Can one be fooled into believing that one intended an action that one in fact did not intend? Past experimental paradigms have demonstrated that participants, when provided with false perceptual feedback about their actions, can be fooled into misperceiving the nature of their intended motor act. However, because veridical proprioceptive/perceptual feedback limits the extent to which participants can be fooled, few studies have been able to answer our question and induce the illusion to intend. In a novel paradigm addressing this (...) question, participants were instructed to move a line on the computer screen by use of a phony brain–computer interface. Line movements were actually controlled by computer program. Demonstrating the illusion to intend, participants reported more intentions to move the line when it moved frequently than when it moved infrequently. Consistent with ideomotor theory, the finding illuminates the intimate liaisons among ideomotor processing, the sense of agency, and action production. (shrink)

We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women’s Health Across the Nation (SWAN), we estimate that at (...) ages 49–55, black women are 7.5 years biologically “older” than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited. (shrink)

This book is a rich blend of analyses by leading experts from various cultures and disciplines. A compact introduction to a complex field, it illustrates biotechnology's profound impact upon the environment and society. Moreover, it underscores the vital relevance of cultural values. This book empowers readers to more critically assess biotechnology's value and effectiveness within both specific cultural and global contexts.

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

We agree with Grossmann that fear often builds cooperative relationships. Yet he neglects much extant literature. Prior researchers have discussed how fear (and other emotions) build cooperative relationships, have questioned whether fear per se evolved to serve this purpose, and have emphasized that human cooperation takes many forms. Grossmann's theory would benefit from a wider consideration of this work.

In this book philosophers, scholars of religion, and activists address the theme of responsibility. Barbara Darling-Smith brings together an enlightening collection of essays that analyze the ethics of responsibility, its relational nature, and its global struggle.

Though assumptions about language underlie all bioethical work, the field has rarely partaken of theories of language. This article encourages a more linguistically engaged bioethics. We describe the tacit conception of language that is frequently upheld in bioethics—what we call the representational view, which sees language essentially as a means of description. We examine how this view has routed the field’s theories and interventions down certain paths. We present an alternative model of language—the pragmatic view—and explore how it expands and (...) clarifies traditional bioethical concerns. To lend concreteness, we apply the pragmatic view to a pervasive concept in bioethics and adjacent fields: decision making. We suggest that problems of the decision-making approach to bioethical issues are grounded in adherence to the representational view. Drawing on empirical work in surgery and critical care, we show how the pragmatic view productively reframes bioethical questions about how medical treatments are pursued. (shrink)

Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a (...) computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. (shrink)

This paper analyses the activities of five organizations shaping the debate over the global governance of genome editing in order to assess current approaches to public engagement (PE). We compare the recommendations of each group with its own practices. All recommend broad engagement with the general public, but their practices vary from expert-driven models dominated by scientists, experts, and civil society groups to citizen deliberation-driven models that feature bidirectional consultation with local citizens, as well as hybrid models that combine elements (...) of both approaches. Only one group practices PE that seeks community perspectives to advance equity. In most cases, PE does little more than record already well-known views held by the most vocal groups, and thus is unlikely to produce more just or equitable processes or policy outcomes. Our exploration of the strengths, weaknesses, and possibilities of current forms of PE suggests a need to rethink both “public” and “engagement.”. (shrink)

This paper raises two problems for plan-expressivism concerning normative judgments about non-corealizable actions: actions which cannot both be performed. First, plan-expressivists associate normative judgment with an attitude which satisfies a corealizability constraint, but this constraint is (in the interpersonal case) unwarranted, and (in the intrapersonal case) warranted only at the price of a contentious normative premise. Ayars (2022) holds that the pair of judgments ‘A should φ’ and ‘B should ψ’ is coherent only if one believes that A can φ (...) while B ψ’s. But this is false. Both Gibbard (2003) and Ayars hold that the pair of judgments ‘A should φ’ and ‘A should ψ’ is coherent only if one believes that A can φ and ψ. But this assumes possibilism. Second, the paper demonstrates, cases involving interpersonal non-corealizability prompt judgments about what multiple agents should do which – contra Gibbard – are not plausibly associated with any planning subject. (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)

