Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s thematic synthesis method was used to synthesise data (...) from identified studies. Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices. (shrink)

A survey of the work of the Majorcan lay theologian and philosopher Ramon Llull (1232-1316), along with examples of its wide influence in late medieval, Renaissance, and early modern Europe and in colonial Spanish America.

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

When hiring for an open position, the branch manager of Intermountain Trust Bancorp was challenged with an ethical dilemma he was not anticipating. An internal applicant challenged the hiring manager's ethical values by insisting that their friendship and other external employment factors be taken into consideration in the hiring decision. This is a classic case of a candidate using undue influence1 to manipulate a colleague and gain employment. In what started as a routine decision, the manager was faced with an (...) unforeseen ethical quagmire. This case describes a real situation that had local impact on the stakeholders of a regional bank, and provides a true example of the types of difficult situations that can affect candidate selection in hiring decisions. (shrink)

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress. Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that although (...) such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident. (shrink)

Faces carry key personal information about individuals, including cues to their identity, social traits, and emotional state. Much research to date has employed static images of faces taken under tightly controlled conditions yet faces in the real world are dynamic and experienced under ambient conditions. A common approach to studying key dimensions of facial variation is the use of facial caricatures. However, such techniques have again typically relied on static images, and the few examples of dynamic caricatures have relied on (...) animating graphical head models. Here, we present a principal component analysis -based active appearance model for capturing patterns of spatiotemporal variation in videos of natural dynamic facial behaviours. We demonstrate how this technique can be applied to generate dynamic anti-caricatures of biological motion patterns in facial behaviours. This technique could be extended to caricaturing other facial dimensions, or to more general analyses of spatiotemporal variations in dynamic faces. (shrink)

Despite decades of research, remaining safety concerns regarding disease transmission, heterotopic tissue formation, and tumorigenicity have kept stem cell‐based therapies largely outside the standard‐of‐care for musculoskeletal medicine. Recent insights into trophic and immune regulatory activities of mesenchymal stem cells (MSCs), although incomplete, have stimulated a plethora of new clinical trials for indications far beyond simply supplying progenitors to replenish or re‐build lost/damaged tissues. Cell banks are being established and cell‐based products are in active clinical trials. Moreover, significant advances have also (...) been made in the field of pluripotent stem cells, in particular the recent development of induced pluripotent stem cells. Their indefinite proliferation potential promises to overcome the limited supply of tissue‐specific cells and adult stem cells. However, substantial hurdles related to their safety must be overcome for these cells to be clinically applicable. (shrink)

Graphical AbstractIdentifying the properties and molecules of the intestinal microbiome may help our understanding of various diseases and therefore facilitate their treatment; from excluding pathogens to manipulation of the immune system and regulation of non-intestinal sites.

The subjective effects and therapeutic potential of the shamanic practice of journeying is well known. However, previous research has neglected to provide a comprehensive assessment of the subjective effects of shamanic-like journeying techniques on non-shamans. Shamanic-like techniques are those that demonstrate some similarity to shamanic practices and yet deviate from what may genuinely be considered shamanism. Furthermore, the personality traits that influence individual susceptibility to shamanic-like techniques are unclear. The aim of the present study was, thus, to investigate experimentally the (...) effect of shamanic-like techniques and a personality trait referred to as "ego boundaries" on subjective experience including mood disturbance. Forty-three non-shamans were administered a composite questionnaire consisting of demographic items and a measure of ego boundaries (i.e., the Short Boundary Questionnaire; BQ-Sh). Participants were randomly assigned to one of three conditions: listening to monotonous drumming for 15 minutes coupled with one of two sets of journeying instructions; or sitting quietly with eyes closed for 15 minutes. Participants' subjective experience and mood disturbance were retrospectively assessed using the Phenomenology of Consciousness Inventory (PCI) and the Profile of Mood States-Short Form, respectively. The results indicated that there was a statistically significant difference between conditions with regard to the PCI major dimensions of visual imagery, attention and rationality, and minor dimensions of imagery amount and absorption. However, the shamanic-like conditions were not associated with a major reorganization of the pattern of subjective experience compared to the sitting quietly condition, suggesting that what is typically referred to as an altered state of consciousness effect was not evident. One shamanic-like condition and the BQ-Sh subscales need for order, childlikeness, and sensitivity were statistically significant predictors of total mood disturbance. Implications of the findings for the anthropology of consciousness are also considered. (shrink)

We welcome Ballantyne & Schaefer’s discussion of the issues concerning consent and use of health data for research. In response to their acknowledgement of the need for public debate and discussion, we provide evidence from our own public consultation on this topic.

