy behind Dr. Engel’s work, both published and practical, that is, as reflected in his writing but also in his influence in the medical curriculum at the institution that he called home for some thirty years (as seems appropriate when considering someone’s bona fides as a pragmatist).Engel’s Philosophy and Medicine’s PhilosophyGeorge Engel’s primary philosophical concern was to fight the powerful belief (or perhaps delusion) that medicine was evolving into a pure physical science, an extension of biochemistry and cell biology, or as we would now call them, proteomics and genomics. There is little evidence that he espoused any one methodology for basic science, so much as he opposed any one methodology for medicine. So to say he was a pragmatist seems underdetermined by his words, if that is taken to mean he advocated for changing the methodological model for scientific research. Rather the question is whether his preferred medical methodology is best characterized as pragmatic, or by some other description. On that score I agree with Lewis wholeheartedly.Of course, it might be that the claim of pragmatism is not meant to suggest a change in method for basic science, but to advocate for retaining an appreciation for the whole range of approaches to knowledge, from experimental science to epidemiology, and from epidemiology to acculturation. By that definition of pragmatism, Engel was indeed a pragmatist. Interpreted this way, he wanted medicine to stop worshipping the scientific method and appreciate that there are many paths to knowledge besides through the wet lab.It might be said that there are different scientific methods for different sciences, and Engel wanted us to appreciate that the reductionist methods [End Page 315] appropriate to the sciences of the small are not necessarily methods that can be applied to all sizes of objects we study, or all levels of reality (like the psychological and social). This is the truth about the world, although I am not sure that this is what Engel meant. As Lewis notes, Engel’s writing does sometimes sound as if he worshipped at the alter of science, as if all subjects of importance can be studied scientifically. But if he believed that, he was not correct. It might be, if all the subjects of the university that Lewis mentions are important, that some will turn out to be able to be studied in academically rigorous methods that are not scientific in any of the usual meanings of the word. Consider philosophy itself, for example.To the degree that it may stretch the evidence to say that Engel would have advocated for a pragmatic scientific method, it is still the case that pragmatism as outlined by Lewis and Engel’s biopsychosocial model can both be used to help medicine understand itself and overcome the temptation to idolize science. Medicine is not a science, or at least it is not just a science; in fact, I would suggest that it never was a science, and it will never be a science. Medicine is about health and illness, and uses whatever science it can to promote health and to treat (ameliorate or cure) illness.None of this should necessarily lead us to idolize pragmatism either. If each subject has its own ideal methodology for study, then it may be that pragmatism is the preferred method for, say, clinical judgment, whereas the scientific method is the best for the ‘hard’ sciences, and logic for philosophy. Or perhaps pragmatism and inductive logic are competing models for clinical... (shrink)

Belief in free will is widespread. The present research considered one reason why people may believe that actions are freely chosen rather than determined: they attribute randomness in behavior to free will. Experiment 1 found that participants who were prompted to perform a random sequence of actions experienced their behavior as more freely chosen than those who were prompted to perform a deterministic sequence. Likewise, Experiment 2 found that, all else equal, the behavior of animated agents was perceived to be (...) more freely chosen if it consisted of a random sequence of actions than if it consisted of a deterministic sequence; this was true even when the degree of randomness in agents’ behavior was largely a product of their environments. Together, these findings suggest that randomness in behavior—one’s own or another’s—can be mistaken for free will. (shrink)

In this paper I explore the nature, varieties, causes and meanings of comebacks related to sport. I argue that comebacks have an axiological dimension, and that the best comebacks involve personal growth. I attempt to show that a major reason that comebacks connected to sport are often inspiring is that we are all in need of a comeback at some point in our lives. When improbable comebacks occur in the world of sport, they expand our sense of possibility.

This comment focuses on the informational distinction Brian Skyrms makes between rational choice theories of the social contract and theories based on evolutionary dynamics. The basic point is that to dismiss the rational choice method because of the restrictive informational assumptions may discount interesting work done in the area of bounded rationality. Further, the comment argues that combining the best elements of both approaches into an evolutionary theory of boundedly rational agents can improve the power of social contract theories. To (...) illustrate the point, we work through an example of analysing the data from a bargaining experiment. (shrink)

The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of (...) humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day. (shrink)

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured (...) by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions. (shrink)

