The main principles of the creed and ethics of the Jews : exhibited in selections from the Yad hachazakah of Maimonides ; with a literal English translation, copious illustrations from the Talmud, & c.

by Hermann Hedwig Bernard

Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Implications of Health Care Reform (Medical Ethics Series, 2011)

A video of a panel discussion on how Obama's Health Care Reform would affect Texas Medical Center institutions and health care in general.Speakers include Tom Cole (moderator), Roberta Schwartz (Methodist Hospital), Pauline Rosenau (UT-Houston School of Public Health), and Laurence McCullough (Baylor College of Medicine).

A study to determine the association between medical decision-making and the performance of an institutional ethics committee

This study developed proxy measures to test the independent effects of medical specialty, institutional ethics committee (IEC) and the interaction between the two, upon a proxy for the dependent variable of the medical decision to withhold/withdraw care for the dying--the resuscitation index (R-index). Five clinical vignettes were constructed and validated to convey the realism and contextual factors implicit in the decision to withhold/withdraw care. A scale was developed to determine the range of contact by an IEC in terms of physician knowledge and use of IEC policy.^ This study was composed of a sample of 215 physicians in a teaching hospital in the Southwest where proxy measures were tested for two competing influences, medical specialty and IEC, which alternately oppose and support the decision to withhold/withdraw care for the dying. A sub-sample of surgeons supported the hypothesis that an IEC is influential in opposing the medical training imperative to prolong life.^ Those surgeons with a low IEC score were 326 percent more likely to continue care than were surgeons with a high IEC score when compared to all other specialties. IEC alone was also found to significantly predict the decision to withhold/withdraw care. Interaction of IEC with the specialty of surgery was found to be the best predictor for a decision to withhold/withdraw care for the dying. ^

Strange bedfellows: The ethics and politics of medical futility in Texas

Background: Futile medical treatments are interventions that are not associated with a benefit to the patient. The definition and concept of medical futility are controversial. The Texas Advance Directives Act (TADA) was passed in 1999 to address medically inappropriate interventions by allowing providers to withdraw inappropriate interventions against a surrogate decision maker's wishes following a review, attempt to transfer the patient, and 10-day waiting period. The original legislation was a negotiated compromise by players across the political spectrum. However, in recent years there has been increasing controversy regarding TADA and attempts to alter its applicability in Texas. ^ Purpose: The purpose of this project was to apply Paul Sabatier's advocacy coalition framework (ACF) to gain understanding into the historical, ethical, and political basis of the initial compromise, and determine the sources of conflict that have led to increased opposition to TADA. ^ Methods: Using the ACF model, key actors within the medical futility policy debate in Texas were aggregated into coalitions based on shared beliefs. A narrative summary based analysis identified the core elements of the policy subsystem, as well as the constraints and resources of the subsystem actors. Externalities that promoted adjustments to coalition beliefs and tactics used by coalition participants were analyzed. Data sources included review of the published literature regarding medical futility, as well as analysis of published newspaper accounts and editorials regarding the medical futility issue in Texas, legislative testimony, and review of weblogs and online commentaries dealing with the issue. ^ Results: Primary coalition participants in developing compromise legislation in 1999 were the Providers and Vitalists, with Autonomists gaining a prominent role starting in 2006. Internal factors associated with the breakdown of consensus included changes to the makeup of the governing coalition and changes in individual case information available to the Vitalist coalition. Externalities related to the intertwining of the Sun Hudson case and the Terri Schiavo case generated negative publicity for the TADA from progressive and conservative viewpoints. Dissemination of information in various venues regarding contentious cases was associated with more polarization of viewpoints, and realignment of coalition alliances. ^ Conclusions: The ACF provided an outline for the initial compromise over the creation of the Texas Advance Directives Act as well as the eventual loss of consensus. The debate between the Provider, Vitalist, and Autonomist coalitions has been affected by internal policy evolution, changes in the governing coalition, and important externalities. The debate over medical futility in Texas has had much broader implications in the dispute over Health Care Reform.^

Mobile Indoor Augmented Reality. Exploring applications in hospitality environments.

Augmented reality (AR) is been increasingly used in mobile devices. Most of the available applications are set to work outdoors, mainly due to the availability of a reliable positioning system. Nevertheless, indoor (smart) spaces offer a lot of opportunities of creating new service concepts. In particular, in this paper we explore the applicability of mobile AR to hospitality environments (hotels and similar establishments). From the state-of-the-art of technologies and applications, a portfolio of services has been identified and a prototype using off-the-shelf technologies has been designed. Our objective is to identify the next technological challenges to overcome in order to have suitable underlying infrastructures and innovative services which enhance the traveller?s experience.

