Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety and necessity (...) of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future. (shrink)

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we (...) outline these challenges unique to women’s healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Volume 20, Issue 4, May 2020, Page 59-61.

Donation after cardiac death (DCD) traditionally occurs in two patient populations: (1) those who do not meet neurological death criteria but who have suffered severe neurological damage, and (2) those who are fully alert and awake but are dependent on machines. This case highlights the unique dilemma when a patient falls between these two populations—conscious and cognitively intact, but completely paralyzed except for limited eye movement, afflicted by what the medical community refers to as locked-in syndrome. Prompted by the treatment (...) team’s discomfort, an ethics consultant examined whether the team was obligated to discuss a decision to donate with the patient, who was a registered organ donor. This article shows how, in determining whether or not to talk to the patient or family during end-of-life decision making, the weight assigned to the various ethical concerns in the case— the patient’s condition, the decision to be made, and the family’s agreement or disagreement regarding the patient’s wishes—can “swing the pendulum” of ethical analysis in different ways. The comfort of the patient must be accorded the highest priority, as well as the needs of the patient’s family. This case study highlights the nuanced contextual factors necessary to guide a treatment team’s approach to DCD for a patient with uncertain decision-making capacity. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Despite an abundance of academic conferences, clinical ethicists lacked a forum to share innovative practices with peers and to generate solutions to common challenges. Organizers of the first Clinical Ethics Un-Conference developed a working event centered on active participation and problem solving through peer learning, with the goal of improving realworld practice. Registrants included 95 individuals from 64 institutions. Attendees were surveyed immediately after the Un-Conference, and again eight months later. After eight months, 85 percent (n = 33/39) of the (...) survey respondents reported that they found the event “highly impactful” or “some-what impactful” to their clinical practice, and 23 attendees reported that they had implemented ideas or projects inspired by the event. Three sets of best practice guidelines and four white papers were published from the event. As the field of clinical ethics continues to advance and evolve, this working event format offers an innovative, disruptive alternative to a traditional conference format and may serve as a model for future efforts aimed at improving real-world clinical ethics practice. (shrink)

In this study, Bethany Somma argues for a dichotomous interpretation of human desire developed by late ancient Greek and medieval Islamic philosophers in response to an ambiguity in Aristotle’s account of desire.

In this book Bruno Latour brings together these different approaches to provide a lively and challenging analysis of science, demonstrating how social context..

A summation of the work of one of the most influential and provocative interpreters of science, it aims at saving what is good and valuable in modernity and ...

The dubious relation of “subjective” experience to “objective” reality finds its correlate in the opposition we often suppose between culture and nature. Twentieth century theorists, most notably Freud, have claimed various methods for interpreting the illusions of one realm that hide the truths of the other. Ricœur has famously called the psychoanalytic method of dream interpretation a “hermeneutics of suspicion,” which he sees as a threat to the “mytho-poetic core of imagination.” John Dewey regarded the binary opposition between culture/nature as (...) particularly dubious, preferring to see them as reciprocal phases of a continuous process; if cultural life is an interpretation of the biophysical environment, that environment surely has its say. However, in the century since Freud, the tactics of suspicion have proven themselves to be indispensable for developing of critiques that reveal the subtle operations of anti-democratic ideologies, perhaps at the expense of democratic faith. This paper considers if there are less suspicious, more Deweyan possibilities for the interpreting and sharing of dreams, not for the benefit of the psychic health of the individual dreamer, but for the sake of a recovery of democratic life. (shrink)

From the book: What is to be done with political ecology? Nothing. What is to be done? Political ecology!

