This article elucidates the premises and limited meaning of medical futility in order to formulate an ethically meaningful definition of the term, that is, a medical intervention’s inability to deliver the benefit for which it is designed. It uses this definition to show the two ways an intervention could become medically futile, to recommend an even more limited usage of medical futility, and to explain why an intervention need not be futile in order to be withdrawn over patient-based objections. If (...) an intervention retains some benefit, then patients or surrogates might legitimately consider that benefit in their case and request the intervention. Physicians might still be justified in declining it on the grounds that the burdens greatly outweigh the benefits, but not on the grounds of futility. Finally, the article uses bioethics research and healthcare litigation to clarify the meaning of futility in practice and recommends alternative language when possible. (shrink)

The term “medical futility” was developed in the 1980s to enable physicians to withdraw life-prolonging procedures over the objections of patients or family members. Using clinical expertise, the physician determines that a particular treatment would be futile in a particular clinical situation. A futility judgment is clear cut when the procedure does not work, but a difficulty arises when a physician believes that a procedure provides too little benefit and then invokes futility. In that case, a patient might consider if (...) the relatively small medical benefit might contribute to appropriately defined goals of treatment, and if so request “extraordinary means.” This article places the concept “medical futility” in relation to the principle of ordinary and extraordinary means, clarifies the concept of futility, and explains the problem of redefining futile means to include procedures that retain some benefit. It advocates very limited use of the term “medical futility” and suggests an alternative reason to withhold or withdraw treatment. National Catholic Bioethics Quarterly 14.1 : 39–45. (shrink)

Neoliberal ideology and exclusionary policies based on racialized identities characterize the current contexts in North America and Western Europe. Nursing knowledge cannot be abstracted from social, political and historical contexts; the task of examining the influence of race and racial ideologies on disciplinary knowledge and inquiry therefore remains an important task. Contemporary analyses of the role and responsibility of the discipline in addressing race‐based health and social inequities as a focus of nursing inquiry remain underdeveloped. In this article, we examine (...) nursing's engagement with ideas about race and racism and explore the ways in which nursing knowledge and inquiry have been influenced by race‐based ideological discourses. Drawing on Henry and Tator's framework of democratic racism, we consider how strategic discursive responses—the discourses of individualism, multiculturalism, colour‐blindness, political correctness and denial—have been deployed within nursing knowledge and inquiry to reinforce the belief in an essentially fair and just society while avoiding the need to acknowledge the persistence of racist discourses and ideologies. Greater theoretical, conceptual and methodological clarity regarding race, racialization and related concepts in nursing inquiry is needed to address health and social inequities. (shrink)

This study examines the cross‐cultural generality of Hering's (1878/1964) color‐opponent theory of color appearance. English‐speaking and Somali‐speaking observers performed variants of two paradigms classically used to study color‐opponency. First, both groups identified similar red, green, blue, and yellow unique hues. Second, 25 English‐speaking and 34 Somali‐speaking observers decomposed the colors present in 135 Munsell color samples into their component Hering elemental sensations—red,green,blue, yellow, white, and black—or else responded “no term.” Both groups responded no term for many samples, notably purples. Somali (...) terms for yellow were often used to name colors all around the color circle, including colors that are bluish according to Hering's theory. Four Somali Grue speakers named both green and blue elicitation samples by their term for green. However, that term did not name the union of all samples called blue or green by English speakers. A similar pattern was found among three Somali Achromatic speakers, who called the blue elicitation sample black or white. Thus, color decomposition by these Somali‐speaking observers suggests a lexically influenced re‐dimensionalization of color appearance space, rather than a simple reduction of the one proposed by Hering. Even some Somali Green‐Blue speakers, whose data were otherwise similar to English, showed similar trends in yellow and blue usage. World Color Survey data mirror these results. These within‐ and cross‐cultural violations of Hering's theory do not challenge the long‐standing view that universal sensory processes mediate color appearance. However, they do demonstrate an important contribution of language in the human understanding of color. (shrink)

Women constitute the majority of both the leadership and the membership of local toxic waste activist organizations; yet, gender and the fight against toxic hazards are rarely analyzed together in studies on gender or on environmental issues. This absence of rigorous analysis of gender issues in toxic waste activism is particularly noticeable since many scholars already make note that women predominate in this movement. This article is an attempt to understand how women activists transcend private pain, fear, and disempowerment and (...) become powerful forces for change by organizing against toxic waste in their communities. This article systematically looks at these connections by examining data from survey research and case studies. The authors are particularly interested in the transformation of self of these women, with an emphasis on “ways of knowing.” They also examine the potential of existing social movement theories to explain women's activism against toxic waste. (shrink)

A longish (12 page) discussion of Richard Sorabji's excellent book, with a further discussion of what it means for a theory of emotions to be a cognitive theory.

