“Female sexual dysfunction” is the type of contested disease that has sparked concern about the role of the pharmaceutical industry in medical science. Many policies have been proposed to manage industry influence without carefully evaluating whether the proposed policies would be successful. We consider a proposal for incorporating citizen stakeholders into scientific research and show, via a detailed case study of the pharmaceutical regulation of flibanserin, that such programs can be co-opted. In closing, we use Holman’s asymmetric arms race framework (...) as a tool for evaluating policies in industry-funded science. (shrink)

:This article considers recent ethical topics relating to medical AI. After a general discussion of recent medical AI innovations, and a more analytic look at related ethical issues such as data privacy, physician dependency on poorly understood AI helpware, bias in data used to create algorithms post-GDPR, and changes to the patient–physician relationship, the article examines the issue of so-called robot doctors. Whereas the so-called democratization of healthcare due to health wearables and increased access to medical information might suggest a (...) positive shift in the patient-physician relationship, the physician’s ‘need to care’ might be irreplaceable, and robot healthcare workers might be seen as contributing to dehumanized healthcare practices. (shrink)

This article introduces the special issue on middle-range theory in science and technology studies, providing the background to its production and reviewing different notions of “middle.” It begins with Merton's ideas about middle-range theory as a way of moving beyond the production of either descriptions or theories of everything. Instead of seeing the middle as the space between the theoretical imagination and the detailed depiction of everyday practices, the authors outline three ways of thinking about the middle range: as an (...) adjective, the closest to Merton's conception; as a noun, the liminal place between theories, audiences, and levels; and as a verb, a process, a means of making connections across time, discipline, community, and place. A summary of each of the articles in this special issue is provided, preceding a call for further discussion about the role of case studies and the nature of the middle in STS. (shrink)

What does it mean to ‘drop out’ of therapy? Many definitions of ‘dropout’ have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the client’s experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether this refined (...) categorisation of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioural Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11-17 years. 32 were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. 67 cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analysed using ideal type analysis. Three types of dropout were constructed: ‘dissatisfied’ dropout, ‘got-what-they-needed’ dropout, and ‘troubled’ dropout. ‘Dissatisfied’ dropouts reported stopping therapy because they did not find it helpful. ‘Got-what-they-needed’ dropouts reported stopping therapy because they felt they had benefitted from therapy. ‘Troubled’ dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of 'dropout' cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment. (shrink)

A total of 378 mathematics undergraduates (selected for being strong at “systemizing”) and 414 students in other (control) disciplines at Cambridge University were surveyed with two questions: (1) Do you have a diagnosed autism spectrum condition? (2) How many relatives in your immediate family have a diagnosed autism spectrum condition? Results showed seven cases of autism in the math group (or 1.85%) vs one case of autism in the control group (or 0.24%), a ninefold difference that is significant. Controlling for (...) sex and general population sampling, this represents a three- to sevenfold increase for autism spectrum conditions among the mathematicians. There were 7 of 1,405 (or 0.5%) cases of autism in the immediate families of the math group vs 2 of 1,669 (or 0.1%) cases in the immediate families of the control group, which again is a significant difference. These results confirm a link between autism and systemizing, and they suggest this link is genetic given the association between autism and first-degree relatives of mathematicians. (shrink)

We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical (...) policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three ‘pillars’ – the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally. (shrink)

There has been considerable interest in the literature about how professions operate in both the private and public interest. This paper examines this issue in the context of the enforcement of the professional code of conduct of a particular professional accounting association. The paper explores whether certain enforcement actions of the association suggest behaviour motivated at least partially by private interest. It then considers whether the consequences of such behaviour or practices are troubling.