Human connection is universally important, particularly in the context of serious illness and at the end of life. The presence of close family and friends has many benefits when death is close. Hospital visitation restrictions during the Coronavirus pandemic therefore warrant careful consideration to ensure equity, proportionality, and the minimization of harm. The Australian and New Zealand Society for Palliative Medicine COVID-19 Special Interest Group utilized the relevant ethical and public health principles, together with the existing disease outbreak literature and (...) evolving COVID-19 knowledge, to generate a practical framework of visiting restrictions for inpatients receiving palliative and end-of-life care. Expert advice from an Infectious Diseases physician ensured relevance to community transmission dynamics. Three graded levels of visitor restrictions for inpatient settings are proposed, defining an appropriate level of minimum access. These depend upon the level of community transmission of COVID-19, the demand on health services, the potential COVID-19 status of the patient and visitors, and the imminence of the patient’s death. This framework represents a cohesive, considered, proportionate, and ethically robust approach to improve equity and consistency for inpatients receiving palliative care during the COVID-19 pandemic and may serve as a template for future disease outbreaks. (shrink)

Environmental problems often outstrip the abilities of any single scientist to understand, much less address them. As a result, collaborations within, across, and beyond the environmental sciences are an increasingly important part of the environmental science landscape. Here, we explore an insufficiently recognized and particularly challenging barrier to collaborative environmental science: value pluralism, the presence of non-trivial differences in the values that collaborators bring to bear on project decisions. We argue that resolving the obstacles posed by value pluralism to collaborative (...) environmental science requires detecting and coordinating the underlying problematic value differences. We identify five ways that a team might coordinate their problematic value differences and argue that, whichever mode is adopted, it ought to be governed by participatory virtues, pragmatic resolve, and moral concern. Relying on our experiences with the Toolbox Dialogue Initiative, as well as with other dialogical approaches that support team inquiry, we defend the claim that philosophical dialogue among collaborators can go a long way towards helping teams of environmental scientists and fellow travelers detect their problematic value differences. Where dialogical approaches fare less well is in helping teams coordinate these differences. We close by describing several principles for augmenting philosophical dialogue with other methods, and we list several of these methods in an appendix with brief descriptions and links for further learning. Overall, the article makes three main contributions to the research collaboration and values in science literatures: It deepens our understanding of problematic value pluralism in team science; It provides actionable guidance and methods for improving values-oriented philosophical dialogue interventions; and It demonstrates one way of doing engaged philosophy. (shrink)

Recent ethics literature suggests that issues involved in non-heart-beating organ procurement are both highly charged and rather urgent. Some fear that NHB is a public relations disaster waiting to happen or that it will create a backlash against organ donation. The purpose of the study described below was to assess ethics committees' current level of involvement in and readiness for addressing the difficult issues that NHB organ retrieval raises—either proactively through policy development or concurrently through ethics consultation.

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved (...) interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability. At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting. (shrink)

In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as well as the potential (...) difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible. (shrink)

Treatment of military-related posttraumatic stress disorder is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have sought VA health care services for PTSD. This recent increased need (...) for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority. (shrink)

ABSTRACTThis study aimed to investigate the emotional impact of sarcasm. Previous research in this area has mainly required participants to answer questions based on written materials, and results have been mixed. With the aim of instead examining the emotional impact of sarcasm when used in a more conversational setting, the current study utilized animated video clips as stimuli. In each clip, one individual answered general knowledge questions while the other provided feedback that could be delivered either literally or sarcastically, and (...) either complimented or criticized the question answerer’s performance. Participants rated the feedback based on the anticipated emotional impact on the recipient, how the speaker intended the recipient to feel, and whether the speaker intended to be humorous. Results overall supported the Tinge Hypothesis, showing that sarcastic criticism was rated as less negative than literal criticism, and sarcastic compliments were rated as... (shrink)

Do cultural models facilitate particular ways of perceiving interactions in nature? We explore variability in folkecological principles of reasoning about interspecies interactions. In two studies, Indigenous Panamanian Ngöbe and U.S. participants interpreted an illustrated, wordless nonfiction book about the hunting relationship between a coyote and badger. Across both studies, the majority of Ngöbe interpreted the hunting relationship as cooperative and the majority of U.S. participants as competitive. Study 2 showed that this pattern may reflect different beliefs about, and perhaps different (...) awareness of, plausible interspecies interactions. Further probes suggest that these models of ecological interaction correlate with recognition of social agency in nonhuman animals. We interpret our results in terms of cultural models of nature and nonhuman agency. (shrink)

Anthropology of Consciousness, EarlyView.