This article begins with an explanation of how moral development for organizations has parallels to Kohlberg's categorization of the levels of individual moral development. Then the levels of organizational moral development are integrated into the literature on corporate social performance by relating them to different stakeholder orientations. Finally, the authors propose a model of organizational moral development that emphasizes the role of top management in creating organizational processes that shape the organizational and institutional components of corporate social performance. This article (...) represents one approach to linking the distinct streams of business ethics and business-and-society research into a more complete understanding of how managers and firms address complex ethical and social issues. (shrink)

Weiss, Propen, and Reid gather a diverse group of scholars to analyze the growing obsolescence of the human-object dichotomy in today's world. In doing so, Design, Mediation, and the Posthuman brings together diverse disciplines to foster a dialog on significant technological issues pertinent to philosophy, rhetoric, aesthetics, and science.

When people engage in conversation, they tailor their utterances to their conversational partners, whether these partners are other humans or computational systems. This tailoring, or adaptation to the partner takes place in all facets of human language use, and is based on a mental model or a user model of the conversational partner. Such adaptation has been shown to improve listeners' comprehension, their satisfaction with an interactive system, the efficiency with which they execute conversational tasks, and the likelihood of achieving (...) higher level goals such as changing the listener's beliefs and attitudes. We focus on one aspect of adaptation, namely the tailoring of the content of dialogue system utterances for the higher level processes of persuasion, argumentation and advice-giving. Our hypothesis is that algorithms that adapt content for these processes, according to a user model, will improve the usability, efficiency, and effectiveness of dialogue systems. We describe a multimodal dialogue system and algorithms for adaptive content selection based on multi-attribute decision theory. We demonstrate experimentally the improved efficacy of system responses through the use of user models to both tailor the content of system utterances and to manipulate their conciseness. (shrink)

Any explanation of the origin and nature of human morality must take into account a powerful and inescapable pan-cultural human awareness. Death is the great pan-cultural human leveller and human awareness of death is a near life-long awareness. However metaphysically or religiously conceived, however long postponed by medical science, however softened by belief or by faith, the basic human fact and fear of death cannot be denied. Neither, in opposition, can the basic human craving for more life.

Research on language processing has shown that the disruption of conceptual integration gives rise to specific patterns of event-related brain potentials —N400 and P600 effects. Here, we report similar ERP effects when adults performed cross-domain conceptual integration of analogous semantic and mathematical relations. In a problem-solving task, when participants generated labeled answers to semantically aligned and misaligned arithmetic problems, the second object label in misaligned problems yielded an N400 effect for addition problems. In a verification task, when participants judged arithmetically (...) correct but semantically misaligned problem sentences to be “unacceptable,” the second object label in misaligned sentences elicited a P600 effect. Thus, depending on task constraints, misaligned problems can show either of two ERP signatures of conceptual disruption. These results show that well-educated adults can integrate mathematical and semantic relations on the rapid timescale of within-domain ERP effects by a process akin to analogical mapping. (shrink)

Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.

BackgroundDefensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.MethodsA qualitative interview study investigated the views and experiences of (...) physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.ResultsAll participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.ConclusionsThe findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. (shrink)

Teaching through discussion is perhaps the most fundamental pedagogical technique of philosophy. When done well, discussion can promote long-term, durable learning. It supports an active-learning classroom, sparks higher-order cognition, and helps students construct their own understanding of the material. Yet it is often not done well: it is easily dominated by a few students; it can waste time on tangents and minutiae; it can fail to motivate students to prepare adequately; and it is not easily scalable. In this paper we (...) present a technique, the random discussion leader (RDL), which addresses all of these shortcomings of traditional discussion. Qualitative and quantitative evidence from our quasi-experimental study (n = 279) suggests that RDL leads to better preparation, better engagement with the material, more equitable participation, and higher quality discussions. Additionally, we provide a toolkit for instructors interested in trying RDL, showing how the technique can be adapted to various course settings and materials. (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)

Next SectionCultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face a (...) perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made. (shrink)

John Paul II is often misread as more of a philosopher than a theologian. But his Theology of the Body, rightly read, is in its entirety an exercise in exegesis. By focusing on the Bible, he gives a more fully theological account of his topic, one focused on the mystery of redemption by grace, rather than on merely human efforts.