Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements (...) usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

This understanding of dirty hands should dispell the air of paradox so often associated with it. Dirty hands is a genuine moral problem, but not a conceptual one. The temptation to see it as a conceptual one arises from a hasty acceptance of these assumptions:Moral criticism is appropriate if and only if we can always do what is right. If we cannot do X or avoid doing Y, we cannot be criticized for failing to do X or for doing Y.We (...) are always free to avoid moral compromise since goodness is a matter of having the will to do what is right.We are morally compromised if and only if we either intentionally do what is wrong, or if we do what is right for the wrong reasons.As a general description of conscientiousness, these conditions are uncontroversial. However, conscientiousness does not exhaust the moral realm. The problem with the individuals in the cases above is not that they are guilty of being unconscientious. They are conscientious and still cannot avoid dirtying themselves.The Kantian aspiration to render ourselves invulnerable to moral compromise is well-intentioned and deserves our respect insofar as it alerts us to the importance of struggling with courage and imagination against evil. But to the extent that it rejects or ignores the possibility of moral tragedy, the Kantian conception paints too optimistic and artificial a picture of the human condition. We are complicated creatures with diverse and often conflicting ethical loves. Rigging our ethical theories to eliminate such conflicts does nothing to change life as real-life moral agents experience it. As with any kind of theory, we need to be careful about unwittingly deforming the world in order to make it conform to the beloved castles we so often build in the air. (shrink)

Three studies were conducted to explore the psychological determinants of COVID-deterrent behaviors. In Study 1, using data collected and analyzed both before and after the release of COVID-19 vaccines, mask-wearing, other preventative behaviors like social distancing, and vaccination intentions were positively related to assessments of the Coronavirus Behavioral Health Mindset ; belief in the credibility of science; progressive political orientation; less use of repressive and more use of sensitization coping; and the attribution of COVID-19 safety to effort rather than ability, (...) powerful forces, fate, or luck. In Study 2, favorable COVID-19 vaccination intentions were related to greater willingness to work, lower emotional distress, and greater customer experience mindset. Study 3 examined the personality and motives of individuals who volunteered to help deliver COVID-19 inoculations to the local community. The vaccine-giving volunteers, especially those with prosocial motives, had high CVBHM scores, belief in the credibility of science, low use of repressive coping, greater attribution of COVID-19 protection to effort, low likelihood of voting conservative, were older, and had more education than others. The majority of public health volunteers expressed prosocial motives to help people or join a cause, but many expressed the personal motives of getting the COVID-19 vaccination for themselves, conveying a public image of compassion, or structuring time. Based on the three research studies, a COVID-19 Mindset Hierarchy model is proposed to integrate the results. (shrink)

Main Response Topics ? Introduction ? Open display and public evaluation ? Publicity versus patient privacy ? Facial tissue donation ? Validity of Louisville Instrument for Risk Acceptance ? Patients' understanding of risk ? Face versus hand transplantation ? Rejection rates/risks ? Patient compliance ? Exit strategy ? Functional recovery ? Societietal implications ? Psychological implications ? Conclusion: Uncertainty likely to persist.

It cannot be denied that a correct notion of justice is very relevant to the solution of most modern problems. The constant appeal to the rights of individuals and groups of individuals and the widespread practice of injustice bear witness to this. Yet the very frequency with which the terms justice and injustice are used has, one fears, reduced those words to mere labels for whatever claim it is desired to make or deny, without regard for the existence of an (...) objectively just order in public and private life. There is need then of a reaffirmation of the idea of justice and an application of its principles, in terms suitable to our modern modes of thought, to current problems of human relationships. (shrink)

© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

According to the ideological surround model of research, a more “objective” psychology of religion requires efforts to bring etic social scientific and emic religious perspectives into formal dialog. This study of 245 Iranian university students illustrated how the dialogical validity of widely used etic measures of religion can be assessed by examining an emic religious perspective on psychology. Integrative Self-Knowledge and Self-Control Scales recorded two aspects of the “Perfect Man” as described by the Iranian Muslim philosopher Mortazā Motahharī. Use of (...) these instruments in correlation and multiple regression procedures identified Intrinsic, Extrinsic Personal, Religious Interpretation, Extrovertive Mysticism, Prayer Fulfillment, Universality, Connectedness, and Religiosity Scales as adaptive in their implications for a Muslim psychology of religion. Religious Crisis had maladaptive and Extrinsic Social, Introvertive Mysticism, and Quest Scales had ambiguous implications. These data illustrated how etic forms of understanding can clarify and can be clarified by emic insights. (shrink)

The current work builds a definition of irritability from both academic definitions and lay perspectives. In Study 1, a quantitative content analysis of academic definitions resulted in eight main content categories. In Study 2, a community sample of 39 adults participated in qualitative interviews. A deductive thematic analysis resulted in two main themes. The first main theme dealt with how participants positioned irritability in relation to other negative states. The second dealt with how participants constructed irritability as both a loss (...) of control and as an experience that should be controlled. The discussion integrates the findings of both studies and provides a concise, but comprehensive definition. (shrink)

Jennifer Hornsby has defended the Reasons-Knowledge Thesis : the claim that \-ing because p requires knowing that p, where the ‘because’ at issue is a rationalising ‘because’. She defends by appeal to the thought that it provides the best explanation of why the subject in a certain sort of Gettier case fails to be in a position to \ because p. Dustin Locke and, separately, Nick Hughes, present some modified barn-façade cases which seem to constitute counterexamples to and undermine Hornsby’s (...) way of motivating it by rendering their alternative Reasons-Explanation Thesis a better explanation of Hornsby’s datum. This paper defends and Hornsby’s argument for it against those objections. First, I point out that their supposedly intuitive verdict about the relevant barn-façade cases is not as intuitive as they think. Second, I point out that even if we share the intuition: we have strong reason to doubt the verdict anyway. And finally, I point out that since is independently implausible, the two problems can be tackled anyway. (shrink)