In lieu of an abstract, here is a brief excerpt of the content:Hyper-Abjects:Finitude, “Sustainability,” and the Maternal Body in the AnthropoceneBethany DoaneThe concept of the Anthropocene prioritizes a new paradigmatic scale that seems to outweigh that of “the political”: imagining deep time or the death of the human species as a result of climate change tends to negate the (relatively speaking) smaller-scale concerns of race, class, gender, or capitalism. While feminist critique is often circumscribed by this political scale, and thus (...) may seem to be dwarfed or rendered obsolete by the geological, deep-time scale of the Anthropocene, examining issues of feminist concern from this geological perspective has profound implications for thinking not only of gender politics but also of how to construct something like the political at all in this new era. Suggesting a new and normative global politics is, of course, beyond the scope of this article, but perhaps we might begin to conceive of a political schema that would function more appropriately in light of this grander scale. At the very least we may begin to think the borders or limits of the species as it has existed in the modern era in a way that neither environmentalism nor posthumanism has yet been able to sufficiently tackle.The Anthropocene marks the epoch in which human activities have caused global environmental changes that will leave their mark in the geological strata of the earth itself.1 While the specific moments of its onset are contested, its beginnings are generally associated with the industrial age; Crutzen and Stoermer mark its onset at roughly 1800 with the beginnings [End Page 251] of the industrial revolution. (Timothy Morton pinpoints it more specifically with the invention of the steam engine in 1794.) The changes made in this era of geological, technological, and climate convergence have accelerated in the last seventy years or so in what scientists call the Great Acceleration, which began around 1940 and quickened anthropogenic impact with events like the testing/dropping of atomic bombs, the homogenization of biodiversity, mass extinctions as a result of human activity, and various types of drilling and mining.2 In the era broadly conceived as modernity, the steady march of “progress” that has so shaped the paradigm of the period has been made possible only through its own abjections: those phenomena that mark the era as limited, limiting, and unsustainable. In other words, the “birth of the modern world” was made possible only through devastating acts of violence: institutionalized inequalities like slavery, oppression, colonization, and war. These acts of violence translate as cannibalization at the global scale: the exploitation of most members of the species and the consumption of their resources for the benefit and luxury of the few. While these forms of violence have been criticized and confronted by political and theoretical movements since at least the middle of the twentieth century, thinking of them in terms of the Anthropocene and deep time allows us to consider their consequences in a new light. Our present awareness of the Anthropocene makes visible phenomena like climate, global warming, earth, and the “anthropos” that present us with the very real eventuality of species finitude. Species finitude calls into question not just the practices of modernity that have brought about the Anthropocene (the exploitation of the many for the benefit of the few), but the entire paradigm of global thinking that is invested in progress, growth, and even in any environmentalism that calls for stewardship of the earth. The notion of care for an entity like “nature” or “the environment” only reinforces the separation between the human and its milieu, a separation that is impossible to maintain in light of the absolute inextricability that the Anthropocene brings to light.At the heart of this essay are two theoretical concepts: Julia Kristeva’s abjection, and Timothy Morton’s hyperobjects, both of which stand for a sort of insufficiency or impossibility of discourse (politics, the Symbolic, etc.) in managing some Real object or phenomenon. Kristeva’s abject is generally thought of as functioning at two levels or scales: the personal, in which an individual must cast off the abject of the maternal body in order to become a proper subject; and the social or... (shrink)

Volume 19, Issue 11, November 2019, Page 37-39.

