Much attention has been given to determining whether an adolescent patient has the capacity to consent to research. This study explores the factors that influence adolescents' decisions to participate in a research study about youth violence and to determine positive or negative feelings elicited by being a research subject. The majority of subjects perceived their decision to participate to be free of coercion, and few felt badly about having participated. However, adolescents who were alone in the room during the assent (...) process were more likely to report that they chose freely to be a research subject. This study may influence the ways physicians communicate with adolescent patients around research assent within a clinical care environment. 1This article was presented at the Annual Meetings of The Pediatric Academic Societies in Baltimore, MD and The Society for Academic Emergency Medicine in Atlanta, GA in May, 2001. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

According to the standard Aristotelian doctrine of the identity of passion and action (Ipa), a passion and the action with which it is identified are distinguished through a distinction of reason, and both passion and action are located in the patient. Descartes has recently been interpreted by some scholars to be rejecting Ipa in favor of a view that throws into contention a dualistic interpretation of his philosophy of mind. This article contends that Descartes did hold Ipa, albeit expressed in (...) his own metaphysical vocabulary of substance and mode. On this interpretation, (1) a passion and the action with which it is identified are distinguished through a conceptual distinction or distinction of reason and (2) the passion and the action constitute one and the same mode which is locatedin the patient. This result is significant first, because it shows Descartes's retention of a fundamentally Aristotelian understanding of the metaphysical categories of passion and action and second, because it removes some of the support for recent interpretations on which Descartes is seen in the Passions of the Soul to diverge from a dualistic view of mind and body. (shrink)

Next SectionObjectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy. Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade level, (...) interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests. Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit. Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required. Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392. (shrink)

Virtue ethicists argue that modern ethical theories aim to give direct guidance about particular situations at the cost of offering artificial or narrow accounts of ethics. In contrast, virtue ethical theories guide action indirectly by helping one understand the virtues—but the theory will not provide answers as to what to do in particular instances. Recently, this had led many to think that virtue ethical theories are self-effacing the way some claim consequentialist and deontological theories are. In this paper I defend (...) virtue ethics against the charge of self-effacement. I distinguish between modestly self-effacing theories, immodestly self-effacing theories and theories that recommend indirect guidance. Though all self-effacing theories are indirect, not all indirect theories are self-effacing. I argue that virtue ethics is not self-effacing, but rather indirectly action-guiding. The response I articulate draws on the distinctive virtue ethical mode of action-guidance: namely, that thinking hard about virtue and what kind of person one aims to be offers the kind of guidance we want (or should want) as we face practical moral problems. (shrink)

Permeabilized cell models provide an experimental middle ground wherein the in vitro properties of mechanochemical proteins can be reconciled with the physical and topological constraints of the intact cell. Several well‐studied examples of organelle motility are described here, including the actin‐based cytoplasmic streaming of Characean algae, the microtubule‐based aggregation and dispersion of pigment granules in chromatophores and the saltatory movements of vesicles along microtubules in fibroblasts and macrophages. The permeabilized models developed for these systems have helped to integrate observations in (...) vivo with in vitro assays of motor proteins. (shrink)

Respect and self-respect are the cornerstone motivations in Kantian moral psychology. But “respect” is an ambiguous term. As Stephen Darwall has argued, sometimes respect refers to a constraint on practical reason, but at other times it refers to a person-directed pro-attitude. In this article, I argue that this distinction is a problem regarding self-respect since self-respect, in the latter sense, lacks warrant. Furthermore, I discuss Nietzsche’s conception of “self-reverence,” which in some ways serves as a replacement for Kantian self-respect in (...) the pro-attitude sense. I argue that, in Nietzsche’s view, the value that a person anticipates and aspires to realize in the future warrants self-reverence, even in cases where the person cannot fully articulate this value. This kind of self-directed value is what Nietzsche means when he claims in Beyond Good and Evil §287, “The noble soul has reverence for itself.”. (shrink)