We can contrast rationalising explanations of the form S φs because p with those of the form S φs because S believes that p. According the Common Kind View, the two sorts of explanation are the same. The Disjunctive View denies this. This paper sets out to elucidate the sense in which the Common Kind Theorist asserts, but the Disjunctivist denies, that the two explanations are the same. I suggest that, in the light of the distinction between kinds of explanation (...) and particular explanations, the relevant sameness thesis is ambiguous, thus giving us two distinct versions of the Common Kind View. I then argue that the only direct arguments for Disjunctivism available in the literature fail because they only succeed in undermining one version of the Common Kind View. I finish, however, by providing a fresh argument for the Disjunctive View which aims to undermine both versions of its competitor. (shrink)

Here is a surprisingly neglected question in contemporary epistemology: what is it for an agent to believe that p in response to a normative reason for them to believe that p? On one style of answer, believing for the normative reason that q factors into believing that p in the light of the apparent reason that q, where one can be in that kind of state even if q is false, in conjunction with further independent conditions such as q’s being (...) a normative reason to believe that p. The primary objective of this paper is to demonstrate that that style of answer cannot be right, because we must conceive of believing for a normative reason as constitutively involving a kind of rationality-involving relation that can be instantiated at all only if there is a known fact on the scene, which the agent treats as a normative reason. A secondary objective, achieved along the way, is to demonstrate that in their Prime Time Errol Lord and Kurt Sylvan do not succeed in undermining the factoring picture in general, only a simple-minded version of it. (shrink)

We show, using the fine structure of K, that the theory ZF + AD + X R[X K] implies the existence of an inner model of ZF + AD + DC containing a measurable cardinal above its Θ, the supremum of the ordinals which are the surjective image of R. As a corollary, we show that HODK = K for some P K where K is the Dodd-Jensen Core Model relative to P. In conclusion, we show that the theory ZF (...) + AD + ¬DCR implies that R† exists. (shrink)

It is now standard in the literature on reasons and rationality to distinguish normative reasons from motivating reasons. Two issues have dominated philosophical theorising concerning the latter: (i) whether we should think of them as certain (non-factive) psychological states of the agent – the dispute over Psychologism; and (ii) whether we should say that the agent can Φ for the reason that p only if p – the dispute over Factivism. This paper first introduces a puzzle: these disputes look very (...) much like merely verbal disputes about the meaning of phrases like `S’s reason’ in motivating reasons ascriptions, and yet charity requires us to think that something substantive is afoot. But what? The second aim of the paper is to extract substantive theses from certain natural arguments for Psychologism and Anti-Factivism – theses which are versions of a controversial view of the nature and normative structure of rationality. The paper ends by arguing against these substantive theses on phenomenological and ethical grounds. The upshot is that proponents of Psychologism and Anti-Factivism are either engaged in the project of defending merely verbal theses or they’re engaged in the project of defending false substantive ones. (shrink)

The primary focus of Susanne Mantel’s excellent 'Determined by Reasons' is to develop a distinctive abilities-based account of acting in response to normative reasons, one which is clearly modelled on extant ability-theoretic accounts of knowledge. This review sketches Mantel’s account and raises a worry: that the account fails to characterise the sort of abilities constitutively involved in responding to reasons because it allows that agents can act for the reason that p even if their belief that p is not accessible (...) to conscious reasoning. (shrink)

An important function of the self is to identify external objects that are potentially personally relevant. We suggest that such objects may be identified through mere ownership. Extant research suggests that encoding information in a self-relevant context enhances memory , thus an experiment was designed to test the impact of ownership on memory performance. Participants either moved or observed the movement of picture cards into two baskets; one of which belonged to self and one which belonged to another participant. A (...) subsequent recognition test revealed that there was a significant memory advantage for objects that were owned by self. Acting on items had no impact on memory. Results are discussed with reference to the importance of self-object associations in cognition. (shrink)

ABSTRACT: In memory of Professor Louise Marcil, from the University of Montreal, who died prematurely in April 1995, this special issue of Dialogue is dedicated to Equality. In addition to presenting the various contributions, the Introduction traces the main strands of Louise Marcil’s work on equality. The impressive corpus of her writings on the subject is characterized throughout by sensitivity to the historical and conceptual complexity of egalitarian theories and policies and by a depth of scholarship, the richness of which (...) defies classification into traditional philosophical schools. Moreover, far from being merely abstract scholarship, this work was clearly intended to strengthen actual egalitarian social projects, to which Louise Marcil was passionately committed. The contributions to this special issue of Dialogue have been selected in large part to reflect the diversity and scholarly standards of Louise Marcil’s approach to equality as well as its engaged spirit. (shrink)

A central mistake in Rolf Gruner's recent article on understanding in the socia sciences in ferreted out, and consideration of it is used both to analyse Gruner's interpretation of understanding and to sketch a more adequate interpretation. The mistake is in distinguishing meanings and facts. The analysis suggests that Gruner was forced to see understanding both as a special kind of explanation and at the same time as no explanation. The sketch offers a distinction of three senses of ?understanding? ? (...) as identification of a certain kind of subject matter, as explanation of it, and as a subjective feeling consequent upon such explanation. (shrink)