Institute for Ethics and Emerging Technologies


The IEET is a 501(c)3 non-profit, tax-exempt organization registered in the State of Connecticut in the United States. Please give as you are able, and help support our work for a brighter future.


Search the IEET
Subscribe and Contribute to:


Technoprogressive? BioConservative? Huh?
Overview of technopolitics


whats new at ieet

Value Conflicts surrounding the Meaning of Life in the Trans/Post/Human Future

Will AI make us immortal?

Trump’s Lying Reveals That He Is Empty Inside

This Country Is Leading The Robot Revolution

What Do Technoprogressives Believe in 2017?

Is Class War as Inevitable as the Return of Karl Marx?


ieet books

Chasing Shadows: Visions of Our Coming Transparent World
Author
David Brin

TECHNOPROG, le transhumanisme au service du progrès social
Marc Roux and Didier Coeurnelle

Philosophical Ethics: Theory and Practice
John G Messerly

eHuman Deception
Nicole Sallak Anderson





JET

Enframing the Flesh: Heidegger, Transhumanism, and the Body as “Standing Reserve”

Moral Enhancement and Political Realism

Intelligent Technologies and Lost Life


RSS feedETHICAL TECHNOLOGY

J. Hughes

Den Wandel mit aller Entschlossenheit ergreifen

by J. Hughes

Ein posthumanistisches Plädoyer für die Gentechnologie

Über eine Bioethik wird in Deutschland noch wenig öffentlich diskutiert. Die neuen Biotechnologien werfen jedoch viele Fragen und Probleme auf, die tief in unser Verständnis von Leben und Person eingreifen werden. Der Bioethiker James Hughes hat ein entschiedenes und provozierendes Plädoyer für die intensive Nutzung der Gentechnologie verfaßt, das wir in Telepolis zur Diskussion stellen wollen.

(4564) Hits • (1) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

The Doctor-Patient Relationship: Does it Really Matter?

by J. Hughes

A large body of literature uses the “doctor-patient relationship” (DPR) is if it were a discrete phenomenon with positive effects on patient satisfaction and clinical outcomes. This paper examines the three assumptions made by this literature: 1) that the DPR is a discrete dichotomous variable, rather than a poorly inter-correlated cluster of attributes; 2) that this cluster of attributes are the most significant predictors of the variables they are purported to effect; and 3) that the beneficial influence of a primary care relationship requires a physician rather than a paraprofessional.

First the components of the DPR addressed in the literature are specified: total physician-patient contact, the comprehensiveness of relationship, patient participation diagnosis and treatment, affectivity of communication, and the intensity of interaction. Since these components are not necessarily co-linear, it is suggested that DPRs are not a discrete, unidimensional variable.

Next, the paper discusses the particular task involved in medical care, and whether these are best carried out by one worker with a medical degree; history-taking; information synthesis; education and counseling; diagnostic and treatment procedures; case-management; and diagnostic and treatment decision-making. The complexity of medical practice, cost-containing managerial efforts at rationalization, and mobilization of non-physician health workers threaten to disaggregate these tasks and assign them to non-physicians.

Next, the paper examines some of the outcomes attributed to the DPR, such as physician and patient satisfaction, compliance with treatment regime, clinical outcomes, and lowered costs. It is argued that the DPR itself appears to make only a minor contribution to determining any of these outcomes.

Finally, the paper asserts that the organized power of the medical profession has supported a black-box approach to the DPR in order to defend physician autonomy against organizational and technological control. A reinterpretation of the DPR literature may suggest that organizational and technological innovations could reduce the role of the physician, and achieve or surpass all the desired outcomes of medicine.

Download the PDF

(4797) Hits • (1) CommentsShare on facebook Stumble This



J. Hughes

Aliens, Technology and Freedom: Science Fiction Consumption and Socio-Ethical Attitudes

by J. Hughes

As we enter the 21st century, we do well to consider the values implicit in science fiction, the principal arena of future speculation in popular culture. This study explored whether consumption of science fiction (SF) is correlated with distinctive socio-ethical views. SF tends to advocate the extension of value and rights to all forms of intelligence, regardless of physical form; enthusiasm for technology; and social and economic libertarianism. This suggests that consumers with these socio-ethical views would be attracted to the SF genre, and that amount of SF consumption would be correlated with adoption of these views.

Groups of respondents involved in medical ethical and environmental issues were surveyed in 1992 (N=278). SF consumption was found, at first-order correlation and controlling for covariates, to be associated with: greater support for extending rights to animal and machine intelligence; greater enthusiasm for technology, and rejection of limits to human endeavors; and greater social libertarianism. SF consumption was not associated with specific views on the cognitively and physically disabled; support for abortion rights; or economic libertarianism.