Why hasn’t democracy been embraced worldwide as the best form of government? Aesthetic critics of democracy such as Carlyle and Nietzsche have argued that modern democracy, by removing the hierarchical institutions that once elevated society’s character, turns citizens into bland, mediocre souls. Joel A. Johnson now offers a rebuttal to these critics, drawing surprising inspiration from American literary classics. Addressing the question from a new perspective, Johnson takes a fresh look at the worth of liberal democracy in these uncertain (...) times and tackles head-on the thorny question of cultural development. Examining the novels of James Fenimore Cooper, Mark Twain, and William Dean Howells, he shows that through their fiction we can gain a better appreciation of the rich detail of everyday life, making the debate relevant to contemporary discussions of liberal democracy. Johnson focuses on an issue that liberals have inadequately addressed: whether people tend to develop fully as individuals under liberal democracy when such a regime does little formally to encourage their development. He argues that, though the liberal fear of state-guided culture is well founded, it should not prevent us from evaluating liberalism’s effect on individual flourishing. By extending the debate over the worthiness of liberal democracy to include democracy’s effect on individual development, he contends that the democratic experience is much fuller than the aristocratic one and thus expands the faculties of its citizens. Critics of American democracy such as John Rawls have sought to transform it into a social or egalitarian democracy in the European style. Johnson shows that neither the debate between Rawls and his communitarian critics nor the ongoing discussion of the globalization of American values adequately addresses the fundamental critique of democratic culture advanced by the aesthetic critics. Johnson’s cogent analysis reaches out to those readers who are ready for a more comprehensive evaluation of liberal democracy, offering new insight into the relationship between the state and the individual while blazing new trails in the intersection of politics and literature. (shrink)

In the Gorgias, Plato has Polus ask Socrates if he would rather suffer injustice than perform it. Socrates’ response is justly famous, affirming a view that Polus himself finds incredible, and one that even contemporary readers find difficult to credit: “for my part, I would prefer neither, but if it had to be one or the other, I would choose to suffer rather than do what is unjust”. In this paper, we take up the part of Socrates’ response that Polus (...) never engages and that has also been completely neglected by contemporary scholars, namely, Socrates’ explicit aversion to being a victim of injustice. We show that this same aversion—though one not nearly as strong as his aversion to doing injustice—appears in several texts, and we argue that the best explanation of such an aversion derives from two important features of Socratic philosophy, both of which have only recently been recognized in Socratic scholarship: his virtue intellectualism, which conceives of virtue as a kind of craft that can be achieved in different degrees, and his conception of moral psychology, which allows for non-rational influences on how we perform the cognitive functions required for proper deliberation. (shrink)

In this paper, I argue against the claim that in Plato's Republic the most important distinguishing feature between the philosopher and non-philosopher is that the philosopher has knowledge while the non-philosopher has, at best, true opinion. This claim is, in fact, inconsistent with statements Plato makes in later books of the Republic. I submit that the important distinction Plato makes concerns the type of knowledge possessed by the philosopher-ruler. As a result, we need to amend widely held scholarly interpretations of (...) important passages in the Republic ; most notably the passages containing the Sun, Line, and Cave. I consider the views of a number of important scholars and suggest a proposal that avoids this inconsistency with the text. An important consequence of my argument is that Philosophers are indeed not the only ones with knowledge in the Kallipolis. (shrink)

In the preface to GS, Nietzsche famously exclaims, "Those Greeks were superficial—out of profundity!".1 And he attributes one aspect of this profound superficiality to the Greeks' "respect for the bashfulness [Scham] with which nature has hidden behind riddles and iridescent uncertainties". For Nietzsche, both the Greeks' shame and their respect for shame played important and healthy psychological and social roles. So, Nietzsche praises shame in the sense that "care [Scham] for one's reputation" is characteristic of noble types and a "highly (...) resourceful" emotion. However, Nietzsche also sometimes condemns shame. For example, in the last three aphorisms of Book 3 of GS, he makes... (shrink)

Among other things, Nietzsche considers himself a psychologist, and many of his ideas about human behaviors, dispositions, and attitudes are empirical and falsifiable. As readers of Nietzsche, we should hope that he got some of his psychological facts right. I agree with Joshua Knobe and Brian Leiter when they argue that "neglect of Nietzsche in moral psychology is no longer an option for those philosophers who accept that moral psychology should be grounded in real psychology."1 This article aims at furthering (...) this project by exploring what Nietzsche thinks about disgust.2 However, the aim is to show not only that recent studies on disgust support many of Nietzsche's observations but also that... (shrink)

