Background: This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient’s decision-making capacity. The study aims to answer: 1) does concern about a patient’s treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and (...) 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient’s treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers. (shrink)

Most arguments about conscientious objections in medicine fail to capture the full scope and complexity of the concept before drawing conclusions about their permissibility in practice. Arguments favoring and disfavoring the accommodation of conscientious objections in practice tend to focus too narrowly on prima facie morally contentious treatments and religious claims of conscience, while further failing to address the possibility of moral perspectives changing over time. In this paper, I argue that standard reasons against permitting conscientious objections in practice—that their (...) permission may result in harm to patients, the idea that medical providers willingly enter into the medical field, and that conscientious objections stand contrary to medical professionalism—do not apply in all cases and that the medical field and health systems in which many physicians now practice should continue to tolerate conscientious objections in practice. (shrink)

Volume 20, Issue 7, July 2020, Page 139-141.

Near-death experiences are a big challenge to the fields of science and philosophy; termed as hallucinatory by neurologists and “stuff of which fantasies are made off” by sceptics, there are some unique near-death experiences which defy these claims. Memories generated during these experiences are of specific interest as they are created without a body and can be recalled post the experience. Call it the mind, soul, psyche or consciousness, if deliberated as a form of quantum generated energy, a strong correlation (...) under a reductionist based perspective can be obtained. Life at a macroscopic level may not be similar to life at a quantum level, and has been proved in quantum physics through its spooky properties like quantum entanglement. Self-sustaining quantum generated energy through entanglement is the answer to all mystical realties and the answer lies in believing in its existence in and around us. It is this energy that brings in the awareness of one’s existence and which performs tasks beyond the imagination of the current self; an energy created at the creation of all that exists; a true supernatural force. This paper reviews a unique void near-death experience and hypothesizes quantum entanglement to be involved in the conception and storage of these energy-based memories in a quantum subatomic cloud which can be restated if returned back to the body or lost to the environment upon death. (shrink)

Events have beginnings, ends, and often overlap in time. A major question is how perceivers come to parse a stream of multimodal information into meaningful units and how different event boundaries may vary event processing. This work investigates the roles of these three types of event boundaries in constructing event temporal relations. Predictions were made based on how people would err according to the beginning state, end state, and overlap heuristic hypotheses. Participants viewed animated events that include all the logical (...) possibilities of event temporal relations, and then made temporal relation judgments. The results showed that people make use of the overlap between events and take into account the ends and beginnings, but they weight ends more than beginnings. Neural network simulations showed a self‐organized distinction when learning temporal relations between events with overlap versus those without. (shrink)

People are typically grateful for medical technologies used in the treatment of illness or injury. This chapter explores how Lucas has led Star Wars audiences astray into accepting false beliefs and fallacies about the value of technology, particularly in a medical context. Via the naturalistic fallacy, Lucas conveys the false belief that most technology is “unnatural” and so is bad, harmful, or associated with the dark side. Lucas is not wrong that technology can be fearful, but its value depends in (...) part on how it's intended to be used. Even the use of some medical technologies that can extend life raise questions about whether they should be used in all cases. Many bioethical conflicts center around whether a seriously ill or injured person would want certain medical interventions used to extend their life, given potential trade‐offs. Lucas's portrayal of technology in Star Wars is biased against its true value in societies. (shrink)

Top-down dynamical models of cognitive processes, such as the one presented by Thelen et al., are important pieces in understanding the development of cognitive abilities in humans and biological organisms. Unlike standard symbolic computational approaches to cognition, such dynamical models offer the hope that they can be connected with more bottom-up, neurologically inspired dynamical models to provide a complete view of cognition at all levels. We raise some questions about the details of their simulation and about potential limitations of top-down (...) dynamical models. (shrink)

There is an ongoing concern about workplace ethics. Many voices say that our educational system ought to do something about it, but they do not agree about how to do this. By the time students reach post‐secondary education, they will have already developed a general moral sense. The concern is whether their moral sense is sufficient for ethical situations in the workplace. If not, post‐secondary education is expected to close the gap. In order to do this, educators need information about (...) what is missing. Educators can set clear, work‐related objectives and use classroom activities to reach those objectives based on an identification of these gaps. (shrink)

We expand on the article “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force” to consider the ways in which rural...

The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients. An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to (...) patients and their families. Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account. This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results. This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees. (shrink)

This paper aims to demonstrate how public disclosure can be used to balance physicians9 conscientious objections with their professional obligations to patients – specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. (...) The argument for publicly disclosing physicians9 conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians9 conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians9 conscientious objections are briefly addressed – potential harassment of physicians, workplace discrimination, and mischaracterising physicians9 professional aptitude – concluding that each of these concerns requires further deliberation in the realm of business ethics. (shrink)

The American Journal of Bioethics, Volume 11, Issue 9, Page 12-13, September 2011.

