While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

: In a short and much-neglected passage in the second Critique, Kant discusses the threat posed to human freedom by theological determinism. In this paper we present an interpretation of Kant’s conception of and response to this threat. Regarding his conception, we argue that he addresses two versions of the threat: either God causes appearances directly or he does so indirectly by causing things in themselves which in turn cause appearances. Kant’s response to the first version is that God cannot (...) cause appearances directly because they depend essentially on the passive sensibility of finite beings. Kant’s response to the second version is that human beings are endowed with transcendental freedom, which blocks the causal transitivity that is presupposed by this version. We also contrast his position on this topic with Leibniz’s and Spinoza’s. (shrink)

Existing research in color naming and categorization primarily reflects two opposing views: A Cultural Relativist view that posits color perception is greatly shaped by culturally specific language associations and perceptual learning, and a Universalist view that emphasizes panhuman shared color processing as the basis for color naming similarities within and across cultures. Recent empirical evidence finds color processing differs both within and across cultures. This divergent color processing raises new questions about the sources of previously observed cultural coherence and cross-cultural (...) universality. The present article evaluates the relevance of individual variation on the mainstream model of color naming. It also presents an alternate view that specifies how color naming and categorization is shaped by both panhuman cognitive universals and socio-cultural evolutionary processes. This alternative view, expressed, in part, using an Interpoint Distance Model of color categorization, is compatible with new empirical results showing divergent color processing within and across cultures. It suggests that universalities in color naming and categorization may naturally arise across cultures because color language and color categories primarily reflect culturally modal linguistic mappings, and categories are shaped by universal cognitive constructs and culturally salient features of color. Thus, a shared cultural representation of color based on widely shared cognitive dimensions may be the proper foundation for universalities of color naming and categorization. Across cultures this form of representation may result from convergent responses to similar pressures on color lexicon evolution. (shrink)

In recent years, scholars have come to understand emotions as dynamic and socially constructed—the product of interdependent cultural, relational, situational, and biological influences. While researchers have called for a multilevel theory of emotion construction, any progress toward such a theory must overcome the fragmentation of relevant research across various disciplines and theoretical frameworks. We present affect control theory as a launching point for cross-disciplinary collaboration because of its empirically grounded conceptualization of social mechanisms operating at the interaction, relationship, and cultural (...) levels, and its specification of processes linking social and individual aspects of emotion. After introducing the theory, we illustrate its correspondence with major theories of emotion construction framed at each of four analytical levels: cultural, interactional, individual, and neural. (shrink)

Although formal barriers to women’s social and political participation have crumbled, society remains, to a significant degree, gendered in the roles that women and men play. Women’s and men’s choices regarding work and family are largely responsible for maintaining and reinforcing the differences. While feminists recognize the need to criticize women’s choices, too often they focus on restrictive conditions rather than the choices themselves. Kimberly A. Yuracko argues instead that encouraging women to make choices in accordance with a grounded (...) and well-defined conception of perfectionism—a philosopy concerned with human flourishing—is the most effective way to redress persistent gender inequality. To this end, Yuracko seeks not only to expose the perfectionism underlying current choice critiques, but to articulate a concrete set of feminist perfectionist principles that would improve the quality of individual women’s lives and improve the social standing of women as a whole. (shrink)

Governing Animals explores the role of the liberal state in protecting animal welfare. Examining liberal concepts such as the social contract, property rights, and representation, Kimberly K. Smith argues that liberalism properly understood can recognize the moral status and social meaning of animals and provides guidance in fashioning animal policy.

The U.S. Supreme Court declared procreation to be a fundamental right in the early twentieth century in a case involving Oklahoma's Habitual Criminal Sterilization Act, an act that permitted unconsented sterilization of individuals convicted of certain crimes. The right that the Court articulated in that case is a negative right: it requires that the government not place unjustified roadblocks in the way of people seeking to procreate, but it does not require the government to take positive steps to help people (...) procreate if they wish to. I argue that a positive legal right is morally necessary in the United States, given the profound significance of procreation, the current barriers to access to care, and the related issues of individual and societal justice. I assume at the outset that the right to procreate should be expansive enough to include a right to noncoital reproduction. The absence of a positive right to procreate reflects not just constitutional tradition but also a governmental and societal commitment to a longstanding set of reproductive hierarchies by which those who fall outside of the traditional framing of family too frequently find their procreative dreams hindered. Reconceiving procreative rights to include a positive right would create greater opportunities to argue and lobby for increased access to technologies that are out of reach for many. (shrink)

In this piece, I extend a transformative power account to the conservation of dark (and starry) night skies. More specifically, I argue that the transformative power that dark nights bear warrants their conservation and is best understood in terms of the important intellectual, cultural, aesthetic, and (psycho-physiologically) restorative effects that they afford. This gives us a pressing set of reasons to combat the growing, global phenomenon of light pollution. To do so, I argue, we ought to preserve the few remaining (...) dark refuges that we have left (what I term wildness regions) and synergistically re-wild (i.e. re-darken) urban and suburban environments. Synergistic re-darkening, I propose, can be achieved by (i) establishing interpretive (educational) ‘dark zones’, (ii) implementing bioluminescent lighting technologies, and (iii) strategically employing lighting design. Finally, and in order to enact a degree of epistemic justice, I argue that we ought to implement multi-cultural ‘co-learning’ initiatives, which promote education pertaining to both Western, scientific and indigenous, North American astronomies. (shrink)