(4705) Hits • (0) CommentsShare on facebook Stumble This



J. Hughes

Buddhism and Medical Ethics: A Bibliographic Introduction

by J. Hughes

with Damien Keown

This article provides an introduction to some contemporary issues in medical ethics and the literature which addresses them from a Buddhist perspective. The first part of the article discusses Buddhism and medicine and outlines some of the main issues in contemporary medical ethics. In the rest of the paper three subjects are considered: i) moral personhood, ii) abortion, and iii) death, dying and euthanasia. The bibliographic references appended to the article will be updated periodically (contributions are welcome), and the latest version of the bibliography will be available from the journal’s “Resources” directory.

(3019) Hits • (0) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

Organization and Information at the Bedside (dissertation)

by J. Hughes

ORGANIZATION AND INFORMATION AT THE BED-SIDE:
THE EXPERIENCE OF THE MEDICAL DIVISION OF LABOR BY UNIVERSITY HOSPITALS’  INPATIENTS

A dissertation submitted to the faculty of the Division of Social Sciences of the University of Chicago in candidacy for the degree of Doctor of Philosophy in Sociology

Download the PDF

Abstract

The practice of medicine is undergoing an industrial revolution akin to the one that occurred in manufacturing in the 19th century. Cost-containment, nursing professionalization and new information technologies combine with growing administrative dominance in health care organizations to challenge the traditional role of the physician. Hospitals and insurance firms threaten to reduce physician autonomy and incomes, and substitute nurses and other allied health professionals into roles traditionally controlled by physicians. In this study, I test for evidence of, and predictors of, nurse substitution for physicians in patient counseling, education and case-management.

Chapter One reviews the literatures related to the doctor-nurse division of labor, including those on the doctor-patient relationship, doctor-hospital relationship, and the doctor-nurse relationship.  I then place these dynamics in the context of academic medical centers (AMCs) strategically adapting to the growth of managed health care. I propose that the division of labor between doctors and nurses will develop curvilinearly with managed care growth and hospital administrative rationalization, moving from:

(a) an initial phase, in which the university hospital is the academic physicians’ workshop, and physicians devote themselves to research and delegate patient care to nurses and housestaff, to
(b) an intermediate phase where physicians and administrators begin to respond to competitive markets by substituting licensed practical nurses (LPNs) for registered nurses (RNs), and by encouraging physicians to return to patient case-management and direct patient care, and then to
(c) a later phase of full administrative rationalization, where administrators begin to substitute nurses for physicians in patient care.

In Chapter Two, I describe the quantitative and qualitative data used in this study. Three years of patient surveys (N=50,000) in 45 university hospitals provide parallel measures of reported amounts of patient care performed by nurses and doctors, and the percent of patients reporting they had a physician case-manager.  These measures reveal some hospitals to be more “physician-centered,” where attending physicians perform more of the patient counseling, education and case-management tasks than nurses and housestaff. Conversely, patients at other hospitals report care being more “nurse-centered,” with less physician case-management, and nurses and housestaff providing as much patient counseling and education as attending physicians.

To complement this quantitative analysis, I conducted three case studies in academic medical centers with widely varying characteristics. I interviewed administrators, physicians and nurses in these AMCs about the key concepts and dynamics of this study. 

In Chapter Three, I examine intra-hospital and patient-level characteristics related to the dependent labor measures. While age, gender, payor status, illness, and medical-surgical status are related to reports of doctor and nurse work, these patient-level variables explain little of the variance, largely obviating the need for case-mix adjustments at the aggregate level. The exception is physician case-management, which is strongly predicted by indigency and medical-surgical status.

In Chapter Four, I demonstrate that managed care growth in local markets is related to variations in the inpatient experience of doctors and nurses. I also demonstrate that staffing ratios appear to be a key intermediate variable between managed care growth and the reported division of labor. The more nurses per bed, the more patients perceive that nurses do, and the less they say doctors do; the more housestaff per bed, the less nurses and doctors are perceived to do.

In Chapter Five, I explore whether “institutional resources” are related to the dependent labor measures, and mediate the managed care-division of labor relationship. In particular, I demonstrate the direct effects of state-ownership, university-ownership, prestige, payor case-mix and hospital size, and the degree to which these characteristics appear to insulate AMCs from the market pressures of managed care. Both direct and mediating effects are found, but not in patterns that support an “institutional resources” model.

