At the request of the Midwest Bioethics Center (MBC), we surveyed nurses' and physicians' attitudes and needs regarding Hospital Ethics Committees (HECs). The primary objective of this research project was to inform the practices and policies of the Ethics Committee Consortium of the Bioethics Center.Four thousand eight hundred and twenty-nine surveys were distributed to the medical and nursing staff of eight Kansas City metropolitan area hospitals. One thousand and fifty-five surveys were returned, representing a response rate of 21%.

The “lone” clinical bioethicist working in a large, multisite hospital faces considerable challenges. While attempting to build ethics capacity and sustain a demanding range of responsibilities, he or she must also achieve an acceptable level of integration, sustainability, and accountability within a complex organisational structure. In an effort to address such inherent demands and to create a platform towards better evaluation and effectiveness, the Clinical Ethics Group at the Joint Centre for Bioethics at the University of Toronto is implementing the (...) Hub and Spokes Strategy at seven hospitals. The goal of the Hub and Spokes Strategy is to foster an ethical climate and strengthen ethics capacity broadly throughout healthcare settings as well as create models in clinical bioethics that are excellent and effective. (shrink)

This paper describes the first three-year experience of the Consortium Ethics Program (CEP-1) of the University of Pittsburgh Center for Medical Ethics, and also outlines plans for the second three-year phase (CEP-2) of this experiment in continuing ethics education. In existence since 1990, the CEP has the primary goal of creating a cost-effective, permanent ethics resource network, by utilizing the educational resources of a university bioethics center and the practical expertise of a regional hospital council. The CEP's conception and specific (...) components stem from recognition of the need to make each hospital a major focus of educational efforts, and to provide academic support for the in-house activities of the representatives from each institution. (shrink)

My discussion is concerned with how symbolic power constitutively structures our very identities in relation to one another and at the bodily level of lived experience. Although many accounts of the self and of subjectivity as socially situated have difficulties in their explanations of agency, Zaners work suggests a basis upon which the selfs independence from others can be understood. His phenomenology of embodied subjectivity explains how the emerging self presupposes presence with others. At the same time, however, co-presence also (...) reveals the selfs distinct perspective and capacity for circumstantial possibilizing, that is to say, actualizing another possible than the actual. My aim is to examine critically the intersections between Zaners phenomenology and other theoretical accounts of the socially situated self. I also show how Zaners work contributes to these discussions a way of understanding the possibility of agency that is rooted in embodied experience. (shrink)

The general purpose of this dissertation is to explore casuistry--case-based reasoning--as a discredited, rehabilitated, and, most importantly, persistent form of moral reasoning. Casuistry offers a much needed corrective to principle-based approaches. I offer a defense of a "principle-modest" casuistry and explore the epistemology of casuistry, describing the prerequisite knowledge required for casuistry. I conclude by arguing that casuistry is best understood as a neo-premodernist approach to moral reasoning.

The proliferation of ethics committees and ethics consultation services has engendered a discussion of the issue of the expertise of those who provide clinical ethics consultation services. In this paper, I discuss two aspects of this issue: the cognitive dimension or content knowledge that the clinical ethics consultant should possess and the practical dimension or set of dispositions, skills, and traits that are necessary for effective ethics consultation. I argue that the failure to differentiate and fully explicate these dimensions contributes (...) to the confusion over the issue of expertise and fuels, at least partly, the controversies about expertise (or authority) in ethics and the legitimacy of the use of ethical knowledge in clinical ethics consultation. (shrink)