While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

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)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

This book takes a new approach to ethics by focusing on the kinds of dilemmas that confront people almost daily on the job.

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Known as the “Mother of Tibetan Buddhism” and the “Mother of Knowledge,” Yeshe Tsogyal built upon indigenous Bön philosophy and Mahāyāna Buddhism to bring about a Buddhism that is identifiably Tibetan. I report on her life, her works and teaching. Then summarize her significance as a philosopher of Tibetan Buddhist metaphysics, epistemology and ethics. Lastly, I append portions of several writings attributed to her.

A History of Women Philosophers, Volume I: Ancient Women Philoophers, 600 B.C. - 500 A.D., edited by Mary Ellen Waithe, is an important but somewhat frustrating book. It is filled with tantalizing glimpses into the lives and thoughts of some of our earliest philosophical foremothers. Yet it lacks a clear unifying theme, and the abrupt transitions from one philosopher and period to the next are sometimes disconcerting. The overall effect is not unlike that of viewing an expansive landscape, (...) illuminated only by a few tiny spotlights. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

In this volume we provide rich examples of non-western philosophy written by women over the last four thousand years. We begin by defining the scope of our non-western terrain: philosophy created outside the Greco-Roman, Judeo-Christian traditions. The philosophers who are the subjects of inquiry here hail from places as distant as pre-colonial Africa, the Americas, Asia and Australia. Together with our expert contributing authors we demonstrate through inquiry and analysis how these women philosophers advanced human thought about profound issues, some (...) to include the nature and treatment of women themselves. (shrink)

Service-learning has received a great deal of attention in the management education literature over the past decade, as a method by which students can acquire moral and civic values as well as gain academic knowledge and practice real-world skills. Scholars focus on student and community impact, curricular design, and rationale. However, the educational environment (“context”) in which service-learning occurs has been given less attention, although experienced educators know that the classroom is hardly a vacuum and that students learn a great (...) deal from the non-curricular aspects of their educational experience. Moral values in particular are conveyed by what is not said. Given this, I argue that the contexts in which service-learning takes place are as important as the activity itself. Three perspectives on context will be described and assessed: the “hidden” curriculum, the educational atmosphere, and the university’s orientation towards social responsibility. (shrink)

Courses in the history of philosophy which exclude contributions made by women cannot legitimately claim to teach this history. This is true, not merely because those histories are incomplete, but rather because they give a biased account. I sketch the difficulties thus posed for the profession, and offer suggestions for developing a less biased, more accurate understanding of the history of philosophy.

Oliva Sabuco's New Philosophy of Human nature (1587) is an early modern philosophy of medicine that challenged the views of the successors to Aristotle, especially Galen and Ibn Sina (Avicenna). It also challenged the paradigm of the male as the epitome of the human and instead offers a gender-neutral philosophy of human nature. Now largely forgotten, it was widely read and influential amongst philosophers of medicine including DeClave, LePois, Harvey,Southey and others, particularly for its account of the role of the (...) nervous system and cerebrospinal fluid in mind-body interaction. In this article I trace its early influence by tracing provenance of the editions produced during the lifetime of its author. (shrink)

Emérita Quito was the first woman from the Philippines to complete a Ph.D. in Philosophy. Her early Scholastic training as an undergraduate was at the University of Santo Tomas expanded to include phenomenology and existentialism during her graduate studies at major European universities. Upon returning home she began to focus on the idea of developing a methodology for investigating indigenous Filipino philosophy. How does one reveal the concepts and principles underlying the belief systems within a country that has suffered a (...) thousand years of occupation by foreign forces, that speaks with hundreds of different dialects across more than seven thousand islands spread across more than one hundred thousand square miles? This amazing philosopher published extensively not only in western philosophy, but on that indigenous to this island nation, prior to the incursions of western nations and the introduction to the Philippines of western philosophical views. (shrink)

The plot thickens--in novels and our lives--forcing us from the fairy tale into a bewildering, even heartbreaking narrative. We look at the god we're holding, and find it too fragile, too brittle to meet reality. Cling tighter? Move on godless? In fact, rejecting a god image (or as C. S. Lewis puts it, allowing God to smash our limited god) opens space for deeper faith in the midst of painful life experience. In OMG, Mary Ellen Ashcroft invites readers (...) to look over her shoulder as she traces her god growth, beginning with a capricious childhood god. The loving savior who embraced her when she was eighteen, followed her into strict fundamentalism, while the god she met in an Anglican seminary shocked her by caring more about poverty than a seven-day creation, but then called her to a South Africa tipping toward revolution. An interweaving of narrative theology and creative nonfiction, OMG invites readers to grow into deeper faith, retelling their stories in the light of the biblical one, dropping inadequate gods to grasp a mysterious, awesome one. (shrink)

In this Chapter I present early Mesopotamian philosophical views and contrast them to En Hedu’Anna’s account of metaphysics, epistemology, ontology, philosophy of religion and her views on several socio-political issues. Through her writings we see her views of the cosmos, of deities, of women’s nature, gender fluidity, justifications for violence, and other significant concepts. Lastly, I summarize her influence and suggest that her work marks a new dawn, a first, for Philosophy.

