Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

This book provides a focus for future discussion in one of the most important debates within historical theology within the protestant tradition - the debate about the definition of a category of analysis that operates over five centuries of religious faith and practice and in a globalising religion. In March 2009, TIME magazine listed ‘the new Calvinism’ as being among the ‘ten ideas shaping the world.’ In response to this revitalisation of reformation thought, R. Scott Clark and D. G. (...) Hart have proposed a definition of ‘Reformed’ that excludes many of the theologians who have done most to promote this driver of global religious change. In this book, the Clark-Hart proposal becomes the focus of a debate. Matthew Bingham, Chris Caughey, and Crawford Gribben suggest a broader and more historically responsible definition for ‘Reformed,’ as Hart and Scott respond to their arguments. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

The Patient Protection and Affordable Care Act turns to a nontraditional mechanism to improve public health: employer -provided financial incentives for healthy behaviors. Critics raise questions about incentive programs' effectiveness, employer involvement, and potential discrimination. We support incentive program development despite these concerns. The ACA sets the stage for a broad-based research and implementation agenda through which we can learn to structure incentive programs to not only promote public health but also address prevalent concerns.

Individuals can often take steps to preserve or improve their own health. They can eat appropriate quantities of healthy foods, exercise, and refrain from smoking. They can obtain preventive care and adhere to their physicians’ advice about how best to manage their health. But they often fail to take these steps.A widespread failure to adopt healthy behaviors can significantly erode public health while increasing health care costs. Obesity, for example, increases the risk of heart disease, stroke, liver disease, and certain (...) cancers. By one estimate, it is responsible for almost 10 percent of medical spending in the United States, or about $147 billion per year. Smoking increases the risk of heart disease, stroke, lung disease, and cancer; it accounts for nearly 20 percent of deaths each year in the United States and about $96 billion in health care expenditures. (shrink)

Physicalists motivate their position by posing a problem for the opposition: given the causal completeness of physics and the impact of the mental (or, more broadly, the seemingly nonphysical) on the physical, antiphysicalism implies that causal overdetermination is rampant. This argument is, however, equivocal in its use of 'physical'. As Scott Sturgeon has recently argued, if 'physical' means that which is the object of physical theory, completeness is plausible, but the further claim that the mental has a causal impact (...) on the physical is no longer so evident. In this paper I assess the damage due to the ambiguity of 'physical' and provide a repair to the overdetermination strategy. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Donors to biobanks are typically asked to give blanket consent, allowing their donation to be used in any research authorized by the biobank. This type of consent ignores the evidence that some donors have moral, religious, or cultural concerns about the future uses of their donations – concerns we call “non-welfare interests”. The nature of non-welfare interests and their effect on willingness to donate to a biobank is not well understood. In order to better undersand the influence of non-welfare interests, (...) we surveyed a national sample of the US population using a probability-based internet panel. Logistic regression models assessed the demographic and attitudinal characteristics associated with participants’ willingness to give consent for unspecified future uses of their donation when presented with 7 research scenarios that raised possible non-welfare interest concerns. Most people had non-welfare interests that significantly affect their willingness to donate to a biobank using blanket consent. Some non-welfare interests are associated with subgroups but others are not. A positive attitude toward biomedical research in general was associated with increased willingness to donate, while concerns about privacy and being African American were associated with decreased willingness. Non-welfare interests matter and can diminish willingness to donate to a biobank. Our data suggest that trust in research promotes willingness to donate. Ignoring non-welfare interests could erode this trust. Donors’ non-welfare interests could be accommodated through greater transparency and easier access to information about the uses of donations. (shrink)

Argumentation as the public exchange of reasons is widely thought to enhance deliberative interactions that generate and justify reasonable public policies. Adopting an argumentation-theoretic perspective, we survey the norms that should govern public argumentation and address some of the complexities that scholarly treatments have identified. Our focus is on norms associated with the ideals of correctness and participation as sources of a politically legitimate deliberative outcome. In principle, both ideals are mutually coherent. If the information needed for a correct deliberative (...) outcome is distributed among agents, then maximising participation increases information diversity. But both ideals can also be in tension. If participants lack competence or are prone to biases, a correct deliberative outcome requires limiting participation. The central question for public argumentation, therefore, is how to strike a balance between both ideals. Rather than advocating a preferred normative framework, our main purpose is to illustrate the complexity of this theme. (shrink)