What is a crip politics of bodymind? Drawing upon Rosemarie Garland-Thomson's theory of the misfit, I explain my understanding of crip and bodymind within a feminist materialist framework, and argue that careful investigation of a crip politics of bodymind must involve accounting for two key, but under-explored, disability studies concepts: desire and pain. I trace the turn toward desire that has characterized DS theory for the last decade, and argue that while acknowledging disability desire, we must also attend to the (...) aspects of disability, including pain, that are sometimes bad. Although I don't argue that pain is always and only bad, I call for recognition of the ways pain complicates disability desire, as well as the possibilities it opens for specifically located, collective forms of care. (shrink)

The paper examines philosophical issues that arise in contexts where one has many different models for treating the same system. I show why in some cases this appears relatively unproblematic (models of turbulence) while others represent genuine difficulties when attempting to interpret the information that models provide (nuclear models). What the examples show is that while complementary models needn’t be a hindrance to knowledge acquisition, the kind of inconsistency present in nuclear cases is, since it is indicative of a lack (...) of genuine theoretical understanding. It is important to note that the differences in modeling do not result directly from the status of our knowledge of turbulent flows as opposed to nuclear dynamics—both face fundamental theoretical problems in the construction and application of models. However, as we shall, the ‘problem context(s)’ in which the modeling takes plays a decisive role in evaluating the epistemic merit of the models themselves. Moreover, the theoretical difficulties that give rise to inconsistent as opposed to complementary models (in the cases I discuss) impose epistemic and methodological burdens that cannot be overcome by invoking philosophical strategies like perspectivism, paraconsistency or partial structures. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

The paper begins with a generic discussion of modelling, focusing on some of its practices and problems. I then move on to a philosophical discussion about emergence and multi-scale modelling; more specifically, the reasons why what looks like a promising strategy for dealing with emergence is sometimes incapable of delivering interesting results. This becomes especially evident when we look more closely at turbulence and what I take to be the main ontological feature of emergent behavior—universality. Finally, I conclude by showing (...) why, despite displaying multi-scale behaviour and some of the characteristics we identify with emergence, turbulence fails to fit neatly into the latter category and is not successfully captured using multi-scale modelling. The complex nature of turbulence illustrates the difficulties in characterizing emergence and why specific criteria are needed in order to prevent every complex behaviour we don’t understand being classified as emergent. (shrink)

Life hurts. There's no getting around it. But surely there's a way through it? Thankfully, God meets us in the broken places. This isn’t just something we can hope for but something we can expect! This study leads women to find God in broken places by examining the life of Christ, the true Healer. Each of the twelve chapters will highlight a moment in which Jesus brought healing and restoration to an individual or situation. Through this study we will find (...) that those areas of life where we experience pain and loss can become emblems of His glory as God transforms and heals us. Features include: 12 sessions of interactive Bible study Perfect for individual or group study Tips for leading a great group included. (shrink)

