The report by Barbara Bierer and Mark Barnes highlights the complexities experienced by institutions that conduct Public Health Service‐funded research involving human subjects and that need to negotiate the requirements of two sets of federal regulations: 45 C.F.R. 46, covering protections for human research subjects, and 42 C.F.R. 93, the PHS policies on research misconduct. As the nation's single largest sponsor of biomedical and behavioral research, the National Institutes of Health seeks to exemplify and promote human research protections and the (...) highest level of scientific integrity, public accountability, and social responsibility in the conduct of science. The NIH is committed to protecting the rights and welfare of research participants and to upholding integrity standards for research supported with public funds. However, human subjects protections must always take priority. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

This study investigates: the changes in three major health-related factors—physical activity, non-physical-activity health behavior, and depressive symptoms, and how changes in physical activity were associated with changes in one’s depressive symptoms among young adults, middle-aged adults, and older adults while controlling non-physical-activity health behavior and sociodemographic characteristics among young, middle-aged, and older adults before and after the COVID-19 outbreak lockdown in the United States. A total of 695 participants completed an online questionnaire via MTurk, and participants were asked to recall (...) their physical activity, depressive symptoms, and non-physical-activity health behavior status in January and May of 2020. The IPAQ-SF was used to evaluate individuals’ physical activity, while the CES-D-10 was used to assess depressive symptoms. Covariates included non-physical-activity health behavior and sociodemographic factors. A Bayesian significance testing of changes was used to examine significant changes in physical activity, non-physical-activity behavior, and depressive symptoms in each age group while Bayesian regression analysis was employed to examine how the changes in physical activity were associated with respondents’ depressive symptoms while controlling for individual NHB and sociodemographic characteristics. The results showed that the participants tended to maintain their physical activity levels after the lockdown despite significant increases in sitting time among young and older adults. Decreases in moderate physical activity frequency were associated with a higher level of depressive symptoms. Although young and middle-aged cohorts experienced fewer differences in depressive symptoms compared to their counterparts in the older group, we found no significant heterogeneity effects in the relationships of interest across all age groups. Considering different influences of physical activity on depressive symptoms depending on different levels of activity and ages, more randomized clinical trials with program-based intervention studies should be conducted with different physical activity programs for different age populations. (shrink)

A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Althoughpatientsand by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are theleastlikely (...) to request them. At many healthcare organisations in the USA, ethics consultations are overwhelmingly requested by physicians and other clinicians. We believe it is vital that healthcare institutions bridge the knowledge gaps and power imbalances over access to ethics consultation services through augmented policies, procedures and infrastructure. With enhanced education and support, patients and families may use ethics consultation to elevate their voices and prioritise their unique characteristics and preferences in the delivery of their healthcare. Empowering patients and families to request ethics consultation can only strengthen the patient/family–clinician relationship, enhance the shared decision-making model of care and ultimately lead to improved patient-centred care. (shrink)

This book critically reviews all principal contributions to the American animal rights debate by activists, campaigners, academics, and lawyers, while placing animal rights in context with other related and competing movements.

