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BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

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BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” who self-identified (...) as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

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A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

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Prayer and the temple were two of the most prominent themes in the Third Gospel and they have garnered scholarly interest. However, the discussion about prayer vis-à-vis the temple in Luke’s special source (L) has gone unnoticed. Using source criticism and narrative criticism, the research shows a connection between prayer and the temple in L. The relationship between the two reflects the development from a belief in the temple as a place for praying and receiving an answer, to Jesus who (...) intercedes for the people. This article argues that the prayer in Luke’s special source revealed Jesus as the new, personified temple through whom the L communities prayed and received answers to their prayers. Based on this finding, this article then shows the possible reconstruction of the separation between Judaism and Christianity from the perspective of L communities. Contribution: This article contributes to the discussion on Lukan Christology by proposing that Jesus is the new personified temple as understood by the L communities. Such a depiction lends new support to Dunn’s reconstruction of the parting of the ways between Jews and Christians. (shrink)

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To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

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This paper critically examinesChristopher Zurn’s suggestion mentioned above that various social pathologies (pathologies of ideological recognition, maldistribution, invisibilization, rationality distortions, reification and institutionally forced self-realization) share the structure of being ‘second-order disorders’: that is, that they each entail ‘constitutive disconnects between first-order contents and secondorder reflexive comprehension of those contents, where those disconnects are pervasive and socially caused’ (Zurn, 2011, 345-346). The paper argues that the cases even as discussed by Zurn do not actually match that characterization, but (...) that it would be premature to conclude that they are not thereby social pathologies, or that they do not have a structure in common. It is just that the structure is more complex than originally described, covering pervasive socially caused evils (i) in the social reality, (ii) in the first order experiences and understandings, (iii) in the second order reflection as discussed by Zurn, and also (iv) in the ‘third order’ phenomenon concerning the pre-emptive silencing or nullification of social criticism even before it takes Place. -/- Research Interests: Critical Theory, Social Theory, Political Theory, Recognition - Social Pathologies, Axel Honneth, Mutual recognition and Dani Zubair . (shrink)

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Hegel’s Logic reveals an insightful and subtle engagement with the traditional problem of free will as it emerges from our basic commitment to the explicability of the world. While the dominant current interpretations of Hegel’s theory of agency find little of significance in the Logic and suggest that Hegel avoided the traditional problem, Yeomans argues both that the problem is unavoidable, and that the two versions of the Logic fruitfully engage the tensions between explicability and both the control and alternate (...) possibilities constitutive of free agency. In particular, Yeomans examines Hegel’s response to three different versions of the principle of sufficient reason that have historically seemed to make free will problematic. The central three chapters take up each of these versions in turn. For each, Yeomans first explores the nature of its challenge to free will with glances both at Hegel’s precursors and contemporaries and at the philosophy of action of our own time. Then Yeomans delves into the arguments of Hegel’s Logic to see how he construed the problematic concepts in question. Finally, Yeomans returns to the issue of free will to bring Hegel’s interpretations of the concepts in the Logic together with elements of his moral psychology from his practical philosophy both to show how the problem of free will can be resolved, and to trace in outline the shape of free will that such a resolution produces. The key connection between the Logic’s reflections on the form of explanation and the practical philosophy’s theory of the will is that both attempt to do justice to the mutual necessity of self-determination and external influence. (shrink)

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ABSTRACTAn essential and yet often neglected motivation of Bernard Suits’ elevation of gameplay to the ideal of human existence is his account of capacities along perfectionist lines and the function of games in eliciting them. In his work Suits treats the expression of these capacities as implicitly good and the purest expression of the human telos. Although it is a possible interpretation to take Suits’ utopian vision to mean that gameplay in his future utopia must consist of the logically inevitable (...) replaying of activities we conduct in the present for instrumental reasons, because gameplay for Suits is identical with the expression of sets of capacities specifically elicited by game rules, it is much more likely that he intends utopian gameplay to be an endless series of carefully crafted opportunities for the elicitation of special capacities, and thus embody his ideal of existence. This article therefore provides a new lens for understanding both... (shrink)