The topic of this chapter, the early philosophical influence of Henri Bergson (1859-1941) on Simone de Beauvoir, may surprise those who remember Beauvoir’s reference to Bergson in her Memoirs of a Dutiful Daughter where she denies Bergson’s importance. She writes there of her interests in 1926: “I preferred literature to philosophy, and I would not have been at all pleased if someone had prophesized that I would become a kind of Bergson; I didn’t want to speak with that abstract voice (...) which, whenever I heard it, failed to move me.” But in this case, as in so many others, Beauvoir’s diaries present a very different picture. Her unpublished 1926 diary, written when Beauvoir was eighteen years old and beginning her study of philosophy, contains several pages of quotations from Bergson’s Time and Free Will: An Essay on the Immediate Data of Consciousness (1889), which Beauvoir describes, in an entry dated August 16, as “a great intellectual intoxication.” The entry continues: “whereas in reading other philosophers I have the impression of witnessing more or less logical constructions, here finally I am touching palpable reality and encountering life. Not only myself, but art, the truths suggested by poets, and everything that I studied this year is magnificently explained. Simply a call to intuition…. in short the method that I spontaneously apply when I want to know myself and the most difficult problems disappear. How many things [there are] in the 180 pages of Bergson’s The immediate givens of consciousness” Intriqued by this diary passage, I began analyzing Beauvoir’s early philosophy for evidence of Bergson’s influence, focusing on Bergson’s three most important texts: Time and FreeWill (1889), Matter and Memory: An Essay on the Relation of the Body to the Mind (1896), and Creative Evolution (1907). My analysis uncovered evidence of Bergson’s influence in several of Beauvoir’s important early texts, especially She Came to Stay, Beauvoir’s metaphysical novel written from 1937 to 1941, but also Beauvoir’s essays in existential ethics and The Second Sex (1949). Indeed Bergson now seems to me to be a key to understanding the roots of Beauvoir’s philosophy. In this paper, I will narrow my focus to Bergson’s philosophical methodology, and its influence on She Came to Stay, identifying three Bergsonian elements of Beauvoir’s philosophical methodology. First of all, Beauvoir takes seriously Bergson's criticism of intellectual understanding and accepts his implicit challenge to do philosophy through the novel. Secondly, Beauvoir shares with Bergson a methodological interest in exposing distortions in perception and thinking. Finally, they both rely on a methodological turn to immediate experience, which discloses our freedom. Beauvoir did not follow Bergson completely or uncritically. She did not follow him, for example, in the vitalist system building of Creative Evolution or the mysticism of his later work, Two Sources of Morality and Religion. In Beauvoir’s short story cycle, When Things of the Spirit Come First, written from 1935-37, which Beauvoir describes as “clarifying the genesis” of her later work, (QPS, viii) she satirizes her early intellectual passions, including Paul Claudel’s morality of feminine self-sacrifice, André Breton’s Surrealism, and Bergson's philosophy. Furthermore, Beauvoir’s early work, including She Came to Stay, focuses on an aspect of reality ignored by Bergson’s early work, i.e. the problem of the opposition of self and other. (shrink)

The mantra of the Western philosopher is “know thyself.” However, many of us in the discipline of philosophy don’t seem to practice what we preach—or even preach this mantra. This is true in the conduct of our profession. The practices and norms of the members of an institution constitute that institution. If we are not rigorously self-examining ourselves, especially in the conduct of our professional lives, then the discipline of philosophy, the institution of philosophy as it exists in the West, (...) is not consistent with this defining imperative. (shrink)

scholars often use letter correspondences to uncover missing historical information. For example, while searching for the influential but unacknowledged women in the history of pragmatism, Charlene Haddock Seigfried discovered John Dewey’s letters to Elsie Ripley Clapp. Using these letters, Seigfried defended Clapp’s name as an early pragmatist. Similarly, Joan Smith cited Dewey’s letter to John T. McManis to show that Ella Flagg Young likewise influenced Dewey’s work. More recently, Eduardo Mendieta has defended a different approach to letters, and argues that (...) we should take the letters, diaries, and notebooks of certain philosophers more seriously—not just for the historical or... (shrink)

If you developed Alzheimer disease, would you want to go all the way to the end of what might be a decade‐long course? Some would; some wouldn't. Options open to those who choose to die sooner are often inadequate. Do‐not‐resuscitate orders and advance directives depend on others' cooperation. Preemptive suicide may mean giving up years of life one would count as good. Do‐it‐yourself methods can fail. What we now ask of family and clinicians caring for persons with dementia, and of (...) patients given no better option than to go on with lives they may not want, is unacceptable. To explore how one might better control one's own dying and avoid burdening others with overwhelming care and morally painful choices, we propose a thought experiment: an advance directive implant that would enable persons with early dementia, while competent, to arrange their own deaths without the subsequent intervention of anyone else. (shrink)