Part of the Renaissance genius was to look at familiar things in unfamiliar ways.1 Although a variety of approaches to the study of leadership are becoming familiar, it still helps to consider new ones. Of use in such moments are the works of unfamiliar writers who have spent considerable energy thinking from an alien perspective. One does not have to accept their assertions uncritically in order to profit from reading them, yet it does take courage sometimes to start down a (...) strange path. In the spirit of applying new ideas to familiar themes, this article interprets volume one of Georges Bataille’s The Accursed Share2 in the light of the phenomenon we refer to as leadership. Bataille, who was born in 1897 and died in 1962, certainly qualifies as a writer with an alien perspective. He has the potential to offend. At times, he becomes positively cryptic, as in asserting ‘that the sexual act is in time what the tiger is in space’. Nonetheless, the book itself develops a plausible line of reasoning. Society, it argues, is determined by how it disposes of energy. And since energy that cannot be used will be squandered, it matters how a society chooses to do this. Bataille argues further that moments of true ‘sovereignty’ occur when we squander what would otherwise have been useful. This paper summarizes the argument of The Accursed Share and applies it to the outpourings that followers make to leaders. Rather than regard these uneven relationships as examples of utilitarian reciprocity, perhaps we can tap into the idea that attentiveness to leadership is more in the form of an offering or sacrifice to something that expresses us, as an excuse to display exuberance. This approach promises insight into issues of charisma, followership as self-denial, and mass psychology. It also pertains to the tendency of followers to turn against leaders in ritual sacrifice as meaningful superfluity.3. (shrink)

Michel Foucault, one of the most cited scholars in the social sciences, devoted his last three lectures to a study of leader development. Going back to pagan sources, Foucault found a persistent theme in Hellenistic antiquity that, in order to qualify for leadership, a person must undergo processes of subjectivation, which is simply the way that a person becomes a Subject. From this perspective, an aspiring leader first becomes a Subject who happens to lead. These processes depend on a condition (...) of _parresia_, which is truth-telling at great risk that is for the edification of the other person. A leader requires a mentor and advisors in order to lead successfully, while also developing the capacity in one’s own mind to heed the truth. In other words, a leader must learn how to guide oneself. A valuable contribution to the field of leadership studies, this book summarizes these last lectures as they pertain to the study and practice of leadership, emphasizing the role of ethics and truth-telling as a check on power. It then presents several other contexts where these same lessons can be seen in practice, including in the life of Alexander Solzhenitsyn, whose career as a writer epitomized speaking truth to power, and somewhat surprisingly in the United States military, in response to its twenty-first century mission of counterinsurgency. (shrink)

The debate of nativisim versus empiricism is over the relative importance of evolutionary versus ontogenetic mechanisms. This is mostly seen today as a false dichotomy. The synthesis of these positions provides a modern viewpoint of grounded category formation. This combined view places equal importance on feedback between these levels in guiding development, and is more appropriately compared to culturalist positions.

Revision of author's thesis (doctoral)--University of Chicago, 2008 under title: The word made flesh and the mazy page: symbol and allegory in Coleridge's philosophy of faith.

Volume 20, Issue 7, July 2020, Page 95-97.

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the (...) practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (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 article examines the issues that are at stake in the current resurgence of interest in the subject of habit. We focus on the role that habit has played in conceptions of the relations between body and society, and the respects in which such conceptions have been implicated in processes of governance. We argue that habit has typically constituted a point of leverage for regulatory practices that seek to effect some realignment of the relations between different components of personhood – (...) will, character, memory and instinct, for example – in order to bring about a specific end. In reviewing its functioning in this regard across a range of modern disciplines – philosophy, psychology, sociology – we explore the tensions between its use and interpretation in different lineages: in particular, the Cartesian–Kantian/ravaisson–bergson–deleuze lineages. The article then identifies how these questions are addressed across the contributions collected in this special issue. (shrink)

What is Life? This is the question asked by Denis Noble in this very personal and at times deeply lyrical book. Noble is a renowned physiologist and systems biologist, and he argues that the genome is not life itself: to understand what life is, we must view it at a variety of different levels, all interacting with each other in a complex web. It is that emergent web, full of feedback between levels, from the gene to the wider (...) environment, that is life. (shrink)

The Modern Synthesis has dominated biology for 80 years. It was formulated in 1942, a decade before the major achievements of molecular biology, including the Double Helix and the Central Dogma. When first formulated in the 1950s these discoveries and concepts seemed initially to completely justify the central genetic assumptions of the Modern Synthesis. The Double Helix provided the basis for highly accurate DNA replication, while the Central Dogma was viewed as supporting the Weismann Barrier, so excluding the inheritance of (...) acquired characteristics. This article examines the language of the Modern Synthesis and reveals that it is based on four important misinterpretations of what molecular biology had shown, so forming the basis of the four Illusions: 1. Natural Selection; 2. The Weismann Barrier; 3. The Rejection of Darwin’s Gemmules; 4. The Central Dogma. A multi-level organisation view of biology avoids these illusions through the principle of biological relativity. Molecular biology does not therefore confirm the assumptions of the Modern Synthesis. (shrink)

What is Life? To answer this question, Denis Noble argues that we must look beyond the gene's eye view. For modern 'systems biology' considers life on a variety of levels, as an intricate web of feedback between gene, cell, organ, body, and environment. He shows how it is both a biologically rigorous and richly rewarding way of understanding life.

This paper seeks to highlight the importance of spatial cognition in Bergson’s Données immédiates by engaging with Robert Watt’s reconstruction of Bergson’s argument that every idea of number involves the idea of space. We focus on the second stage of Watt’s reconstruction, where Bergson argues that only space can provide the distinction required for our counting of otherwise identical items. Watt bases his reconstruction on a premise regarding the possibility that identical objects, in the absence of spatial distinction, might remain (...) identical across different “temporal locations”. Our paper raises the prospect that Bergson is committed to a stronger thesis, namely one implying that identical objects would necessarily remain indistinguishable without the intervention of space. The paper thus concludes by emphasizing the indispensability of space for knowledge according to Bergson. (shrink)