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This book is about fundamental questions in normative ethics. It begins with the idea that we often respond to ethical theories according to how principled or pragmatic they are. It clarifies this contrast and then uses it to shed light on old debates in ethics, such as debates about the rival merits of consequentialist and deontological views. Using the idea that principled views seem most appealing in dilemmas of acquiescence, it goes on to develop a novel theory of pattern-based reasons. (...) These are reasons to play one’s part in some larger pattern of action because of the goodness or rightness of that pattern. Existing accounts of pattern-based reasons usually assume that such reasons can exist only in cooperative contexts. This book rejects that assumption, and claims instead that we can have pattern-based reasons even when the other agents involved in the pattern are wholly unwilling to cooperate. The result is a pluralist teleological structure for ethics, with similarities to some forms of Rule Consequentialism. Woodard claims that this structure achieves an attractive balance between the two virtues of being pragmatic and being principled. (shrink)

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An interpretation of war and foreign affairs in Machiavelli's writings.

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Do states have the right to prevent potential immigrants from crossing their borders, or should people have the freedom to migrate and settle wherever they wish?Christopher Heath Wellman and Phillip Cole develop and defend opposing answers to this timely and important question.

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Deconstructing Azawad -- The plundering of Mali, past and present -- The African trace -- The Sahelian specter -- The duty of violence -- Nyama, fratricide, and reconciliation -- What is to be done? -- Zongo, Sankara, and the Burkinabe revolution.

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Christopher Woodard presents a new and rich version of utilitarianism, the idea that ethics is ultimately about what makes people's lives go better. He launches a state-of-the-art defence of the theory, often seen as excessively simple, and shows that it can account for much of the complexity and nuance of everyday ethical thought.

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"These notes are about the process of design: the process of inventing things which display new physical order, organization, form, in response to function." This book, opening with these words, presents an entirely new theory of the process of design. In the first part of the book,Christopher Alexander discusses the process by which a form is adapted to the context of human needs and demands that has called it into being. He shows that such an adaptive process will (...) be successful only if it proceeds piecemeal instead of all at once. It is for this reason that forms from traditional un-self-conscious cultures, molded not by designers but by the slow pattern of changes within tradition, are so beautifully organized and adapted. When the designer, in our own self-conscious culture, is called on to create a form that is adapted to its context he is unsuccessful, because the preconceived categories out of which he builds his picture of the problem do not correspond to the inherent components of the problem, and therefore lead only to the arbitrariness, willfulness, and lack of understanding which plague the design of modern buildings and modern cities. In the second part, Mr. Alexander presents a method by which the designer may bring his full creative imagination into play, and yet avoid the traps of irrelevant preconception. He shows that, whenever a problem is stated, it is possible to ignore existing concepts and to create new concepts, out of the structure of the problem itself, which do correspond correctly to what he calls the subsystems of the adaptive process. By treating each of these subsystems as a separate subproblem, the designer can translate the new concepts into form. The form, because of the process, will be well-adapted to its context, non-arbitrary, and correct. The mathematics underlying this method, based mainly on set theory, is fully developed in a long appendix. Another appendix demonstrates the application of the method to the design of an Indian village. (shrink)