In lieu of an abstract, here is a brief excerpt of the content:Eucharistic Adoration:Veils for VisionEmmanuel Perrier O.P.Translated by Amy Christine DevaudTo the Virgin of the AnnunciationEucharistic adoration is an eminently personal form of prayer.1 Not in the sense that each one of us could fill this time spent in the presence of the Lord with what he or she wants; if this were to be the case, there would be no adoration at all, since it would simply be a (...) matter of meeting oneself and one's ideas about God. Eucharistic adoration is a personal prayer in the sense that the adorer welcomes in his soul the divine person of the eternal Son, through the vision of the human body united to the Son in the womb of the Virgin Mary, just as this body is offered by faith in the sacrament of the Eucharist. Therefore, what is crucial to this meeting is that prayer be guided by the truth of the Eucharistic mystery and not by the feelings of the adorer, even less by the introspection of himself while adoring. In presenting the theological foundations of Eucharistic adoration, the following pages have a threefold goal: to enlighten beginners about the very things which shape this prayer; to help those who are progressing in their adoration to align it to the vision of the Word who became flesh; and [End Page 397] to accompany and support those who are more advanced in putting into words what they are already experiencing.After having specified the foundations of Eucharistic adoration, we will address the themes that sustain it in the same order in which the soul welcomes the mystery of the Word become flesh. This is an order that can be followed as steps to take during a time of adoration. One will then take care to allow enough time for each step. But it may be more relevant to focus on a limited number of themes, or even on a single one. We will be careful to ensure that we do not neglect any of the themes presented throughout the various meditations for adoration.The Hope of VisionEucharistic adoration begins and is consumed in vision, in the gaze toward the Body of Christ in his sacrament. God has accustomed us to listen to him, ever since he began to speak to Abraham, to Moses, to David, through the prophets. The Law begins with this commandment: "Hear now, O Israel!" To hear the Word is to welcome it, to put it into practice, and in doing so, to let it bear fruit within us. But seeing God is quite different.In the days of Christ, the central part of the Temple in Jerusalem, one of the wonders of the world, had two rooms, one called the Holy Place and the other called the Holy of Holies. The entrance to each room was obstructed by a huge curtain (see Exod 26:31–32). The priests usually celebrated their services behind the curtain of the Holy Place. However, they did not enter the Holy of Holies, the dwelling place of God among men (see Exod 29:43–46), which sheltered, before its destruction (probably in 587 BC), the Ark of the Covenant containing the tables of the Law given at Sinai, as well as a relic of the manna, the bread that came down from heaven to feed the people of Israel during the Exodus (see Heb 9:4). Only once a year the High Priest would cross the veil of the Holy of Holies to stand in the presence of God and pronounce the Name above all names, in remembrance of God's encounters with Moses:Whenever Moses went out to the tent, all the people rose up, and every man stood at his tent door, and looked after Moses, until he had gone into the tent. When Moses entered the tent, the pillar of cloud would descend and stand at the door of to the tent, and the Lord would speak with Moses. And when all the people saw the pillar of cloud standing at the door of the tent, all the people would rise up and worship. … The Lord used to speak with Moses... (shrink)

The identity of lesbian-mother combines a marginalized identity with one of the most revered mainstream identities. With data collected through exploratory in-depth interviews from nine lesbian-mothers, the authors use symbolic interaction framework to explore the strategies that lesbian birth mothers and comothers employ to gain acceptance for their marginal-mainstream identities in their family networks. Respondents experienced varying levels of resistance from their social networks, with comothers being especially vulnerable due to their lack of both biological and legal substantiation. The authors (...) explore the process of identity negotiation in three realms of everyday experience: in relationships with extended families, in relations within the nuclear family, and in lesbian relationships that have ended. (shrink)

Shanker & King argue for a shift in the focus of ape language research from an emphasis on information processing to a dynamic systems approach. We differ from these authors in our understanding of how this “new paradigm” emerged and in our perceptions of its limitations. We see information processing and dynamic systems as complementary approaches in the study of communication.

Institutional Review Boards have expressed concern that research into sensitive topics such as mental disorder will cause participants undue distress. This study investigated the emotional responses of 5,220 Australians to a survey on mental-health-related discrimination. Participants were interviewed about their mental health and experiences of discrimination across 10 life domains and then the emotional impacts of the survey. Results suggested that a minority experienced a negative reaction in contrast to 88% reporting positive experiences. A mental health problem was associated with (...) both negative and positive reactions. (shrink)

This paper advocates for the inclusion of patient perspectives in the diagnosis and treatment of eating disorders (EDs) for ethical, epistemological, and pragmatic reasons. We build upon the ideas of a recent editorial published in this journal. Using EDs as their example, the authors argue against dominant DSM-oriented approaches in favor of an increased focus on understanding patients’ subjective experiences. We argue that their analysis stops too soon for the development of practical—and actionable—insights into how to effect the integration of (...) first-person and third-person accounts of EDs. Methods Contextual analysis was used to make the case for patient perspectives. (shrink)