We consider four mechanisms by which apparent discontinuities in the distribution of antisociality could arise: (1) executive genes or hormonal systems, (2) multiplicative interactions of predisposing factors, (3) environmental tracking into a limited number of social roles, and (4) cross-generational gene—environment interactions. A more explicit consideration of complex self-organizing dynamic systems may help us understand the maintenance of antisocial subpopulations.

To examine the underlying processes of an innovative mind-body practice, Mindful Body Awareness, this exploratory study involved four case studies analyzed phenomenologically using the dialogal method. Mindful Body Awareness combines manual and verbal processing, and is focused on facilitation of client body awareness. Four individuals were recruited to receive weekly 1.25 hour sessions over four weeks. The Helpfulness Aspects of Therapy form was administered immediately after each session to access participants’ perceptions of the therapy experience. In addition, the Scale of (...) Body Connection was used to examine pre- and post-body awareness and bodily dissociation. Analysis involved phenomenology and descriptive statistics. The overall perceived helpfulness of the intervention was evident in the four themes that emerged from the analysis. These themes were gaining interoceptive awareness, personal agency, therapist trust and conceptual framing, and transformation. The participants’ responses were also used to investigate the therapy process across time. A pattern of increased interoceptive depth was apparent, as was a concomitant progression in embodied sense of self. Improvements in body awareness and bodily dissociation were evident for two of the four participants. These findings help to identify primary components of Mindful Body Awareness and suggest the role of these components in the embodiment process. (shrink)

In an influential essay entitled Why abortion is wrong, Donald Marquis argues that killing actual persons is wrong because it unjustly deprives victims of their future; that the fetus has a future similar in morally relevant respects to the future lost by competent adult homicide victims, and that, as consequence, abortion is justifiable only in the same circumstances in which killing competent adult human beings is justifiable.1 The metaphysical claim implicit in the first premise, that actual persons have a future (...) of value, is ambiguous. The Future Like Ours argument (FLO) would be valid if “future of value” were used consistently to mean either “potential future of value” or “self-represented future of value”, and FLO would be sound if one or the other interpretation supported both the moral claim and the metaphysical claim, but if, as I argue, any interpretation which makes the argument valid renders it unsound, then FLO must be rejected. Its apparent strength derives from equivocation on the concept of “a future of value”. (shrink)

It is claimed by the future like ours anti-abortion argument that since killing adult humans is wrong because it deprives them of a future of value and the fetus has a future of value, killing fetuses is wrong in the same way that killing adult human beings is wrong. In The morality of abortion and the deprivation of futures (this journal, April 2000) I argued that the persuasive power of this argument rests upon an equivocation on the term “future of (...) value”. If the expression means “a potential future of value” then the moral claim is implausible because people do not in general have rights to what they need to fulfill their potential; if the expression means “self-represented future of value” then the argument fails because the fetus does not represent its future. Under no interpretation is the argument sound. In Deprivations, futures and the wrongness of killing (this journal, December 2001) Donald Marquis, author of the future like ours argument, responds at length to this objection. In the present essay the focus of the debate shifts to the proper interpretation of the right not to be killed. Donald Marquis argues that this liberty right entails the welfare right to the means necessary to sustain life; I argue that the right not to be killed does not entail unlimited welfare rights. On Marquis's view, the right not to be killed confers upon the fetus the right to whatever it takes to sustain life; on the view I defend, the right not to be killed does not confer upon the fetus or anyone else the right to another person's body. On Marquis's view, abortion is almost never permissible; on my view abortion is almost always permissible. (shrink)

Out-of-network air ambulance bills are a pernicious and financially devastating type of surprise medical bill. Courts have broadly interpreted the Airline Deregulation Act to preempt most state attempts to regulate air ambulance billing abuses, so a federal solution is ultimately needed. However, in the absence of a federal fix, states have experimented with a variety of approaches that may survive preemption and provide some protections for their citizens.

This is the introduction to the Routledge Companion to Thought Experiments.