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Georg Lukács wrote that "there is autonomy and 'autonomy.' The one is a moment of life itself, the elevation of its richness and contradictory unity; the other is a rigidification, a barren self-seclusion, a self-imposed banishment from the dynamic overall connection." Though Lukács' concern was with the conditions for the possibility of art, his distinction also serves as an apt description of the way that Hegel and Hegelians have contrasted their own interpretations of self-determination with that of Kant. But it (...) has always been difficult to see how elevation is possible without seclusion, or how rigidification can be avoided without making the boundaries of the self so malleable that its autonomy looks like a mere cover for the power of external forces. Yeomans explores Hegel's own attempts to grapple with this problem against the background of Kant's attempts, in his theory of virtue, to understand the way that morally autonomous agents can be robust individuals with qualitatively different projects, personal relations, and commitments that are nonetheless infused with a value that demands respect. In a reading that disentangles a number of different threads in Kant's approach, Yeomans shows how Hegel reweaves these threads around the central notions of talent and interest to produce a tapestry of self-determination. Yeomans argues that the result is a striking pluralism that identifies three qualitatively distinct forms of agency or accountability and sees each of these forms of agency as being embodied in different social groups in different ways. But there is nonetheless a dynamic unity to the forms because they can all be understood as practical attempts to solve the problem of autonomy, and each is thus worthy of respect even from the perspective of other solutions."Everyone recognizes the importance of Hegel's critique of Kantian morality as empty, but until now there has not been a fully worked out presentation of how Hegel's views in his discussion of Sittlichkeit actually provide the missing content. Yeomans has finally provided us with a reconstruction of Hegel's mature position that makes good on all the promissory notes that Hegel gives in his famous descriptions of his alternative to Kantian ethics. Yeomans offers a compelling account of Hegel's view of individuality, societal differentiation and its roots in Kantian and Fichtean moral theory. The book will be a major contribution to the scholarship on Hegel's practical philosophy." - Dean Moyar, Associate Professor of Philosophy, Johns Hopkins University -/- "Yeomans' book is a subtle, detailed and original explication of some key ideas having to do with how Hegel's general philosophy of action relates to his social and political philosophy. It is attentive to Hegel's texts, and it ties its discussions into all the relevant contemporary themes in philosophy. It is very ambitious in its attempt to make Hegel's theory into a real competitor to other views that are currently in wide play in the philosophical world. It will very likely become one of the key texts in the secondary literature on Hegel." - Terry Pinkard, University Professor of Philosophy, Georgetown University. (shrink)

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It is often claimed that states enjoy, as a consequence of their sovereign status, the right to control the passage of outsiders through their territory and that they have a discretion to admit or to refuse to admit outsiders, whether those outsiders be tourists, business travelers, would-be economic migrants, or even refugees. Or, to be more exact, such limitations on that right to control are derived from the agreement of states to treaties and conventions, agreement which they could have withheld (...) and could yet revoke. As a statement of the legal position this is not completely uncontroversial,1 but my aim in this paper is not to make a contribution to international law or law at all. Rather, my concern is with political philosophy and with the issue of whether.. (shrink)

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Christopher Gill offers a new analysis of what is innovative in Hellenistic--especially Stoic and Epicurean--philosophical thinking about selfhood and personality. His wide-ranging discussion of Stoic and Epicurean ideas is illustrated by a more detailed examination of the Stoic theory of the passions and a new account of the history of this theory. His study also tackles issues about the historical study of selfhood and the relationship between philosophy and literature, especially the presentation of the collapse of character in Plutrarch's (...) Lives, Senecan tragedy, and Virgil's Aeneid. As all Greek and Latin is translated, this book presents original ideas about ancient concepts of personality to a wide range of readers. (shrink)

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This essay focuses on three features of attention: (1) that it can be manifested in behaviour; (2) that it improves one’s epistemic position vis-à-vis one’s activities; and (3) that attentive performance is experienced as single-minded concentration. I show that views according to which there is a particular process of attention struggle to accommodate all three of these features, and that the most natural alternative to these process-based views is a view that treats attention as an adverbial phenomenon analogous to unison.

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Method as Identity considers how social identity shapes methodological standpoints. With a refreshing hip hop sensibility, Miller and Driscoll reorient the contemporary academic study of religion toward recognition of the costs and benefits of manufacturing “critical” distance from our objects of study.

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In this article, we review approaches to modeling a connection between spatial and mathematical thinking across development. We critically evaluate the strengths and weaknesses of factor analyses, meta-analyses, and experimental literatures. We examine those studies that set out to describe the nature and number of spatial and mathematical skills and specific connections between these abilities, especially those that included children as participants. We also find evidence of strong spatial-mathematical connections and transfer from spatial interventions to mathematical understanding. Finally, we map (...) out the kinds of studies that could enhance our understanding of the mechanisms by which spatial and mathematical processing are connected and the principles by which mathematical outcomes could be enhanced through spatial training in educational settings. (shrink)

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Published with the aim of enriching the literature dealing with the measurement of scientific and technological activities.