The first ethics casebook that integrates clinical ethics (medical, nursing, and dental) and research ethics with public health and informatics. The book opens with five chapters on ethics, the development of interprofessional ethics, and brief instructional materials for students on how to analyze ethical cases and for teachers on how to teach ethics. In today's rapidly evolving healthcare system, the cases in this book are far more realistic than previous efforts that isolate the decision-making process by professions as if each (...) is not embedded in a larger context that involves healthcare teams, hospital policies, and technology. The central claim of this book is that ethics is an important common ground for all of the health professions. Furthermore, when we recognize that our professions converge upon a common goal we will find less conflict and more pleasure in working together. (shrink)

The author analyzes the lessons for ethics consultants presented by McCrary and colleagues in their case, “Elective Delivery Before 39 Weeks’ Gestation: Reconciling Maternal, Fetal, and Family Interests in Challenging Circumstances.” Clinical ethics cases that involve different specialists representing the best interests of different parties in a case, such as this case involving neonatologists and perinatologists, are complex and time-consuming. The author concludes that ethics must insure the interests of the fetus and future person are not subsumed to the interests (...) of those with a voice, without deliberate reflection and strong ethical justification. (shrink)

This target article by Samuel Brown and colleagues (2013) comes to what sound like reasonable and defensible conclusions, but frames them in an overly timid way. The reason may be the authors’ over...

The author of “How Bioethics and Case Law Diverge in Assessments of Mental Capacity: An Argument for a Narrative Coherence Standard” (2020) arrives at a reasonable conclusion; however, it is far le...

Technology tends toward perpetual innovation. Technology, enabled by both political and economic structures, propels society forward in a kind of technological evolution. The moment a novel piece of technology is in place, immediately innovations are attempted in a process of unending betterment. Bernard Stiegler suggests that, contra Heidegger, it is not being-toward-death that shapes human perception of time, life, death, and meaning. Rather, it is technological innovation that shapes human perception of time, life, death, and meaning. In fact, for Stiegler, (...) human evolution has always been part of technological evolution. While one can quibble with the notion of human-technology co-evolution, there is something to be said for the way in which human perception of time, of ageing, and of death seems to be judged against the horizon of perpetual evolution of technological innovation. In this technological imaginary, of which modern medicine is constituent, ageing and death seemingly may be infinitely deferred, and it is this innovating deferral that shapes the contemporary social imaginary around ageing and death in modern medicine. Yet, the reality of living and dying always manifests itself differently than the scripts given to us by the technological imaginary with its myth of endless innovation. In fact, I shall argue that, where the Church created an ars moriendi, the technological imaginary gives us an ars ad mortem when it becomes clear that ageing and death cannot be infinitely deferred. And further, I shall argue that the Church must revivify its ars vivendi—that is to say, its liturgies, its arts, its technics—as a counter narrative to the myth of perpetual innovation that shapes the technological imaginary. (shrink)

To test the notion that shifts in visual imagery and attention are correlated with experiences of emotion, we studied 10 dream reports using an affirmative probe of emotion and a quantitative measure of plot discontinuity. We found that emotion, especially changes in emotion, are correlated with discontinuities in visual imagery. These correlations are quantified using a new graph theoretical method for analyzing narrative reports.

It is a common refrain in sports discourse that one should try one's hardest in sports, or some other variation on this theme. In this paper I argue that there is no generalized duty to try one's hardest in sports, and that the claim that one should do so is ambiguous. Although a number of factors point in the direction of my conclusion, particularly salient is the claim that, in the end, the putative requirement is too stringent for creatures like (...) human beings. The putative duty to try one's hardest in sports does not comport with psychological realism. That being said, there are contexts in which it is reasonable to expect athletes to try hard. Perhaps there is even a duty to put forth such effort. Even so, this obligation does not rise to the level of a generalized duty to try one's hardest in sports. (shrink)

Despite a century of progress in medical knowledge, many diagnostic odysseys end in disappointment, especially when the child has a developmental disorder. In cases of autism and intellectual disability, relatively few children receive a specific diagnosis, and virtually none of those diagnoses lead to a specific medical treatment. Whole‐genome or ‐exome sequencing offers a quantum leap in the diagnostic odyssey, in that we will always learn something from sequencing—sometimes much more than families bargained for, as discussed elsewhere in this special (...) report. The trick is whether the knowledge gained will help the child and family. A family‐centered approach gives families permission to choose but does not lay all of the responsibility on them. The goal is to pursue the degree of medical diagnostic evaluation that matches the family's values. (shrink)