Thought experiments are a means of imaginative reasoning that lie at the heart of philosophy, from the pre-Socratics to the modern era, and they also play central roles in a range of fields, from physics to politics. The Routledge Companion to Thought Experiments is an invaluable guide and reference source to this multifaceted subject. Comprising over 30 chapters by a team of international contributors, the Companion covers the following important areas: -/- · the history of thought experiments, from antiquity to (...) the trolley problem and quantum non-locality; -/- · thought experiments in the humanities, arts, and sciences, including ethics, physics, theology, biology, mathematics, economics, and politics; -/- · theories about the nature of thought experiments; -/- · new discussions concerning the impact of experimental philosophy, cross-cultural comparison studies, metaphilosophy, computer simulations, idealization, dialectics, cognitive science, the artistic nature of thought experiments, and metaphysical issues. -/- This broad ranging Companion goes backwards through history and sideways across disciplines. It also engages with philosophical perspectives from empiricism, rationalism, naturalism, skepticism, pluralism, contextualism, and neo-Kantianism to phenomenology. This volume will be valuable for anyone studying the methods of philosophy or any discipline that employs thought experiments, as well as anyone interested in the power and limits of the mind. (shrink)

Prior knowledge structures (or schemas) confer multiple behavioral benefits. First, when we encounter information that fits with prior knowledge structures, this information is generally better learned and remembered. Second, prior knowledge can support prospective planning. In humans, memory enhancements related to prior knowledge have been suggested to be supported, in part, by computations in prefrontal and medial temporal lobe cortex. Moreover, animal studies further implicate a role for the hippocampus in schema-based facilitation and in the emergence of prospective planning signals (...) following new learning. To date, convergence across the schema-enhanced learning and memory literature may be constrained by the predominant use of hippocampally dependent spatial navigation paradigms in rodents, and non-spatial list-based learning paradigms in humans. Here, we targeted this missing link by examining the effects of prior knowledge on human navigational learning in a hippocampally dependent virtual navigation paradigm that closely relates to foundational studies in rodents. Outside the scanner, participants overlearned Old Paired Associates (OPA – item-location associations) in multiple spatial environments, and they subsequently learned New Paired Associates (NPA – new item-location associations) in the environments while undergoing fMRI. We hypothesized that greater OPA knowledge precision would positively affect NPA learning, and that the hippocampus would be instrumental in translating this new learning into prospective planning of navigational paths to NPA locations. Behavioral results revealed that OPA knowledge predicted one-shot learning of NPA locations, and neural results indicated that one-shot learning was predicted by the rapid emergence of performance-predictive prospective planning signals in hippocampus. Prospective memory relationships were not significant in parahippocampal cortex and were marginally dissociable from the primary hippocampal effect. Collectively, these results extend understanding of how schemas impact learning and performance, showing that the precision of prior spatial knowledge is important for future learning in humans, and that the hippocampus is involved in translating this knowledge into new goal-directed behaviors. (shrink)

An implicit goal of many interventions intended to enhance integrity is to minimize peoples' exposure to unethical events. The intent of the present effort was to examine if exposure to unethical practices in the course of one's work is related to ethical decision making. Accordingly, 248 doctoral students in the biological, health, and social sciences were asked to complete a field appropriate measure of ethical decision making. In addition, they were asked to complete measures examining the perceived acceptability of unethical (...) events and a measure examining perceptions of ethical climate. When these criterion measures were correlated with a measure examining the frequency with which they had been exposed to unethical events in their day-to-day work, it was found that event exposure was strongly related to ethical decision making but less strongly related to climate perceptions and perceptions of event acceptability. However, these relationships were moderated by level of experience. The implications of these findings for practices intended to improve ethics are discussed. (shrink)

What do corporations look like when they have integrity, and how can we move more companies in that direction? Corporate Integrity offers a timely, comprehensive framework- and practical business lessons - bringing together questions of organizational design, communication practices, working relationships, and leadership styles to answer this question. Marvin T. Brown explores the five key challenges facing modern businesses as they try to respond ethically to cultural, interpersonal, organizational, civic and environmental challenges. He demonstrates that if corporations are to (...) meet the needs of civil society, they must facilitate inclusive communication patterns based on mutual recognition and civic cooperation. Corporate Integrity is essential reading for professionals in organizational ethics, business leaders, and graduate students looking for practical and reflective insights into doing business with integrity and purpose. (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)

Background Empirical studies of surrogate decision-making tend to assume that surrogates should make only a 'substituted judgement'—that is, judge what the patient would want if they were mentally competent. Objectives To explore what people want in a surrogate decision-maker whom they themselves select and to test the assumption that people want their chosen surrogate to make only a substituted judgement. Methods 30 undergraduate students were recruited. They were presented with a hypothetical scenario about their expected loss of mental capacity in (...) the future and asked to answer some questions about their choice of surrogate. These data were analysed qualitatively using thematic content analysis. Results Most respondents talked about choosing someone who was caring and competent in certain ways, giving interesting evidence for their judgements. Surprisingly few highlighted how well they thought their chosen surrogate knew their preferences and would be able to make a substituted judgement. Moreover, few specified that their chosen surrogate had similar attitudes and values to their own and so would make a similar decision to theirs in the circumstances presented. Some respondents also referred to the social role of their chosen surrogate or the social dynamics of their situation which influenced their choices, as well as to ideas of reciprocity and characteristics of honesty and loyalty. Conclusion In the event that they lose mental capacity, many people will not select a surrogate to decide about medical treatments on their behalf solely on the basis that they expect their surrogate to make a substituted judgement. (shrink)