In Chapter Six, I explore Total Quality Management (TQM), hospital automation, case-management nursing, and the internal segregation of the indigent as adaptations to managed care market growth, which may in turn effect patients’ experience of the division of labor. The data do not support the hypotheses that these organizational innovations are either direct responses to market evolution, or affect the division of labor.

In Chapter Seven, I discuss the role of nursing culture in inhibiting or encouraging nursing role expansion and labor substitution for physicians. I demonstrate that nursing schools are related to reports of expanded nursing roles, while nursing unions are related to more limited nursing roles.

In the concluding chapter I explore summary regression models, and the implications of this study for the ongoing changes in health care organization.

(5562) Hits • (5) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

Social Ecology and Evolutionism

by J. Hughes

Taught at the University of Chicago in 1994

 

Goals: This course is an introduction to the ecological and evolutionary concepts which have influenced the social sciences. After introducing these concepts, the course will first discuss the different units of selection in the social order. Sociobiological theories will be compared to those which posit that selection takes place at the level of software, e.g. norms and ideas. We will next explore the writings of classic University of Chicago sociologists who attempted to interpret the life-cycles of cities and local economies with ecological tools. We will thenturn to the modern organizational sociologists who explain the growth and decline of organizational populations.

In the second half of the course we will explore the notion of "society as body," starting with the ideological uses of this concept. Then we will explore the ideas of anthropological and sociological evolutionists and functionalists, such Herbert Spencer and Talcott Parsons, and the underlying functionalist assumptions of Marxism. In the last week we will examine the notion that the world is an integrated system, governed by its own organic laws, and how this idea has struck a chord with modern political movements.

(4364) Hits • (0) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

Beginnings and Endings: The Buddhist Mythos of the Arising and Passing Away of the World

by J. Hughes

Exegesis of the Agganna and Cakkavatti Suttas.

(6395) Hits • (0) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

Better Living Through World Government:: Transnationalism as 21st Century Socialism

by J. Hughes

(9577) Hits • (0) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

Monogamy as a Prisoner’s Dilemma: Non-Monogamy as a Collective Action Problem

by J. Hughes

An essay on the difficulties of establishing stable polyamorous threesomes.

(6668) Hits • (0) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

Birth Doctors and Death Doctors

by J. Hughes

Materials Complexity and the Development of Obstetrics, Pediatrics and Geriatrics

Table of Contents
Introduction 4

1. Birth, Youth, Dying and Death as Material Bases 8

1a. Birth as Raw Material 11

1b. Death as Raw Material 14

1c. Differences between Birth and Death 18

2. The Social Construction of Medical Specialization 22

2a. The Origins of Obstetrics and Pediatrics 24

2b. Shaping State Policy and Building the Market 32

2c. Rising Specialization 34

3. Shaping the Materials and the Technologies 38

4. Conclusions 42

4a. Policy Issues 43

4b. Further Research 46

Appendix

Bibliography

Download PDF

(5072) Hits • (0) CommentsShare on facebook Stumble ThisFull Story...



J. Hughes

World Buddhism and the Peace Movement

by J. Hughes

(3812) Hits • (0) CommentsShare on facebook Stumble This



J. Hughes

Buddhist Feminism

by J. Hughes

Drawing upon both the insights of Buddhism and the Western liberal tradition, this essay criticizes established Buddhism’s restrictions on the involvement of women and develops a Buddhist feminist agenda appropriate to our own age and culture.

(4345) Hits • (0) CommentsShare on facebook Stumble This



J. Hughes

Altered States of Consciousness and Social Structure: Glossolalia in the Pentecostal Church

by J. Hughes

Honor’s Bachelors Thesis

Table of Contents

Introduction
Chapter One: Subject and Research Methodology
Chapter Two: ASCs and Personality
Chapter Three: Self in Community
Chapter Four: Liminal, Thinkable and Legitimate
Chapter Five: Power in Community
Chapter Six: Social Structure and Change
Conclusions

Download the PDF (8mbs)

(6281) Hits • (0) CommentsShare on facebook Stumble This




Page 325 of 325 pages ‹ First  < 323 324 325

HOME | ABOUT | STAFF | EVENTS | SUPPORT  | CONTACT US
JOURNAL OF EVOLUTION AND TECHNOLOGY

RSSIEET Blog | email list | newsletter |
The IEET is a 501(c)3 non-profit, tax-exempt organization registered in the State of Connecticut in the United States.

Executive Director, Dr. James J. Hughes,
35 Harbor Point Blvd, #404, Boston, MA 02125-3242 USA
Email: director @ ieet.org