The field of narrative medicine holds that personal narratives about illness have the potential to give illness meaning and to create order out of disparate facets of experience, thereby aiding a patient’s treatment and resisting universalizing medical discourse. Two narratives of bipolar disorder, Kay Redfield Jamison’s prose memoir An Unquiet Mind and Ellen Forney’s graphic memoir Marbles challenge these ideas. These writers demonstrate that one result of bipolar disorder is a rupture to their sense of identity, making straightforward and verbal (...) forms of narrative impossible. During periods of relative mood stability, reliable memories of mania or depression are equally impossible. As a result, these memoirists seek to develop sources of self-knowledge other than memory and introspection, long the foundations of personal narrative. Finally, An Unquiet Mind and Marbles return attention to questions of selfhood at a time when scholarship on memoir rejects interpretations of life stories as clear and reliable expressions of identity. (shrink)

We used attractiveness judgements as a proxy to visualize the ideal female and male body for male and female participants and investigated how individual differences in the internalization of cultural ideals influence these representations. In the first of two studies, male and female participants judged the attractiveness of 242 male and female computer-generated bodies which varied independently in muscle and adipose. This allowed us to map changes in attractiveness across the complete body composition space, revealing single peaks for the attractiveness (...) of both men and women. In the second study, we asked our participants to choose the most attractive male and female bodies in a method of adjustment task in which they could independently vary muscle and adipose to create the most attractive body. We asked whether individual differences in internalization of cultural ideals, drive for muscularity, eating disorder symptomatology and depressive symptoms could systematically shift the location of peak attractiveness in body composition space. We found a clear preference by both genders for a male body with high muscle and low adipose, and a toned, low adipose female body. The degree of internalization of cultural ideals predicted large individual differences in the composition of the most attractive bodies. (shrink)

I argue against the interpretation of propositions as intentions and proof-objects as fulfillments proposed by Heyting and defended by Tieszen and van Atten. The idea is already a frequent target of criticisms regarding the incompatibility of Brouwer’s and Husserl’s positions, mainly by Rosado Haddock and Hill. I raise a stronger objection in this paper. My claim is that even if we grant that the incompatibility can be properly dealt with, as van Atten believes it can, two fundamental issues indicate that (...) the interpretation is unsustainable regardless: (1) it is hard to determine, without appealing to propositional intentions on pain of circularity, what intention a proof-object should be understood as a fulfillment of; (2) due to a difficult fulfillment dilemma, it is unclear, at best, what the object of an intention corresponding to a proposition is. (shrink)

Throughout his career, Schelling assigns knowledge of the absolute first principle of philosophy to intellectual intuition. Schelling's doctrine of intellectual intuition raises two important questions for interpreters. First, given that his doctrine undergoes several changes before and after his identity philosophy, to what extent can he be said to “hold onto” the same “sense” of it by the 1830s, as he claims? Second, given that his doctrine of intellectual intuition restricts absolute idealism to what he calls a “science of reason”, (...) which he says cannot prove the absolute’s existence, what other doctrine does he require in order to prove this? I will answer these questions by tracing the shifts in Schelling’s doctrine of intellectual intuition from the 1790s to the 1830s and drawing out its evolving methodological role within his science of intelligibility. (shrink)

Max Weber, the grandfather of organizational theory, recognized the close association between health care organizations and law. When he introduced the concept of a legallaw-saturated,rational bureaucracies, healthcare organizations have highly formalized rules and procedures. They pay a great deal of attention to legal criteria in decisionmaking, and some have entire departments devoted to legal risk management.