A higher order potential analysis of moral status clarifies the issues that divide Human Being Theorists who oppose embryo research from Person Theorists who favor embryo research. Higher order potential personhood is transitive if it is active, identity preserving and morally relevant. If the transition from the Second Order Potential of the embryo to the First Order Potential of an infant is transitive, opponents of embryo research make a powerful case for the moral status of the embryo. If it is (...) intransitive, then the Person Theorist can draw lines between levels of moral status that permit embryo research to proceed. (shrink)

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands—problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands’ and wives’ financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands’ and wives’ marital satisfaction, in relation to (...) profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers. Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only. However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed. (shrink)

The somatic integration definition of life is familiar from the debate on the determination of death, with some bioethicists arguing that it supports brain death while others argue that some brain‐dead bodies exhibit sufficient somatic integration for biological life. I argue that on either interpretation, the somatic integration definition of life implies that neither the preimplantation embryo nor the postimplantation embryo meet the somatic integration threshold condition for organismal human life. The earliest point at which a somatic integration determination of (...) life could be made would be the beginning of the fetal stage, 9 weeks postfertilization. Bioethical implications are considered, specifically with respect to the moral status of the postimplantation embryo in embryo research and abortion. (shrink)

Moral status ascribes equal obligations and rights to individuals on the basis of membership in a protected group. Substance change is an event that results in the origin or cessation of individuals who may be members of groups with equal moral status. In this paper, two substance changes that affect the moral status of human embryos are identified. The first substance change begins with fertilization and ends with the formation of the blastocyst, a biological individual with moral status comparable to (...) that ascribed to human organs. The second substance change begins at implantation and ends late in embryological development with the formation of the human body, an organism with moral status as a human being. The bioethical implications of each substance change are explored. The Two Substance Change theory is contrasted with continuity theories, which recognize no substance change in embryological development and with fertilization-only substance change theories. (shrink)

This paper approaches the question of corporate integrity and leadership from a civic perspective, which means that corporations are seen as members of civil society, corporate members are seen as citizens, and corporate decisions are guided by civic norms. Corporate integrity, from this perspective, requires that the communication patterns that constitute interpersonal relationships at work exhibit the civic norm of reciprocity and acknowledge the need for security and the right to participate. Since leaders are members of corporate relationships, their integrity (...) will be determined by the integrity of these interpersonal relationships, and by their efforts to improve them. (shrink)

Next SectionIn an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives and two types of medical interventions. These were stated to be equally effective in improving outcomes in five contexts: weight loss and smoking cessation programmes, and adherence in treatment programmes for drug addiction, serious mental illness and physiotherapy after surgery. Financial incentives were judged less acceptable and to be less fair than medical interventions (...) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study. (shrink)

When a handful of people thrive while whole industries implode and millions suffer, it is clear that something is wrong with our economy. The wealth of the few is disconnected from the misery of the many. In Civilizing the Economy, Marvin Brown traces the origin of this economics of dissociation to early capitalism, showing how this is illustrated in Adam Smith's denial of the central role of slavery in wealth creation. In place of the Smithian economics of property, (...) class='Hi'>Brown proposes that we turn to the original meaning of economics as household management. He presents a new framework for the global economy that reframes its purpose as the making of provisions instead of the accumulation of property. This bold new vision establishes the civic sphere as the platform for organizing an inclusive economy and as a way to move toward a more just and sustainable world. (shrink)

If personal identity consists in non-branching psychological continuity, then the sharp breaks in psychological connectedness characteristic of Multiple Personality Disorder implicitly commit psychological continuity theories to a metaphysically extravagant reification of alters. Animalist theories of personal identity avoid the reification of alternate personalities by interpreting multiple personality as a failure to integrate alternative autobiographical memory schemata. In the normal case, autobiographical memory cross-classifies a human life, and in so doing provides access to a variety of interpretative frameworks with their associated (...) clusters of general event memory and episodic memory. Multiples exhibit erratic behavior because they cannot access reliably the intersecting autobiographical memory schemata that permit graceful transitions between social roles, behavioral repertoire and emotional dispositions. Selves, in both normal and certain pathological cases, are best understood as semi-fictional narratives created by human animals to serve their social, emotional and physical needs. (shrink)

Bioethics, Volume 35, Issue 7, Page 672-679, September 2021.

Illustrates how using ethics in decision making can improve communication, resolve disagreements, and set just standards for worker-management relations. Presents strategies for how organizations can use ethics to uncover values and beliefs, and determine whether they are acting upon just and moral decisions.