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Proponents of the dominant contemporary model of corporate governance maintain that the shareholder is the primary constituent of the firm. The responsibility for managerial decision makers in this governance system is to maximize shareholder wealth. Neoclassical economists ethically justify this objective with their interpretation of Adam Smith's notion of the Invisible Hand. Using a famous quotation from The Wealth of Nations, they interpret the Invisible Hand as Smith's (An Inquiry into the Nature and Causes of the Wealth of Nations, Methuen (...) & Co., London) assertion that market participants, in pursuing their own self-interests without regard to the interests of others, will collectively provide the optimal economic benefit to society. We argue that the traditional interpretation of Smith is too narrow and potentially harmful to society. In order to fully understand Smith's notion of the influence of the Invisible Hand on human behavior, one must also consider The Theory of Moral Sentiments. In that work, Smith (The Theory of Moral Sentiments, A. Millar, London) portrays the pursuit of self-interest as only one of several potential motivations for human action. He also acknowledged the existence of a “sympathy principle,” which refers to the ability and propensity of human beings to consider the interests of others. Heilbroner (The Essential Adam Smith, W.W. Norton, New York, p. 59) suggests that Smith's sympathy principle allows one to “determine the appropriate degree of self-interest, the proper display of benevolence, the desirable strictness of justice.” In fact, Smith indicates that (1) a society whose members pursue self-interest without a sense of justice will eventually collapse; (2) a society whose members pursue self-interest checked by their sense of justice alone will survive; (3) a society whose members pursue self-interest, justice, and the interests of others will flourish. Since a more complete reading of Smith indicates that human beings, in considering their own interests, also reflexively consider the interests of others when making decisions, then the traditional corporate governance model appears to be lacking. A broader, multiple stakeholder approach to corporate governance that considers the interests of other constituencies may be more consistent with Smith's views. In particular, Smith's sympathy principle provides a theoretical foundation for a shift away from the narrow, yet dominant, shareholder-based corporate governance model and toward multiple stakeholder models of corporate governance [e.g., Business and Society: A Strategic Approach to Corporate Citizenship, Houghton Mifflin, Boston, MA] and internal decision-making [e.g., Sloan Management Review 38, (1997) 25–37]. (shrink)

A quick mental survey of one's friends or acquaintances reveals an important difference between them. On the one hand, there are seemingly stoic people for whom emotional events (e.g., having a pap...

In this article, the insertion of a two-staged highly interesting question in an online, survey-based field experiment is shown to produce better survey completion rate (i.e., decreases completion refusal by 8%) and sample representativeness (increases the number of moderate answer patterns by 12%) than a typical (same) highly interesting question at the beginning of a survey only. Using nonparametric tests and subgroup probability analysis, measured effects include survey completion rates, response bias and reported demographic differences. In regards to sample representativeness, (...) the results also raise questions about the sensitivity of the conventional practice of comparing early to late respondent means scores as a method of investigating nonresponse bias in marketing research. Alternative approaches to measuring potential non-response bias are compared with the tradition of comparing early-wave verses late-wave mean respondent differences. The results indicate that the conventional mean test fails to identify differences in nonresponse bias; the scores of highly interested or opposed respondents in the first waves produce equivalent means to the scores of the less interested or opposed respondents in the latter wave between the surveys (e.g., 1's and 5's vs. 2's and 4's, both averaging to 3's) that are identifiable through kurtosis and probability analysis. (shrink)