BackgroundThe Public Health Service Increased Risk designation identified organ donors at increased risk of transmitting hepatitis B, hepatitis C, and human immunodeficiency virus. Despite clear data demonstrating a low absolute risk of disease transmission from these donors, patients are hesitant to consent to receiving organs from these donors. We hypothesize that patients who consent to receiving offers from these donors have decreased time to transplant and decreased waitlist mortality.MethodsWe performed a single-center retrospective review of all-comers waitlisted for liver transplant from (...) 2013 to 2019. The three competing risk events (transplant, death, and removal from transplant list) were analyzed. 1603 patients were included, of which 1244 (77.6%) consented to offers from increased risk donors.ResultsCompared to those who did not consent, those who did had 2.3 times the rate of transplant (SHR 2.29, 95% CI 1.88–2.79, p < 0.0001), with a median time to transplant of 11 months versus 14 months (p < 0.0001), as well as a 44% decrease in the rate of death on the waitlist (SHR 0.56, 95% CI 0.42–0.74, p < 0.0001). All findings remained significant after controlling for the recipient age, race, gender, blood type, and MELD. Of those who did not consent, 63/359 (17.5%) received a transplant, all of which were from standard criteria donors, and of those who did consent, 615/1244 (49.4%) received a transplant, of which 183/615 (29.8%) were from increased risk donors.ConclusionsThe findings of decreased rates of transplantation and increased risk of death on the waiting list by patients who were unwilling to accept risks of viral transmission of 1/300–1/1000 in the worst case scenarios suggests that this consent process may be harmful especially when involving “trigger” words such as HIV. The rigor of the consent process for the use of these organs was recently changed but a broader discussion about informed consent in similar situations is important. (shrink)

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)

In a healthcare setting, a multitude of ethical and moral challenges are often present when patients and families direct uncivil behavior toward clinicians and staff. These negative interactions may elicit strong social and emotional reactions among staff, other patients, and visitors; and they may impede the normal functioning of an institution. Ethics Committees and Clinical Ethics Consultation Services (CECSs) can meaningfully contribute to organizational efforts to effectively manage incivility through two distinct, yet inter-related channels. First, given their responsibility to promote (...) a humane, respectful, and professional climate, many CECSs and Ethics Committees may assist institutional leadership in evaluating and monitoring incivility policies and procedures. Second, when confronted with individual incidents of patient/family incivility, Ethics Consultants can and often do work with all stakeholders to address and mitigate potentially deleterious impacts. This manuscript presents an overview of the multifaceted ethical implications of incivility in the healthcare environment, discusses the inherent qualifications of Ethics Consultants for assisting in the management of incivility, and proposes specific mitigating actions within the purview of CECSs and Ethics Committees. We also invite healthcare organizations to harness the skills and reputation of their CECSs and Ethics Committees in confronting incivility through comprehensive policies, procedures, and training. (shrink)

The psychological work environment is composed of both stressful and motivational work conditions at different levels of analysis. However, most relevant theory and research lack an integrative conceptualization and appropriate instrumentation to account for this work context structure. These limitations are particularly present in non-mainstream populations, such as the Spanish community of researchers and practitioners. In this study, based on the job demands–resources model, we present an updated conceptualization in which stressful and motivational psychosocial factors are integrated and defined at (...) the job, the group, and the organizational level of analysis into a single conceptualization. Furthermore, derived from this conceptualization, we present a study of the development and validation of a questionnaire to account for the psychosocial work environment in Spanish, labeled Psychosocial Factors Questionnaire 75, which provides measures for 23 different psychosocial factors. The results of this study supported the questionnaire’s construct, convergent, divergent, and predictive validity, together with its reliability. Thus, this conceptualization and questionnaire provides researchers and partitioners with a more comprehensive approach to the assessment of the psychosocial work environment and promises benefits for interventions in the workplace. (shrink)

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of (...) a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives. (shrink)

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small-N study to explore the associations between stress and psychological symptoms (...) during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms, as well as stressful life experiences prior to-versus during the pandemic. Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers’ experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers’ mental health. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

In cognitive science, there is a tacit norm that phenomena such as cultural variation or synaesthesia are worthy examples of cognitive diversity that contribute to a better understanding of cognition, but that other forms of cognitive diversity (e.g., autism, attention deficit hyperactivity disorder/ADHD, and dyslexia) are primarily interesting only as examples of deficit, dysfunction, or impairment. This status quo is dehumanizing and holds back much-needed research. In contrast, the neurodiversity paradigm argues that such experiences are not necessarily deficits but rather (...) are natural reflections of biodiversity. Here, we propose that neurodiversity is an important topic for future research in cognitive science. We discuss why cognitive science has thus far failed to engage with neurodiversity, why this gap presents both ethical and scientific challenges for the field, and, crucially, why cognitive science will produce better theories of human cognition if the field engages with neurodiversity in the same way that it values other forms of cognitive diversity. Doing so will not only empower marginalized researchers but will also present an opportunity for cognitive science to benefit from the unique contributions of neurodivergent researchers and communities. (shrink)