Attachment orientations reflect individuals’ expectations for interpersonal relationships and influence emotion regulation strategies and coping. Previous research has documented that anxious and avoidant attachment orientations have deleterious effects on the trauma recovery process leaving these survivors vulnerable to posttraumatic stress disorder symptoms. However, avoidant attachment may be more complicated. Prior work has also found those high in avoidant attachment but also low in anxious attachment may not experience such vulnerabilities. Further, avoidant attachment individuals often report higher self-efficacy than their anxiously (...) attached counterparts. The present study examined trauma coping self-efficacy as a previously unexamined mechanism of action between adult attachment and PTSD symptoms. Structural equation modeling results showed that anxious attachment was associated with lower CSE-T and greater PTSD symptoms six weeks later. Further, a significant indirect effect of anxious attachment on PTSD symptoms through CSE-T was found. Contrary to hypotheses, avoidant attachment also exhibited an indirect effect on PTSD symptoms through CSE-T, such that avoidant attachment was associated with lower CSE-T, which in turn, was associated with greater PTSD symptoms. Also contrary to hypotheses, the interaction between anxious and avoidant attachment was not significantly associated with either CSE-T or PTSD symptoms. Results suggest that both anxious and avoidant attachment orientations contribute to poor self-regulation following trauma, as they undermine perceptions of trauma coping self-efficacy. (shrink)

For the students, while the numbers are up,… the problem that minorities face – and it is persistent – is that there is still too much of a patronizing air in the professional schools. And there's still too much of the notion that if you're here it must be because someone gave you a break and you're different and you really don't belong here. And indeed when my son went off to school four years ago… I really wanted to warn (...) him about the atmosphere that you see on all too many campuses, diat if you're black and walking on campus, that all too many people look at you and say, “You must be an affirmative action product,” whatever that means to them. “You're here only at our good grace.” And no one's looking at the individual. Thinking about it in retrospect, I guess, in some ways I enjoyed an advantage in being [the only black in my law school class]. It was a terrible disadvantage in a lot of ways, but, because I was the only black, the one thing I never faced was anyone ever challenging my intellectual capability. The way they brought this off was to say, “Well, you're different. You're black but you're not really black.” I think it's a lot worse now…. Professional schools are hard enough as it is, and to constantly have the pressure of what others are thinking about you and wondering whether you really belong, that really is a difficult burden. (shrink)