The arts and nursing are profoundly connected. While the relationship between nursing and art has persisted over time, the majority of nursing scholarship on the arts has historically centered upon the art of nursing practice and the cultivation and application of aesthetic knowing. However, there is a burgeoning use of arts‐based strategies is nursing education, research, and practice. Correspondingly, there is a need to understand how such approaches can uniquely contribute knowledge to the nursing discipline in order to support arts‐integration (...) for nursing scholars. We structure our inquiry into arts’ contributions according to two dominant methods of engaging with arts‐based strategies: knowing about (e.g., phenomena) vis‐à‐vis art‐viewing, and knowing through (e.g., embodied knowing) vis‐à‐vis art‐making. In doing so, we explore critical contributions of art to nursing research and educational practices, including arts’ capacity to augment traditional research and communication approaches, democratize the research space, challenge issues of representation, and facilitate education, dissemination, and reflexivity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: Hume's Skepticism about Inductive Inference N. SCOTT ARNOLD IT HAS BEEN A COMMONPLACE among commentators on Hume's philosophy that he was a radical skeptic about inductive inference. In addition, he is alleged to have been the first philosopher to pose the so-called problem of induction. Until recently, however, Hume's argument in this connection has not been subject to very close scrutiny. As attention has become focused on (...) this argument, a debate has been shaping up concerning just what Hume intended to establish here. The principal purpose of this article is to settle this interpretive issue as decisively as the texts permit. I should also like to locate Hume's main argument about induction in the larger context of his discussion of skepti- cism in book 1 of the Treatise. I shall suggest that arguments for the radical skepticism commonly attributed to Hume can be found only very late in book 1 of the Treatise and that the most famous argument about inductive inference establishes and is intended to establish only a relatively modest form of skepticism. The argument under consideration can found in book l, part 3, section 6 of the Treatise. It can also be found in essays 4 and 5 of the Enquiries and in the abstract of the Treatise published anonymously by Hume. I shall concen- trate on the Treatise version since it is the first and perhaps most explicit formulation of the argument and because part of my purpose is to place this argument in the larger context of book 1 of the Treatise. The received opinion concerning Hume's argument has it that Hume was highly skeptical about the mind's claims to knowledge about the future (or, more generally, about the unobserved). All beliefs arrived at via inductive I should like to thank M. G. Anderson, John Bahde, Jon Nordy, and Robert Paul Wolff, as well as David Fate Norton and a referee for the Journal of the History of Philosophy, for helpful comments on earlier drafts on this article. 32 HISTORY OF PHILOSOPHY inferences are unreasonable or unjustified. The alternative interpretation, to be defended below, is that Hume held that no such belief is or can be rendered certain relative to past experience and that such beliefs are not, upon that account, unreasonable or unjustified. Something like this inter- pretation has been defended by Tom L. Beauchamp, Thomas Mappes, and Alexander Rosenberg. ~ My view differs from theirs in that I shall argue that Hume did offer arguments for the more radical skepticism commonly attri- buted to him (though it is unclear whether he regarded them as decisive). These arguments, however, come at the end of book ~ of the Treatise and are independent of the more famous argument to be discussed below. Defenders of the received view are both numerous and distinguished. Versions of this interpretation of the main argument can be found in the writings of Karl Popper, Wesley Salmon, F. L. Will, and Norman Kemp Smith; most recently a variation on the standard interpretation has been defended by Barry Stroud. The fullest and most elaborate defense of the standard interpretation can be found in a monograph by D. C. Stove. '~ Stove's discussion is perhaps the most impressive because of his painstaking efforts to lay bare the structure of Hume's reasoning and to give a line-by- line analysis of the argument. This has the effect of bringing more clearly into focus the main grounds for the standard view. If this standard interpre- tation is correct, then Hume's position is that scientific method is epistemically no better than "superstition" and "enthusiasm." And, Hume would be among those for whom this claim, if true, would be very bad news, because one of his primary purposes in the Treatise is to construct a science of man. Thus, this argument is of considerable internal significance because, if my opponents are correct, Hume appears to have cut the ground out from under what he took to be one of his most important projects -- the construc- tion of a science of man. The other feature of this argument that makes it worthy of serious con- sideration is that it is philosophically... (shrink)

In this paper, I examine three significant periods of the cosmological argument which exemplify the importance of contestation: first, Plato’s and Aristotle’s formulation of it, second, Philoponus’ own reactions and influence, third, the contemporary state of such discourses. Contestation has an inestimable role in philosophical development and reflection, as will be demonstrated through the examination of such periods.

In this paper, I wish to reflect on the psyche of the West with respect to the changing cultural trends involving Christianity, Islam, and the human person. I propose that we first understand the context we find ourselves in regarding the apparent confusion surrounding Islam in the West. Then from there, in the second section, I suggest that it will be useful to define and examine some terms including religion, relativism, tolerance, and intolerance. This will help provide a clearer picture (...) of some of the conflicting and confusing ideas circulating throughout the media, academic institutions, and everyday life. Third, it will be important to provide an examination of the discourse on apologetics, while primarily focusing on Christian and Islamic apologetics. (shrink)

In this paper, I will argue that the best explanation for the origin of embodied human consciousness is grounded in God as understood through the doctrine of divine simplicity. First, I will present a modern expression of Aquinas’ understanding of divine simplicity. I will focus on one of Aquinas’ main contentions, namely, the impossibility that God possesses any spatial or temporal parts. Second, I will offer a modern version of a cosmological argument that will fortify the doctrine of divine simplicity (...) with respect to the implied transcendent cause. Third, for embodied consciousness to arise, given modern science, it must arise through an evolutionary process of some sort. I will take a theistic evolutionary approach. Such an understanding will be explored while providing a connection to Jacques Maritain’s view of human evolution as expressed in his sixth chapter of Untrammeled Approaches titled “Toward a Thomist Idea of Evolution.” From there I will tie the main three threads of this paper together. (shrink)

