The increasing incidence of ethical dilemmas in long-term care settings, in concert with recommendations from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, has prompted long-term care institutions to develop mechanisms to address these concerns. Some facilities have chosen to set up an ethics committee, although estimates obtained in the past few years indicate that only between 2 and 27% of institutional long-term care settings have such committees. Ethics committees are responsible for (...) assisting staff, residents, and families with the resolution of ethi- cal concerns, and typically engage in policy review and development, case review, and education. Such committees usually count among their membership representatives from a variety of disciplines, with family members, patients, and representatives from patient advocacy groups supplementing the professional component of the committee. (shrink)

There have been two parallel views regarding the role of voting in deliberation. The first is that deliberation before the fabrication of balloting was completely devoid of voting. The second is that voting is, not just part of deliberation, but is standard to deliberation. I argue in this article that neither of these views is correct. Implicit voting has always existed across time and space but only as a last resort in the event of a failure of natural unanimity. What (...) is relatively modern is the establishment of what I call explicit voting, namely, balloting, outside deliberation and often without deliberation. I also distinguish between natural and artificial unanimities, and clarify that artificial unanimities are products of implicit voting. I demonstrate these clarifications with some examples of deliberation. I deploy these clarifications to rid a certain debate of confusion regarding the precise role of voting in consensual deliberation. (shrink)

L’argument de base de cet article est que le débat consensuel n’a pas été une notion très significative jusqu’à présent parce que le consensus n’a pas été étudié de manière approfondie en tant que concept et que la délibération n’a pas été étudiée précisément en termes de sa propension à parvenir à un accord commun. En particulier, la délibération et les problèmes qui en découlent n’ont pas été classées en plusieurs niveaux afin d’exposer les différents défis qui se posent lorsque (...) l’on tente de parvenir à un accord et les types d’approches délibératives impliquées dans chaque catégorie. La présente recherche propose une telle catégorisation dans le but de clarifier davantage le débat. (shrink)

Hospital ethics committees must be knowledgeable if they are to perform consultations, advise administrators on policy, or offer educational programs. Because the membership of the committee is interdisciplinary, with most drawn from the healthcare professions, the individuals who join cannot be expected to bring knowledge of bioethies with them. Therefore, a new committee must spend time developing expertise before it can appropriately serve the hospital community. Although the need for committee self-education is generally recognized, it is seldom discussed in any (...) detail. When discussed at all, expertise in bioethies is usually described as composed of a familiarity with an identifiable body of knowledge and mastery over techniques of moral reasoning. It is assumed that a committee can develop this expertise early in its life through a short course of study. (shrink)