Although the field of bioethics usually emphasizes ethical dilemmas arising from contemporary biomedical research, at another level the foundation of ethical judgments can be explored in the light of evolutionary biology. Two scientific approaches illuminate the relationships between human nature, social environments, and standards of ethical judgment: first, ethology and the observational study of nonhuman primates; second, evolutionary theory and new developments in the understanding of natural selection. Ethology shows that humans, like the species most closely related to us, are (...) naturally both cooperative and competitive. Evolutionary theory can "explain" cooperation at diverse levels of social organization , suggesting which forms of social cooperation are to be expected in specific cases. By focusing on the emotions underlying the sense of justice, moreover, an evolutionary approach can provide a more realistic assessment of the motivations and intentions underlying ethical controversies. Because individuals inevitably have competing claims as well as competing moral obligations, evolutionary bioethics thus teaches the need for balance and judgment. Emotions elicited by the all-too-human tendency to engage in moralistic aggression need to be balanced by reasoned judgment of the consequences of our own actions. The ethicist, no more or less than any other human, needs to be aware of the risks of deceptions and self-deception. Or, to put it more simply, an evolutionary bioethics leads back to the humility of the Socratic injunction: know thyself. Im allgemein üblichen Sinne befaßt sich Bioethik meist mit ethischen Problemstellungen, die durch die Fortschritte der biologischen Forschung hervorgerufen werden. Unter einem anderen Blickwinkel kann sie aber auch die Grundlage ethischer Urteile im Licht der Entwicklungsbiologie untersuchen. Zwei Wissenschaftszweige befassen sich mit dem Verhältnis zwischen der menschlichen Natur, dem sozialen Umfeld und den Standards für ethische Urteile; erstens, die Ethologie und Verhaltensstudien an nichtmenschlichen Primaten; zweitens, die Evolutionstheorie und neue Entwicklungen beim Verständnis der natürlichen Selektion. Die Ethologie zeigt, daß Menschen genauso wie die Tiere, die ihnen am nächsten verwandt sind, von Natur aus sowohl zur Kooperation als auch zur Konkurrenz miteinander neigen. Die Evolutionstheorie kann die verschiedenen Weisen von Kooperation auf den verschiedenen Ebenen sozialer Organisation "erklären" und dabei Hypothesen aufstellen, welche Formen sozialer Zusammenarbeit in spezifischen Fällen erwartet werden können. Soweit sie sich mit den Emotionen befaßt, die dem Sinn für Gerechtigkeit zugrunde liegen, kann die Evolutionstheorie darüber hinaus eine realistischere Einschätzung der Beweggründe und Intentionen vermitteln, die hinter ethischen Kontroversen stehen. Weil Individuen unvermeidlich konkurrierende Ansprüche, aber auch konkurrierende moralische Verpflichtungen haben, zeigt die evolutionäre Bioethik das Bedürfnis nach Ausgleich und Schlichtung. Die Emotionen, die durch die allzu menschliche Neigung zu Aggression im Namen der Moral hervorgerufen werden, rufen nach Ausgleich durch begründete Urteile über die Folgen unserer eigenen Handlungen. Der Ethiker muß sich, nicht mehr und nicht weniger als jeder andere Mensch, des Risikos von Täuschung und Selbsttäuschung bewußt sein. Oder, um es einfacher auszudrücken, evolutionäre Ethik führt zurück zu der Bescheidenheit der Sokratischen Forderung: Erkenne dich selbst. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Open Letter to Certified Nursing Assistants:Lessons from a Life Well Lived1Margaret FletcherI can't be sure what I want to say, or how to say it. Seeing as how I'm now eighty years old, and somewhat forgetful, I cease remembering the good old days.I have written a lot of short articles for the Nursing Assistant Program. My journey of life has been very interesting, very wonderful and fully blessed.My (...) career as a nursing assistant started in my 16th year back in 1947. Once I was involved in the work, [End Page 155] I understood about the journey of life and all the things that living brings into a life of a human being.I learned being a nursing assistant is not just a job and a paycheck. It's a beautiful and wonderful life of kindness, honesty, courtesy, fairness, pity, help, trust and forgiveness.Its principles will take hold of your lifestyle and future. If we realize we are a valuable and unique person, then accepting life with optimism, making sure of our goals, striving to give our best, and growing in awareness helps us learn to be productive and efficient in our work.Understand that everyone and every thing around us has something to teach us. It's not just the classroom learning that's going to put us on the road of good caregiving with a kind loving heart.It's going to take desire, concern and total devotion with lots of hard work. We must learn from the day-to-day needs and expectations of our patients or residents, doctors, wing nurses and the patients' or residents' families.There will be changes, and these changes can be frequent. Therefore, we will need to know and be aware what is expected of us.Now as an old fogy, I'd like to point out that experience is required for developing expertise. And that a sound educational base is necessary for acquiring advanced skills because it forms the best position for developing our ability to sort through concepts and facts. And to focus on the aspects of the various types of patient care situations. It will indicate priorities and offer guidelines for action. Even in seemingly routine situations the nursing assistant must be alert to special circumstances and adapt their care accordingly.Never once did I regret my choice of becoming a caregiver. I can remember one kindhearted doctor who always had his special way for chitchats, telling me, "What you leave behind is not engraved in stone, but what is woven into the lives of other human beings, you must always make the right connections." Then, jokingly, the good doctor asked, "If a cabbage, a tomato, and a faucet ran a race, who would win?" His answer, "The cabbage would be a head, the tomato would ketch up, and the faucet would still be running. Which would you be most like?" My answer, "but doctor, I'm not running a race, I'm on a journey." That journey is life and love. Life is so precious. Where there is love, love makes us whole.No matter what obstacles we face, love gives us the strength to overcome them. As a writer, I'll share in this story. It should be as though we're all family now. Our world is as great as we make it.Realize we all deserve a little lift now and then, but we also need to realize there is no cosmetic for beauty, like happiness. A very personal happiness is what you say and do as a nursing assistant making life better for those entrusted in our care.Down through the years my patients and residents have taught me well what love is really all about. I want to share my lesson with you. Love is friendship that has caught fire, it is quiet understanding, mutual confidence, sharing and forgiving. It is loyalty through good and bad times. Love settles for less than perfection and makes allowances for human weaknesses. Love is content with the present, love hopes for the future, but doesn't brood over the past. Love: it's the day-in... (shrink)