In Contesting Nietzsche, Christa Davis Acampora analyzes the significance for Nietzsche’s thought of the ancient Greek agon. She aims to show why the agon is important for understanding several philosophical themes prevalent in Nietzsche’s work, including naturalism, agency, and responsibility. Acampora also argues that we should understand Nietzsche’s own engagement with other philosophical contestants as part of his own agonistic enterprise, highlighting Homer, Socrates, Paul, and Wagner as four such competitors. Acampora’s analysis of the agon is helpful for understanding how (...) Nietzsche’s early interest in the ancient Greeks influenced the development of his thought, especially in... (shrink)

Evidence from a growing number of studies suggests leader character as a means to advance leadership knowledge and practice. Based on this evidence, we propose a process model depicting how leader character manifests in ethical leadership that has positive psychological and performance outcomes for leaders, along with the moderating effect of leaders’ self-control on the character strength–ethical leadership–outcomes relationships. We tested this model using multisource data from 218 U.S. Air Force officers and their subordinates and superiors. Findings provide initial support (...) for leader character as a mechanism triggering positive outcomes such that only when officers reported a high level of self-control did their honesty/humility, empathy, and moral courage manifest in ethical leadership, associated with higher levels of psychological flourishing and in-role performance. We discuss the implications of these results for future theory development, research, and practice. (shrink)

Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct and disciplinary procedures. The article (...) concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach. (shrink)

When do probability distribution functions (PDFs) about future climate misrepresent uncertainty? How can we recognise when such misrepresentation occurs and thus avoid it in reasoning about or communicating our uncertainty? And when we should not use a PDF, what should we do instead? In this paper we address these three questions. We start by providing a classification of types of uncertainty and using this classification to illustrate when PDFs misrepresent our uncertainty in a way that may adversely affect decisions. We (...) then discuss when it is reasonable and appropriate to use a PDF to reason about or communicate uncertainty about climate. We consider two perspectives on this issue. On one, which we argue is preferable, available theory and evidence in climate science basically excludes using PDFs to represent our uncertainty. On the other, PDFs can legitimately be provided when resting on appropriate expert judgement and recognition of associated risks. Once we have specified the border between appropriate and inappropriate uses of PDFs, we explore alternatives to their use. We briefly describe two formal alternatives, namely imprecise probabilities and possibilistic distribution functions, as well as informal possibilistic alternatives. We suggest that the possibilistic alternatives are preferable. -/- . (shrink)

We introduce the resurrection axioms, a new class of forcing axioms, and the uplifting cardinals, a new large cardinal notion, and prove that various instances of the resurrection axioms are equiconsistent over ZFC with the existence of an uplifting cardinal.

Using the lottery preparation, we prove that any strongly unfoldable cardinal $\kappa$ can be made indestructible by all.

I defend a model of the musically extended mind. I consider how acts of “musicking” grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of “musical affordances” and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances – via soliciting different forms of entrainment – enhance the functionality of various endogenous, emotiongranting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal (...) character. I argue that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea. (shrink)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

The present paper draws on climate science and the philosophy of science in order to evaluate climate-model-based approaches to assessing climate projections. We analyze the difficulties that arise in such assessment and outline criteria of adequacy for approaches to it. In addition, we offer a critical overview of the approaches used in the IPCC working group one fourth report, including the confidence building, Bayesian and likelihood approaches. Finally, we consider approaches that do not feature in the IPCC reports, including three (...) approaches drawn from the philosophy of science. We find that all available approaches face substantial challenges, with IPCC approaches having as a primary source of difficulty their goal of providing probabilistic assessments. (shrink)

We introduce the strongly uplifting cardinals, which are equivalently characterized, we prove, as the superstrongly unfoldable cardinals and also as the almost-hugely unfoldable cardinals, and we show that their existence is equiconsistent over ZFC with natural instances of the boldface resurrection axiom, such as the boldface resurrection axiom for proper forcing.