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Moral judgments attempt to describe a reality that does not exist, so they are all false. This troubling view is known as the moral error theory.Christopher Cowie defends it against the most compelling counter-argument, the argument from analogy: Cowie shows that moral error theory does not compromise the practice of making epistemic judgments.

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In Rights Forfeiture and Punishment,Christopher Heath Wellman argues that those who seek to defend the moral permissibility of punishment should shift their focus from general justifying aims to moral side constraints. On Wellman's view, punishment is permissible just in case the wrongdoer has forfeited her right against punishment.

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What is subsistence and does it constitute an individual substance which is distinct from its individual nature? Relying upon Thomas, and to a lesser extent, his successors, this dissertation presents a probable solution. This is a thematically organized study, with much textual analysis and a strong attendant interest in the problems of explicating authentically the meaning and systematic coherence of Thomas's doctrine of subsistence. Arguing from authority and reason, this dissertation tries to present the reality and ratio of the supposit (...) and subsistence in three contexts. ;Chapter One examines Thomas's metaphysics of being and how the supposit relates to a being's reality, principles, and modes. The notions of a being , its transcendentals, existence , nature, and substance are examined, and then the supposit and its proper determinations are situated within the context of these constitutive factors and aspects. ;Chapter Two shows how some of these principles are manifested in Thomas's account of the hierarchy of subsistents. Are nature and supposit distinct in certain substances? If distinct, what principles bring about such a distinction? Is esse an act in regard to a supposit or to a nature? What is the act of existence and must it be distinguished from other existential realities? Is a supposit composed of a substantial thing and esse? Or does it compose with esse? ;Chapter Three examines the doctrine of subsistence which arises from Thomas's studies of the Trinity and the Incarnation. In these contexts, the supposit as a subsistent distinct from its individual nature is explicitly presented. By the end of this chapter, the exposition of subsistence according to the mind of Thomas should be more manifest. ;The conclusion presents a summary, recalling the major evidences for the most reasonable and authentically Thomist notion of subsistence: a substantial term. (shrink)

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Plato's Utopia Recast is an illuminating reappraisal of Plato's later works, which reveals radical changes in his ethical and political theory.Christopher Bobonich examines later dialogues, with a special emphasis upon the Laws, and argues that in these late works Plato both rethinks and revises the basic ethical and political positions that he held in his better known earlier works, such as the Republic. This book will change our understanding of Plato. His controversial moral and political theory, so influential (...) in Western thought, will henceforth be seen in a new light. (shrink)

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Since _Jung and Film_ was first published in 2001, Jungian writing on the moving image in film and television has accelerated. _Jung and Film II: The Return_ provides new contributions from authors across the globe willing to tackle the broader issues of film production and consumption, the audience and the place of film culture in our lives. As well as chapters dealing with particular film makers such as Maya Derren and films such as _Birth, The Piano, The Wrestler _and _Breaking (...) the Wave_, there is also a unique chapter co-written by documentary film-maker Tom Hurvitz and New York Jungian analyst Margaret Klenck. Other areas of discussion include: the way in which psychological issues come under scrutiny in many movies the various themes that concern Jungian writers on film how Jungian ideas on psychological personality types can be applied in fresh ways to analyse a variety of characters. The book also includes a glossary to help readers with Jungian words and concepts. _Jung and Film II_ is not only a welcome companion to the first volume, it is an important stand- alone work essential for all academics and students of analytical psychology as well as film, media and cultural studies. (shrink)

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We offer a novel argument for one-boxing in Newcomb’s Problem. The intentional states of a rational person are psychologically coherent across time, and rational decisions are made against this backdrop. We compare this coherence constraint with a golf swing, which to be effective must include a follow-through after the ball is in flight. Decisions, like golf swings, are extended processes, and their coherence with other psychological states of a player in the Newcomb scenario links her choice with the way she (...) is predicted in a common cause structure. As a result, the standard argument for two-boxing is mistaken. (shrink)

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