This paper draws on classical theories of wisdom to explore the organisational impact of nurses on Australian general practice. Between 2004 and 2008, numbers of general practice nurses doubled, the most rapid influx of nurses into any Australian workplace over the decade. Using data from the Australian General Practice Nurses Study, we argue that nurses had a positive impact because they introduced techne at the organisational level and amplified phronesis in clinical activities. In its Hippocratic formulation, techne refers to a (...) field of definable knowledge, which is purposeful and useful and requires mastery of rational principles. Nursing, with its focus on system and accountability, brought techne out of the GP’s consulting room and into the general practice as a whole. Nurses also exemplify phronesis, an Aristotelian virtue connoting a reasoned and honourable capacity to make judgements: the practical wisdom that defines the interaction between clinician and patient in general practice. At a time of significant GP shortage, doctors and nurses began to collaborate around their more complex and time-consuming patients, leading to a deepening of phronesis in the workplace. By bringing techne to bear on the organisation, and complementing and enhancing phronesis, nurses propel organisational wisdom in general practices. (shrink)

Preface and acknowledgments -- Prelude -- 1. Gender, sexuality, and meaning: An overview -- Part I. Politics and scholarship: 2. Language and gender -- 3. Feminism in linguistics -- 4. Difference and language: A linguist's perspective -- Part II. Social practice, social meanings, and selves: 5. Communities of practice: Where language, gender, and power all live -- 6. Intonation in a man's world -- 7. Constructing meaning, constructing selves: Snapshots of language, gender, and class from Belten High -- Part III. (...) Constructing content in discourse: 8. The sexual reproduction of meaning: A discourse-based theory -- 9. Prototypes, pronouns, and persons -- 10. What's in a name?: Social labeling and gender practices -- 11. Queering semantics: Definitional struggles -- Coda: 12. Breaking through the 'glass ceiling': Can linguistic awareness help? (shrink)

Previous research has demonstrated that attitudes are a primary determinant of intention to gamble on electronic gaming machines consistent with the Theory of Reasoned Action. This paper aims to address how biases in judgment can contribute to attitudes and subsequently behavior, including maladaptive problematic gambling behavior. We take a novel approach by viewing overconfidence in one’s understanding of how outcomes are determined on EGMs as an indication of cognitive distortions. The novelty of this paper is further increased as we compare (...) attitudes to existing EGMs with novel EGMs which include a skill component, referred to as skill-based gaming machines, which enables a better controlled comparison between actual and perceived skill. In Study 1, 232 US-based participants were recruited online who were shown various slot machines and SGMs and asked a series of questions about perceived skill and chance in determining outcomes to assess their understanding, then were asked their confidence in their understanding, attitudes toward the machines and they completed the Problem Gambling Severity Index. In Study 2, 246 Australian participants were recruited through community and university student samples; they attended a laboratory where they were randomly allocated to play a real EGM or SGM without money and completed the same measures as in Study 1. In Study 2, participants were randomly told that the outcomes on the machine they would play were determined entirely by chance, skill, or a mixture of both. In both studies, our findings suggest that there are more extreme values in overconfidence in how EGMs work, whereas individuals are more similar in their confidence in understanding SGMs. We also find a relationship between overconfidence in EGM understanding and positive attitudes toward EGMs, but no such relationship with SGMs. There was no impact from controlling for demographics, problem gambling severity, or labeling of machines on these relationships. (shrink)

BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, and (...) patient care among ICU nurses.Sample and SettingThe sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period.MethodsAlvita K. Nathaniel’s Theory of Moral Reckoning guided development of the nursing ethics huddle process.1 The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects’ level of MD.2 Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects’ perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions.ResultsOverall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant (p < 0.0001). (shrink)

This research focuses on women in corporate positions “above the glass ceiling” and explores their perceptions on corporate mobility and strategies for success in elite positions. Through interviews with 16 men and women corporate presidents and chief executive officers in Southern California, it is found that while white men promote the dominant ideology of individualism and patriarchal gender ideology as explanations of corporate mobility and success, white women emphasize alternative perspectives by confirming the importance of social networks and peer similarities (...) for succeeding in elite positions. These women strategically attempt to increase their cultural capital to negotiate male-dominated networks and maintain their high-status positions through such measures as obtaining advanced educational degrees or modifying speech and behavior. (shrink)