Ethics and materials: Some Spanish Cases

The problem is general: modern architects and engineers are trying to understand historic structures using the wrong theoretical frame, the classic (elastic) thery of structures developed in the 19th Century for iron and stell, and in the 20th century for reinforced concrete, disguised with "modern" computer packages, mainly FEM, but also others. Masonry is an essentially different material, and the structural equations must be adapted accordingly. It is not a matter of "taste" or "opinion", and the consequences are before us. Since, say 1920s, historic monuments have suffered the aggression of generations of archietcts and engineers, trying to transform masonry in reinfored concrete or steel. The damage to the monuments and the expense has been, and is, enormous. However, as we have an adequate theory (modern limit analysis of masonry structures, Heyman 1966) which encompasses the "old theory" used successfully by the 18th and 19th Century practical engineers (from Perronet to Sejourné), it is a matter of "Ethics" not to use the wrong approach. It is also "contra natura" to modify the material masonry with indiscriminate injections, stitchings, etc. It is insane to consider, suddenly, that buildings which are Centuries or milennia old, are suddenly in danger of collapse. Maintenance is necessary but not the actual destruction of the constructive essence of the monument. A cocktail of "ignorance, fear and greed" is acting under the best of intentions.

Ethics and materials. Some Spanish Case Studies

In Navea, north of Spain, a medieval arch bridge shows a visible distortion (fig.1a). A stone falls down from the web of a gothic vault in a big parish church in Burgos (fig. 1b), and a voussoir falls down from the rib of another gothic vault in Oviedo (fig. 1c). An oval dome collapses in Zaragoza, though another four identical domes remain safe (fig. 1d). Sometimes the building has to support new, heavier loads. The ruin of the abandoned (since the 19th Century) monastery of Melón should be consolidated, some vaults are rebuilt and the visitors can walk over them. A Franciscan Convent is going to be turned into a Cultural Centre, the loads to be supported being multiplied by a factor of two. A little medieval bridge is asked to support the pass of heavy lorries. These are some of the cases I have studied in the last two decades, all of them referring to questions of structural safety. These are the kind of situations which often occurs in the field of Historic Structures. They require a study and an answer. This is no scholarly work (though in some cases new lines of future research will emerge). A judgement must be made by the expert and this judgement affects the safety and economy, in the last instance, of people. As there are rarely unique answers, the behaviour of the expert, then, can also be judged as "ethical", if he proposes an intervention that is necessary and adequate (or, recommends no intervention, judging the situation safe), or "non-ethical", if recommends an unnecessary or disproportionate intervention. In relation to the monument, also, the proposal can be judged ethically; any intervention damaging seriously the character of the monument may be labelled un-ethical.

Business ethics: a way to identify fraud from the basics

When we look to perform a work for developing a framework to create a business and take it correctly, there are always some persons looking as a challenge those bases and finding a mistake. The way to work in these situations is not a matter of law, is a matter of devoting time to identify these situations. It is always said that the evil goes a step ahead. The business ethics have been altered for quite time by some would-be entrepreneurs. These people have learned to play with business ethics to show your business as prosperous as something that is sought to highlight and adulterate their results quickly. Once the company reaches an international dimension, many companies take on global responsibility and, in these cases where you can see if the objective has been to obtain a rapid capital increase or growth is in line with its proportions. A business ethics is based on establishing a strong base so that interest is encouraged from an early time. Good staff, organizational level should be achieved and not only at the company but, out of the company too. Thus, you can create a secure base to convince potential investors and employees about the business. There are no freeways in business ethics and all fast track can be or a genius or leads to failure. We must find where these jumps are occurring, such errors or corrections to business ethics and their rules. Thus we can differentiate a company or an entrepreneur who is working correctly from the cloaking. Starting from the basics of business ethics and studying the different levels from the personal to the prospect that the company shows in the world. Lets see where these changes are occurring and how we can fight against them and anticipate the market to possible cases of fraud or strange movements seeking to attract the unwary

Naturaleza, ética, y arquitectura: Autenticidad y criterios éticos que integran el desarrollo de una arquitectura más sostenible = Nature, ethics and architecture: Authenticity and ethics criteria that integrate the development of a more sustainable architecture