Existing research has examined if undergraduate factors influence chemistry and physics, or physical science, doctoral degree entry and whether variables during PhD programs associate with graduation. Yet research on the transition from bachelor’s degree to doctoral degree entry (i.e., PhD entry in less than 6 months, attainment of a master’s degree prior to doctoral degree entry, or working in a science-related job for more than a year prior to doctoral degree entry) on PhD degree graduation remains scarce. Our study examines (...) the transition from bachelor’s to doctoral degrees to see if experiences therein associate with female PhD graduation, after doctoral degree enrollment. Our logistic regression analysis, of female chemistry and physics doctorates (n = 867), indicated that attainment of a master’s degree did not change the likelihood of graduation, when compared to direct entry into physical science doctoral programs. Meanwhile working in a science-related job for a year or more is associated with a significantly lower likelihood of physical science doctoral graduation when compared to women who entered directly into PhD programs or received a master’s degree prior to enrollment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:242 HISTORY OF PHILOSOPHY his political and religious predispositions prodded him to demonstrate that the roots of modern science were in the Christian Middle Ages. Sarton's particular foibles are best understood by referring them to his pacifist commitments and the moralistic assumption that the values of science are transferable to other human endeavors. Categories such as inductivism, conventionalism and Popperianism are of little help in gaining historical understanding. For (...) this, they are in fact Platonic ideals which have little heuristic value. I would venture that a truly historical historiography of science would aid us in spotting errors in the past and help us in the future. My guess is that a good analysis would reveal a major source of trouble to have stemmed from preconceived notions which the history of science was meant to illustrate. Surely some of them have been philosophical in character, and even Baconian or conventionalist. But until recent times, most of these preconceptions have stemmed from religious, nationalistic, or personal motivations, or from scientists who wanted support for a particular concept. I agree with Agassi only in the suggestion that a parti pris was at the root of our troubles. Why, then, substitute a Popperian preconception for a conventionalist one? Why not, on the contrary, combat their distorting influence and reduce their impact? This is in fact what has happened in recent times. As the history of science has fallen into the hands of a gradually organized profession, the blatant motivations --of any type--which colored past historical writings have slowly receded. By a constant and critical confrontation of opposing views among specialists, the purpose for examining the history of science has slowly been transformed. The older external motivations have given way to an interest in the subject for its own sake and a gradual transformation has been in the making for the last few decades. As happens in other human endeavors, professionalization has already raised the standards in the discipline and there is every reason to think it will continue to do so in the future. We need not really be as pessimistic as Agassi, nor embrace his particular salvation. ROGEa HAm~ University o] Cali]ornia, Berkeley A MEDIEVAL ANALYSIS OF INFINITY IN THE COURSEof arguing that time must have had a beginning, St. Bonaventure (1221-74) put forward a demonstration which in some ways seems to anticipate Cantor's definition of infinity.1 Bonaventure pointed out that, if the world were infinitely old, then there would have been an infinite number of annual revolutions of the sun around the ecliptic. But during each such period there occur (roughly) twelve revolutions of the moon, i.e. lunar months or lunations. Thus there would be one infinity which was twelve times another--which, says Bonaventure, is impossible. This attempted proof might be formulated as the following For other adumbrationsof this definition,see I. Thomas,"A TwelfthCentury Paradoxof the Infinite,"Journal o] Symbolic Logic, XXIII (1958), 133-134, and W. & M. Kneale, The Development of Logic (Oxford,1962),p. 440. NOTES AND DISCUSSIONS 243 reductio ad absurdum, in which a revolution of the sun is specified as the period between successive vernal equinoxes. If there could be an infinite set of past lunations, then clearly it could be put in a one-to-one correspondence with a proper sub-set of itself--viz., with the set of past lunar months during which vernal equinoxes occurred. But this consequence is preposterous; no set could be so correlated with its own sub-set. Therefore the set of past lunar months cannot be infinite, and the world must have had a beginning. The passage, which is found in Bonaventure's commentary on the Sentences of Peter Lombard, reads as follows :2 Si mundus est aeternus, revolutiones solis in orbe suo sunt infmitae ; rursus, pro una revolutions solis necesse est fuisse duodecim ipsius lunae: ergo plus revoluta est luna quam sol; et sol infinities: ergo infinitorum ex ea parle, qua infinita sunt, est reperire excessum. Hoe autem est impossibile : ergo etc. PA~-r~asoN BROWN Harpur College, State University o] New York Sententiarum L/b. H, Dist. I, P.I, Art. I, Quaest. II, as found in S. Bonaventurme, Opera Omnla... (shrink)

Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73–99% in New Zealand and 72–94% in Australia depending on the scenario) the percentage who would not (...) discuss expensive unfunded drugs was substantially lower in New Zealand (6.4–11.1%) than it was in Australia (28–41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians' decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced. (shrink)

BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)

The project we highlight in this article stems from our philosophical work on moral disagreements that appear to be—and sometimes are—intractable. Deliberative democratic theorists tout the merits of dialogue as an effective way to bridge differences of values and opinion, ideally resulting in agreement, or perhaps more often resulting in greater mutual understanding. Could dialogue mitigate disagreements about a controversial education policy such as affirmative action? Could it foster greater understanding? We conceived of a project that would simultaneously fulfill two (...) goals that we had as philosophers, education researchers, and aspiring public intellectuals. First, it would allow us to use philosophy in research, grounding our mixed methods research in a philosophically informed framework. The tools and analytic techniques that are particular to philosophers felt uniquely suited for an empirical study concerning political theory. Second, we aimed to use philosophy in the community. We were able to put our own expertise in philosophy and race-conscious education policy to good use by purposefully creating opportunities for diverse community members in our larger metropolitan area to engage in dialogue and deliberation with each other over the issue of affirmative action. (shrink)

This article notices a trend in work done by philosophers who build on P. F. Strawson’s account of the reactive attitudes; it looks as though philosophers supplement Strawson with a more robust ethical program in order to address questions concerning the moral appropriateness of the reactive attitudes. I argue feminist care ethics can serve as a promising moral supplement to Strawson. Then, I diagnose a problem in Strawson— namely, the assumption that members of moral communities will express all three kinds (...) of reactive attitudes. Once we consider these three expressions from a feminist perspective, it becomes clear that while some may express indignation on behalf of others and guilt toward themselves, many will not express resentment directly toward others for good reasons under oppressive conditions. (shrink)

Certain kinds of prediction, foreknowledge, and future‐oriented action appear to require settled future truths. But open futurists think that the future is metaphysically unsettled: if it is open whether p is true, then it cannot currently be settled that p is true. So, open futurists—and libertarians who adopt the position—face the objection that their view makes rational action and deliberation impossible. I defuse the epistemic concern: open futurism does not entail obviously counterintuitive epistemic consequences or prevent rational action.

Law, Ethics and the Biopolitical explores the idea that legal authority is no longer related to national sovereignty, but to the 'moral' attempt to nurture life. The book argues that whilst the relationship between law and ethics has long been a central concern in legal studies, it is now the relationship between law and life that is becoming crucial. The waning legitimacy of conventional conceptions of sovereignty is signalled the renewal of a version of natural law, evident in discourses of (...) human rights, that de-emphasises the role of a divine law-giver in favour of an Aristotelian conception of the natural purpose of life and the 'common good'. Synthesising elements of legal scholarship on sovereignty, theories of biopolitics and biopower, as well as recent developments in the domains of ethics, Amy Swiffen examines the invocation of 'life' as a foundation for legal authority. The book documents the connection between law, life and contemporary forms of biopolitical power by critically analysing the fundamental principles of the bioethical paradigm. Unique in its critical and cross-disciplinary approach, Law, Ethics and the Biopolitical will be of interest to students and teachers in the areas of law and society, law and literature, critical legal studies, social theory, bioethics, psychoanalysis, and biopolitics."--P. [iv] of cover. (shrink)