The central goal of this essay is to develop a theory of justified paternalism that will be useful in evaluating and designing paternalistic public policies. The theory is designed for a society that promotes the development of characteristics of autonomy in its members. In the opening chapter I analyze widely-held legal, familial and philosophic conceptions of paternalism, discuss the inadequacies of each of those conceptions and develop a "unified" conception of paternalism. In Chapter II I analyze what it means to (...) be "morally responsible" and base this analysis on the legal, psychological and psychiatric accounts of responsibility that inform an autonomist society. From these analyses I develop two principles which inform an autonomist society: Respect for Others and Non-Interference and discuss the restraints on justifiable paternalism entailed by them. In Chapter III I discuss the roles of voluntariness and consent in the legal, phychiatric and philosophic concepts of moral responsibility and turn to an analysis of the disappointing treatments of these concepts in traditional philosophic justifications for paternalism. I argue that "unencumbered consent" is an appropriate concept of consent to utilize in any philosophic justification for paternalism that would be consistent with the concepts of moral responsibility and autonomy and the principles of respect for others and of non-interference. Chapter IV offers a decision-theoretic model justifying acting paternalistically for others. Each of the necessary conditions for justified paternalism is drawn from the aforementioned concepts and principles. In Chapter V, I show that if Rawls is to be consistent, he must adopt a theory of paternalism similar to mine, and I argue that my theory of paternalism overcomes libertarian, utilitarian and statistical arguments against it. I then apply the theory to specific forms of paternalism including involuntary commitment and guardianship, mandatory blood transfusions, flouridation of public water supplies, mandatory motorcycle helmets and seatbelts, social security taxation, mandatory education of children and suicide intervention. A 267-entry bibliography is appended. (shrink)

aspirations, the rise of western monasticism was the most note worthy event of the early centuries. The importance of monasteries cannot be overstressed as sources of spirituality, learning and auto nomy in the intensely masculinized, militarized feudal period. Drawing their members from the highest levels of society, women's monasteries provided an outlet for the energy and ambition of strong-willed women, as well as positions of considerable authority. Even from periods relatively inhospitable to learning of all kinds, the memory has been (...) preserved of a good number of women of education. Their often considerable achievements and influence, however, generally lie outside even an expanded definition of philo sophy. Among the most notable foremothers of this early period were several whose efforts signal the possibility of later philosophical work. Radegund, in the sixth century, established one of the first Frankish convents, thereby laying the foundations for women's spiritual and intellectual development. From these beginnings, women's monasteries increased rapidly in both number and in fluence both on the continent and in Anglo-Saxon England. Hilda (d. 680) is well known as the powerful abbsess of the double monastery of Whitby. She was eager for knowledge, and five Eng lish bishops were educated under her tutelage. She is also accounted the patron of Caedmon, the first Anglo-Saxon poet of religious verse. The Anglo-Saxon nun Lioba was versed in the liberal arts as well as Scripture and canon law. (shrink)

Philosophy became known as a “man’s” profession over the past three thousand years. This is an account of how, in the case of Diotima of Mantinea, the histories of philosophy came to systematically ignore, overlook, doubt and declare false the fact that some philosophers had uteruses. The effect has been a massive hysterectomy –the removal from or ignoring of women’s contributions to Philosophy as related by the major histories and encyclopedias of Philosophy. This nearly discipline-wide hysterectomy has created the false (...) impression that women cannot think philosophically. In this PowerPoint presentation I will present historical and archeological evidence relative to Diotima of Mantinea who may have been the first woman philosopher to receive a posthumous hysterectomy by later historians of philosophy. (shrink)

Concerns of public responsibility and professional certification may sometimes mean it is unethical to teach ethics.

This book presents the views of 22 women philosophers from outside the Greco-Roman and Judeo-Christian worlds. These eminent thinkers are from Mesopotamia, India, Tibet, China, Korea, Japan, Australia, America, the Philippines and Nigeria. Six philosophers, the earliest of whom predates the Greek pre-Socratics by two thousand years, lived at “the dawn of philosophy”; another six from late Antiquity through the Classical period; five more taught and wrote during the Middle Ages up to the Age of Exploration, and yet five others (...) were active during the modern period to the mid-twentieth century. Most belonged to major philosophical traditions: Hinduism, Buddhism, Confucianism, Taoism, Zen, or Sufism. The chapters of the book describe the life and views of the philosophers, outline the fundamental features of their respective schools, and contain translations of their writings. The book is intended for scholars of philosophy and women’s studies who wish to expand their knowledge of non-Western philosophical traditions and is ideally suited for undergraduate education. Comprehensive multilingual bibliographies of carefully documented sources offer scholars many promising resources for further research. (shrink)