La ecología no solamente ha puesto de manifiesto problemas ambientales, sino que ha confirmado la necesidad de una nueva armonía entre los propios seres humanos y de éstos con la naturaleza y con todos los seres que la habitan. Es necesario un nuevo contrato que determine nuestras relaciones con la Naturaleza (Serrs1), y una nueva Ética para nuestras vidas (Guattari2). La ética medioambiental nos ha dado una visión universal y supra-generacional de la gestión de la naturaleza y como consecuencia, una nueva forma de construir nuestra ‘segunda’ Naturaleza, que es la arquitectura. ¿Qué es lo esencial que esta nueva ética exige para la arquitectura? Este es un momento crucial para reconsiderar los objetivos de la arquitectura, porque lo ‘eco’ está produciendo grandes cambios. ¿Implica esta era post-ecológica una particular ética, es decir, referida a sus fines y medios? ¿Porqué, para qué, para quién, cómo debemos hacer la arquitectura de nuestro tiempo? Es momento de afrontar críticamente el discurso de la eco-arquitectura, e incluso de repensar los propios límites de la arquitectura. El desarrollo actual del conocimiento medioambiental es esencialmente técnico y utilitario, pero ¿es el reto solamente técnico?¿Es suficiente la suma de lo medioambiental-social-económico-cultural para definirla? ¿Hay claves que nos puedan dar la dimensión ética de esta aproximación técnica-empírica? ¿Sabemos lo que estamos haciendo cuando aplicamos este conocimiento? Y, sobre todo, ¿cuál es el sentido de lo que estamos haciendo? La tesis que se propone puede resumirse: De acuerdo con el actual conocimiento que tenemos de la Naturaleza, la Arquitectura de nuestro tiempo deber reconsiderar sus fines y medios, puesto que la ética medioambiental está definiendo nuevos objetivos. Para fundamentar y profundizar en esta afirmación la tesis analiza cómo son hoy día las relaciones entre Ética-Naturaleza-Arquitectura (Fig.1), lo que facilitará las claves de cuáles son los criterios éticos (en cuanto a fines y medios) que deben definir la arquitectura del tiempo de la ecología. ABSTRACT Ecology shows us not only environmental problems; it shows that we need a new balance and harmony between individuals, beings, communities and Nature. We need a new contract with Nature according to Serres576, and a new Ethics for our lives according to Guattari577. Environmental ethics have given us a universal and supra-generational vision of the management of our Nature and, as a consequence, a new way to construct our ‘second’ nature, which is architecture. What is essential for this new architecture that the new ethics demand? This is a critical moment to reconsider the object of architecture, because the ‘eco’ is making significant changes in it. Are there any specifically ethical concerns (ends and means) in the post-ecological era? Why, for what, for whom, how should we make architecture in our times? This is the time to approach the eco-architectural discourse critically and to question the current boundaries of architecture itself: Where is eco-architecture going? The current development of environmental knowledge is essentially technical and utilitarian, but it is its technical aspect the only challenge? Is the sum of environmental-social-economic aspects enough to define it? Are there any clues which can give an ethical sense to this technical-empirical approach? Do we know what we are doing when we apply this knowledge? And overall, what is the meaning of what we are doing? Exploring this subject, this thesis makes a statement: In accordance with the actual knowledge of Nature, Architecture of our time must reconsider its ends and means, since the environmental ethics is defining new objectives. To support that, the thesis analyzes what the relationships between Ethics –Nature- Architecture (Fig. 53) are like nowadays, this will provide the clues of which ethical criteria (ends and means) must architecture of an ecological era define.

Ethics and access to teaching materials in the medical library: the case of the Pernkopf atlas*

Conflicts can occur between the principle of freedom of information treasured by librarians and ethical standards of scientific research involving the propriety of using data derived from immoral or dishonorable experimentation. A prime example of this conflict was brought to the attention of the medical and library communities in 1995 when articles claiming that the subjects of the illustrations in the classic anatomy atlas, Eduard Pernkopf's Topographische Anatomie des Menschen, were victims of the Nazi holocaust. While few have disputed the accuracy, artistic, or educational value of the Pernkopf atlas, some have argued that the use of such subjects violates standards of medical ethics involving inhuman and degrading treatment of subjects or disrespect of a human corpse. Efforts were made to remove the book from medical libraries. In this article, the history of the Pernkopf atlas and the controversy surrounding it are reviewed. The results of a survey of academic medical libraries concerning their treatment of the Pernkopf atlas are reported, and the ethical implications of these issues as they affect the responsibilities of librarians is discussed.

Clinical ethics revisited

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.