Extending literature on health information to entertainment television, we analyze the prostate cancer narrative presented in the police drama, NYPD Blue. We explain how the physician-patient interaction depicted on the show followed (and sometimes did not follow) the medical dialogue model. Findings reveal that the producers of this show advocate a more dialogic model of medical interaction. Portrayals of incompetent, ineffective physicians are contrasted with the superior, effective efforts of other physicians. The audience learns that a non-dialogic approach characterizes “bad (...) doctors,” while the dialogic method typifies “good doctors.” Likewise, medical professionals can use such texts to enhance physician-patient interaction. (shrink)

This paper argues that we should solve paradoxes for propositions (such as the Russell–Myhill paradox) in essentially the same way that we solve Russellian paradoxes for sets. That is, the standard, iterative approach to sets is extended to include properties, and then the resulting hierarchy of sets and properties is used to construct propositions. Propositions on this account are structured in the sense of mirroring the sentences that express them, and they would seem to serve the needs of philosophers of (...) language and metaphysicians who rely on such propositions. The resulting account has limitations, comparable to those faced by the iterative approach to sets, but it is argued to be in important ways preferable to others that have been proposed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reply to CriticsBethany Henningplato knew that philosophy is not something we write; it is something we live. As Deweyans, we know philosophy is an ideal that emerges within experience as the highest possibility for dialogue. Insofar as a book appears as an extended monologue, it obscures the qualitative and transactive dimensions of philosophy as it is practiced. But sessions like these reveal that books are moments in a conversation, (...) "perchings" in a dialogue that is forever in media res. I am deeply grateful to Bill Myers for organizing this panel, and for the generosity of Frank Ryan, Gregory Pappas, and Jim Garrison for having taken the time to read and think about this book. Each of them has served as a model for philosophical scholarship, and I am humbled and honored to have the opportunity to engage with them directly. They have challenged me in three distinct ways and have engaged with what I have written on separate plateaus of thought, at times revealing layers of which I was not fully aware. So I will do my best to respond to their concerns and develop our shared inquiry in their light. I will also own that my reading of Dewey is selective, and it is my attempt to work through a problem that materialized, as all problems do, in the course of ordinary lived experience.At Southern Illinois University Carbondale, where I attended graduate school, we offered a course called "The American Mind." The title was a provocation, so I applied to teach it one semester. It was a fantastic challenge to try to curate a selection of texts that would serve as an encounter with an intellectual tradition that eludes me as much as it informs me—after all, prior to college, I only knew that a "philosopher" is what becomes of the loser in the board game called Life. I did not know that there was something called "American philosophy" until I applied to study at SIUC.If philosophy is the way that a culture reflects upon itself, then in this book, I have tried to invite the American mind to lie down on the couch. [End Page 95] Or, it might be more accurate to say that I have asked John Dewey, as the representative of American philosophy, how he might psychoanalyze such a mind. My hypothesis is that Dewey's theory of aesthetic experience, and the art that communicates and preserves such moments of intensified vitality, touches the deepest, but unspoken meanings that human beings encounter. This is where quality, the character of an event as a singular whole, the immediate aspect of an event that we feel rather than know, can be stabilized and communicated. If an interpretation can be made of the deep conflicts that have left philosophy at the margins of American life, I believe we would be wise to begin with our "dreams," with the creations of our imagination, the artistic products that reveal the felt dimension of our shared world.Many readers of Dewey choose to focus on his theory of inquiry, his recasting of the scientific method, and his instrumentalism as forming the core of his thought. This is an understandable approach; his work here is novel and corrects bad intellectual habits. However, for the purposes of this book, I have emphasized aesthetic experience, the role of the qualitative, and pursuit of meaning over the correction of practice in my interpretation. This is a controversial choice since it courts the irrational and the vague, but I believe that our neglect of these portions of experience prevents philosophy from reconnecting with American life.Response to Frank RyanFrank Ryan is concerned about the extent to which I have cast the organism as porous, and that I have identified aesthetic experience as unconscious. I agree with Dr. Ryan's assessment that defining aesthetic experience as wholly unconscious would be a grievous error—and I hope not to have made it. There is a misleading ambiguity in the title of the book that might predispose the reader to suspect that I am claiming an equivalence, but what I intended to argue was not that aesthetic experience itself is unconscious, but rather... (shrink)