In this article, I examine a critical issue that is central to the Christian faith; one that has divided Western Christendom ever since. I will explore Martin Luther's and Jacques Maritain's positions on justification by faith. First, I will outline Luther's view which is more accurately known as sola fide, that is, justification by faith alone. Second, I will outline Maritain's understanding of faith and examine his criticism of Martin Luther in his Three Reformers (1925) which analyzes the coherence of (...) Luther's position. The introduction of Luther's 95 theses is recognized by many as the incipient moment of the reformation. One may ask a practical question: where in our present context, can Catholics and Protestants situate themselves in this wider dialogue regarding justification? I will conclude with a brief reflection on this question. (shrink)

The five books of Artemidorus of Ephesus’ Oneirocritica (c. second century CE) constitute the largest collection of divinatory dream-interpretations to survive from Graeco-Roman antiquity. This article examines Artemidorus’ contribution to longstanding medico-philosophical debates over the ontological and epistemic character of such dreams. As with wider Mediterranean traditions concerning premonitory dreams, Greeks and Romans popularly understood them as phenomena with origins exterior to the dreamer (e.g. a visitation of a god). Presocratic and Hippocratic thinkers, however, initiated an effort to bring at (...) least some dream events within the body as interior processes of a physical soul, a bodily turn which ultimately engendered a split in thinking about the possibility and scope of prophetic and diagnostic dreams (e.g. Hippocrates Regimen 4, Aristotle On Prophecy in Dreams, Rufus of Ephesus, and Galen). Here, I examine the way that Artemidorus meant the Oneirocritica to address seriously questions about the origins of dreams and the powers of empirical science in two, related ways. We will see that his defense of oneirocriticism as a techne unfolds along two main axes. First, Artemidorus constructs a necessary veneer of scientific credibility by mobilizing the tropes and organizational strategies characteristic of contemporary technical literature. Secondly, he anchors that authority upon a materialist account of prophetic dreams as “semiotic movements of the soul.” As Price, S. 1986. “The Future of Dreams: From Freud to Artemidorus.” Past & Present 113: 3–36 and Harris-McCoy, D. 2012. Artemidorus’ Oneirocritica: Text, Translation, and Commentary. Oxford: Oxford University Press observed, this explicit commitment to an empirical method of dream-interpretation resembles that of the Hellenistic medical ‘sect’ known as ‘Empiricists,’ who eschewed interest in theoretical etiology in favor of observation, comparison, and compilation of symptoms and outcomes. Pushing beyond similarity, I argue that Artemidorus not only deployed this method to defend empirically grounded accounts of dream-divination (cf. Cicero De div. 1), but endeavored to show that such a scientific method can be used to stabilize and corral productively the potentially infinite number of interpretations any dream-sign might bear without recourse to an underlying, causal theory. (shrink)

Richard Thaler and Cass Sunstein, in Nudge: Improving Decisions About Health, Wealth, and Happiness, assert that rejecting the use nudges is ‘pointless’ because ‘[i]n many cases, some kind of nudge is inevitable’. Schlomo Cohen makes a similar claim. He asserts that in certain situations surgeons cannot avoid nudging patients either toward or away from consenting to surgical interventions. Cohen concludes that in these situations, nudging patients toward consenting to surgical interventions is uncriticizable or morally permissible. I call this argument: The (...) Unavoidability Argument. In this essay, I will respond to Cohen's use of the unavoidability argument in support of using nudges during the process of informed consent. Specifically, I argue that many so-called ‘unavoidable nudges’ are, in fact, avoidable. Although my argument is directed toward Cohen's use of the unavoidability argument, it is applicable to the unavoidability argument more generally. (shrink)

Review of Nabeel Qureshi's conversion from Ahmadiyya Islam to Christianity.

In this essay I discuss a novel engineering ethics class that has the potential to significantly decrease the likelihood that students will inadvertently or unintentionally act unethically in the future. This class is different from standard engineering ethics classes in that it focuses on the issue of why people act unethically and how students can avoid a variety of hurdles to ethical behavior. I do not deny that it is important for students to develop cogent moral reasoning and ethical decision-making (...) as taught in traditional college-level ethics classes, but as an educator, I aim to help students apply moral reasoning in specific, real-life situations so they are able to make ethical decisions and act ethically in their academic careers and after they graduate. Research in moral psychology provides evidence that many seemingly irrelevant situational factors affect the moral judgment of most moral agents and frequently lead agents to unintentionally or inadvertently act wrongly. I argue that, in addition to teaching college students moral reasoning and ethical decision-making, it is important to: 1. Teach students about psychological and situational factors that affect people’s ethical judgments/behaviors in the sometimes stressful, emotion-laden environment of the workplace; 2. Guide students to engage in critical reflection about the sorts of situations they personally might find ethically challenging before they encounter those situations; and 3. Provide students with strategies to help them avoid future unethical behavior when they encounter these situations in school and in the workplace. (shrink)

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting (...) Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core. (shrink)