Using a policy-capturing approach with a broad student sample we examine how individuals’ economic, social and environmental values influence their propensity to engage in a broad range of sustainability-related corporate actions. We employ a multi-dimensional sustainability framework of corporate actions and account for both the positive and negative impacts associated with corporate activity—termed strength and concern actions, respectively. Strong economic values were found to increase the propensity for concern actions and the willingness to work in controversial industries. Individuals with balanced (...) values were as likely as those with strong economic values to pursue positive economic outcomes, but without the same downside potential for concern actions. We also found significant gender effects, with females being less likely to engage in concern actions and more supportive of social and environmental strength actions. (shrink)

While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader (...) implications for just and equitable healthcare delivery. (shrink)

Stakeholder theory is often unable to distinguish those individuals and groups that are stakeholders from those that are not. This problem of stakeholder identity has recently been addressed by linking stakeholder theory to a Rawlsian principle of fairness. To illustrate, the question of stakeholder status for the non-human environment is discussed. This essay criticizes a past attempt to ascribe stakeholder status to the non-human environment, which utilized a broad definition of the term "stakeholder." This paper then demonstrates how, despite the (...) denial of stakeholder status, the environment is nonetheless accounted for on a fairness-based approach through legitimate organizational stakeholders. In addition, since stakeholder theory has never claimed to be a comprehensive ethical scheme, it is argued that sound reasons might exist for managers to consider their organization's impact on the environment that are not stakeholder-related. (shrink)

This study examines cheating behaviors among 422 business students at two public Association to Advance Collegiate Schools of Business-accredited business schools. Specifically, we examined the simultaneous influence of attitudinal characteristics and motivational factors on reported prior cheating behavior, the tendency to neutralize cheating behaviors, and likelihood of future cheating. In addition, we examined the impact of in-class deterrents on neutralization of cheating behaviors and the likelihood of future cheating. We also directly tested potential mediating effects of neutralization on cheating behavior. (...) Using structural equations modeling procedures, we conducted an assessment of the validity of a modified version of the K. J. Smith, Davy, Rosenberg, and Haight model of cheating behavior and its antecedents. The modified model included motivation as a potential predictor of cheating behavior. Results supported the differentiation of the theoretical constructs within the specified process model. Furthermore, tests of the aforementioned theoretical model indicated a significant positive relation between extrinsic motivation and prior cheating and a significant negative relation between both intrinsic motivation and academic performance, and prior cheating. Finally, prior cheating had a significant positive relation, whereas deterrents had a significant negative relation to likelihood of future cheating. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

One of liberalism’s core commitments is to safeguarding individuals’ autonomy. And a central aspect of liberal social justice is the commitment to protecting the vulnerable. Taken together, and combined with an understanding of autonomy as an acquired set of capacities to lead one’s own life, these commitments suggest that liberal societies should be especially concerned to address vulnerabilities of individuals regarding the development and maintenance of their autonomy. In this chapter, we develop an account of what it would mean for (...) a society to take seriously the obligation to reduce individuals’ autonomy-related vulnerabilities to an acceptable minimum. In particular, we argue that standard liberal accounts underestimate the scope of this obligation because they fail to appreciate various threats to autonomy. (shrink)

Willard V. Quine’s 1951 article, “Two Dogmas of Empiricism” (Two Dogmas) was taken to be revolutionary because it rejects the analytic-synthetic distinction and the thesis that empirical statements are confirmed individually rather than holistically. The present chapter, however, argues that the overcoming of modern philosophy already included the overcoming of these theses by Hegelians, pragmatists and two critics of Hegelianism and pragmatism, Grace and Theodore de Laguna. From this perspective, Two Dogmas offers a Hegelian epistemology that was already superseded in (...) 1910. The perspective is largely based on the de Lagunas’ 1910 book Dogmatism and Evolution: Studies in Modern Philosophy. The de Lagunas’ book also helps to make clear that the real revolution Two Dogmas participated in was the marginalisation of their work and that of other speculative philosophers. Grace de Laguna surely recognised much of this when she stood opposite Quine as he first presented Two Dogmas. (shrink)