Of all the changes to the Human Fertilisation and Embryology Act 1990 that were introduced in 2008 by legislation of the same name, foremost to excite media attention and popular controversy was the amendment of the so-called welfare clause. This clause forms part of the licensing conditions which must be met by any clinic before offering those treatment services covered by the legislation. The 2008 Act deleted the statutory requirement that clinicians consider the need for a father of any potential (...) child before offering a woman treatment, substituting for it a requirement that clinicians must henceforth consider the child’s need for “supportive parenting”. In this paper, we first briefly recall the history of the introduction of s 13(5) in the 1990 Act, before going on to track discussion of its amendment through the lengthy reform process that preceded the introduction of the 2008 Act. We then discuss the meaning of the phrase “supportive parenting” with reference to guidance regarding its interpretation offered by the Human Fertilisation and Embryology Authority. While the changes to s 13(5) have been represented as suggesting a major change in the law, we suggest that the reworded section does not represent a significant break from the previous law as it had been interpreted in practice. This raises the question of why it was that an amendment that is likely to make very little difference to clinical practice tended to excite such attention (and with such polarising force). To this end, we locate debates regarding s 13(5) within a broader context of popular anxieties regarding the use of reproductive technologies and, specifically, what they mean for the position of men within the family. (shrink)

Abstract.Altruism, defined here as a regard for or devotion to the interest of others with whom we are interrelated, is pitted against two other dispositions in human beings: nepotism and egoism. We propose that to become fully human is to become more altruistic. We describe how altruism is mediated by our physiology, is expressed in our psychological development, is evolving in our social institutions, and becomes the moral communities that enforce our sense of right and wrong. A change in any (...) one of these influences changes our disposition—changes who we are and what we do—potentially making altruism more possible in the world. (shrink)

After a brief overview of ethical issues in an Australian context catalyzed by the current pandemic, this article focuses on data protection in the light of recent debates about COVID-19 data tracking in Australia and globally. This article looks at the issue of trust as a fundamental principle of effective and ethical COVID-safe measures undertaken by the government. Key to ensuring such trust are Habermasian participatory dialogs, which assume trust as a condition of authentic illocution, and an emphasis on short-term (...) data capture. (shrink)

Research Ethics, Volume 18, Issue 2, Page 114-125, April 2022. Learning about research ethics and research integrity is greatly facilitated by case studies, which illuminate, ground and personalise abstract questions. This paper argues that fiction can provide similar learning experiences, incarnating ethical dilemmas through a medium that is highly accessible yet sophisticated in its depictions of how researchers behave. Examples of fictional illustrations are given to illustrate various themes such as animal experimentation, exploitation of the vulnerable, researcher bias and research (...) fraud. (shrink)

Learning about research ethics and research integrity is greatly facilitated by case studies, which illuminate, ground and personalise abstract questions. This paper argues that fiction can provide similar learning experiences, incarnating ethical dilemmas through a medium that is highly accessible yet sophisticated in its depictions of how researchers behave. Examples of fictional illustrations are given to illustrate various themes such as animal experimentation, exploitation of the vulnerable, researcher bias and research fraud.

This is the second of two volumes announcing the emergence of the new legal realism. At a time when the legal academy is turning to social science for new approaches, these volumes chart a new course for interdisciplinary research by synthesizing law on the ground, empirical research, and theory. Volume 2 explores the integration of global perspectives and information into our understanding of law. Increasingly, local experiences of law are informed by broader interactions of national, international, and global law. Lawyers, (...) judges, and other legal actors often have to respond to these broader contexts, while those pursuing justice in various global contexts must wrestle with the specific problems of translation that emerge when different concepts of law and local circumstances interact. Using empirical research, the authors in this path-breaking volume shed light on current developments in law at a global level. (shrink)

This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Tool—a dialogical (...) and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

As the capabilities of artificial intelligence systems improve, it becomes important to constrain their actions to ensure their behaviour remains beneficial to humanity. A variety of ethical, legal and safety-based frameworks have been proposed as a basis for designing these constraints. Despite their variations, these frameworks share the common characteristic that decision-making must consider multiple potentially conflicting factors. We demonstrate that these alignment frameworks can be represented as utility functions, but that the widely used Maximum Expected Utility paradigm provides insufficient (...) support for such multiobjective decision-making. We show that a Multiobjective Maximum Expected Utility paradigm based on the combination of vector utilities and non-linear action–selection can overcome many of the issues which limit MEU’s effectiveness in implementing aligned AI. We examine existing approaches to multiobjective AI, and identify how these can contribute to the development of human-aligned intelligent agents. (shrink)

Three interrelated communicative issues emerge from recent U.S. political discourse in the wake of Donald Trump’s campaign for and election to the presidency. TRUTH figures prominently in social commentary on language. Semantically, truth relates to applicability conditions for linguistic expressions, which change and can be contested. Pragmatically, truth affects updating participants’ changing public commitments to what the world is like and to their own and others’ future actions. Updating as the speaker wants requires TRUST. Taking speakers as personally credible is (...) heavily tied to social identities and power relations. Experts and other “authorities” are often automatically accorded credibility but sometimes wrongly shielded from criticism. Disdain for expertise fueled Trump’s campaign and the social divides it exploited, continuing during his presidency. Although TRUMPERY (orig., “deceit, fraud”) is not confined to Trump or Trumpists, they are consummate practitioners. Communicative trumpery exploits “confirmation bias,” desires, and assumptions producing beliefs. It also arises from shifting interpretations and is key to evade communicative accountability (“just joking,” “a figure of speech”) or from refusing to engage with other discourse participants. (shrink)

Evidence from optic ataxic patients with bilateral lesions to the superior parietal lobes does not support the view that there are separate planning and control mechanisms located in the IPL and SPL respectively. The aberrant reaches of patients with bilateral SPL damage towards extrafoveal targets seem to suggest a deficit in the selection of appropriate motor programmes rather than a deficit restricted to on-line control.

Juxtaposing distinct approaches to gesture in order to explore the ways in which they at once shape and are influenced by culture, the contributors examine the works of writers Henri Michaux and Stphane Mallarm, photographers Henri Cartier ...

Examination of naturally occurring cases in which a person reports that a word is on the tip of his or her tongue has led several theorists to propose that an important role is played by blocking words whose intrusions hinder access to the correct targets. As yet, however, the blocking mechanism appears to have received little direct investigation experimentally. It was studied here by adapting the classic method of Brown and McNeill in which a person is presented with a definition (...) of a rare word and uses it to attempt to generate that target word. The adaptation that was made was to append a potential blocking word to the presentation of each definition. The potential blocking words were either phonologically related to the target or not, either semantically related to the target or not, and either rare or not. Only the first of these factors exerted a significant effect—more cases of tip of the tongue were experienced when the potential blocking word was phonologically related to the target than when it was not. This result suggests that the recall of a word on the basis of its meaning may proceed via an intermediate stage characterised by partial retrieval of its phonology. (shrink)

This paper presents an analysis of conversational actions and category relations exhibited in an episode of argument between a brother and sister during a family meal. The paper is based on two sets of auspices: on a conversation analytic concern with the interconnection between the sequential and categorical ‘layers’ of organization to which parties to talk-in-interaction are demonstrably oriented, and on ‘Sacks’ Conjecture’ regarding children’s culture and adult—child ‘culture contact’. In terms of these auspices, the analysis shows that the children (...) use both sequential and categorical cultural resources to produce their argument. To adapt a concept of Garfinkel’s — the documentary method of interpretation — the category relationship between the children is the underlying matter that the sequential particulars are used to reflexively document and constitute. Specifically, through the sequentially organized particulars of degradation and resistance the children recognizably and reflexively constitute their category relationship. (shrink)