Although it is not yet officially recognized as a clinical entity which is diagnosable, Internet Gaming Disorder (IGD) has been included in section III for further study in the DSM-5 by the American Psychiatric Association (APA, 2013). This is important because there is increasing evidence that people of all ages, in particular teens and young adults, are facing very real and sometimes very severe consequences in daily life resulting from an addictive use of online games. This article summarizes general aspects (...) of IGD including diagnostic criteria and arguments for the classification as an addictive disorder including evidence from neurobiological studies. Based on previous theoretical considerations and empirical findings, this paper examines the use of one recently proposed model, the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, for inspiring future research and for developing new treatment protocols for IGD. The I-PACE model is a theoretical framework that explains symptoms of Internet addiction by looking at interactions between predisposing factors, moderators, and mediators in combination with reduced executive functioning and diminished decision making. Finally, the paper discusses how current treatment protocols focusing on Cognitive-Behavioral Therapy for Internet addiction (CBT-IA) fit with the processes hypothesized in the I-PACE model. (shrink)

Kant's theory of the intuitive intellect has a broad and substantial role in the development and exposition of his critical philosophy. An emphasis on this theory's reception and appropriation on the part of the German idealists has tended to divert attention from Kant's own treatment of the topic. In this essay, I seek an adequate overview of the theory Kant advances in support of his critical enterprise. I examine the nature of the intuitive intellect's object; its epistemic relation to its (...) object; its mode of comprehension; the relationship between these cognitive elements; and I ask which minds Kant regards as intuitive intellects. (shrink)

A philosophically and historically influential section of the Critique of Judgement presents an ‘intuitive intellect’ as a mind whose representation is limited to what actually exists, and does not extend to mere possibilities. Kant’s paradigmatic instance of such an intellect is however also the divine mind. This combination threatens to rule out the reality of the mere possibilities presupposed by Kant’s theory of human freedom. Through an analysis of the relevant issues in metaphysical cosmology, modal metaphysics and philosophical theology, I (...) show that Kant in fact possesses the resources to reconcile the philosophical claims of §76 of the Critique of Judgement with his keystone commitment to the reality of human freedom. (shrink)

This book provides an invaluable overview of the competing schools of thought in traditional and contemporary normative international theory and seeks to provide a new basis for doing international political theory and thinking about ethics in world politics today. · Part one explains the role and place of normative theory in the study of international politics before critically examining mainstream approaches in international relations and applied ethics. Here the student is introduced to the central debates between realists and idealists, and (...) cosmopolitans and communitarians. · Part two introduces the conceptual challenges of contemporary perspectives from critical theory, postmodernism and feminism and provides a platform for the author to develop her own Hegelian-Foucauldian approach for doing normative international theory. · In Part three the insights drawn from the first two parts are applied to the study of two key topics in contemporary theoretical debate: the principle of self-determination, and the democratic ideals of political cosmopolitanism. Finally conclusions are made for the future practice of theorizing international politics. Accessibly written and wide-ranging, this text will quickly become essential reading for all students and academics of politics and international relations seeking a deeper understanding of the underlying tensions and future potential of international or global political theory today. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Invisible HarmKimberly ZieselmanI’m a 48–year–old intersex woman born with Androgen Insensitivity Syndrome (AIS) writing to share my personal experience as a patient affected by a Difference of Sex Development (DSD). Although I appear to be a DSD patient “success story”, in fact, I have suffered and am unsatisfied with the way I was treated as a young patient in the 1980’s, and the continued lack of appropriate care for (...) intersex people even today.As the Executive Director of the advocacy organization Advocates for Informed Choice and a board member of the AIS–DSD Support Group since 2012, I have heard doctors reference the “silent happy majority” of DSD patients all too often. They speak [End Page 122] of patients who were treated in childhood and went on to live (seemingly) contented lives. It appears however that doctors have drawn this conclusion from the fact that most of their patients have not returned to complain about their treatment. While there is little evidence to support the success doctors claim, there is quite a bit of evidence that suggests my suffering is the norm rather than the exception.Medical professionals would likely include me in that “silent majority,” only seeing a woman who identifies and appears typically female, graduated law school, married for over twenty years, with adopted children and a successful career. And while I have been fortunate in many ways, I no longer want my voice to be presumed buried within that silent majority. Instead, I am speaking out today to tell my story.My StoryAt age 15 I was diagnosed with amenorrhea and referred to a reproductive oncologist who told my parents I had a partially developed uterus and ovaries that would likely soon become cancerous. We were told my vagina was abnormally short and might require surgery in order to have heterosexual intercourse.Neither my parents nor I was ever told I had AIS and XY chromosomes, or that the gonads being removed were testes, not ovaries. I was told I needed a “full hysterectomy” to prevent cancer and hormone replacement therapy. That summer I spent my 16th birthday recuperating from surgery. I spent the next 25 years living a lie.A lie that has had a profound and harmful impact on me.At some level, I knew I was not being told the whole truth. My parents’ and the doctors’ actions signaled to me something more might be going on. But I was afraid to ask questions; my parents were distressed and I didn’t want to cause them any more pain. Over the years I have wondered just how much my parents knew but withheld from me (albeit with good intentions). I sensed something awful was being hidden from me, and I didn’t know whom I could trust.When I asked my doctor if I could meet someone else with my condition, I was told I was different, that there was “nobody” with my medical condition in the world, that my situation was “very rare.” I was told to get on with my life and not talk about my surgery because it wasn’t important; I was healthy and could adopt if I wanted to become a parent. I was told I must take a hormone pill each day for the rest of my life to stay healthy.But what I heard was, “you are not a real woman: you are a damaged freak, so go out and fake the rest of your life and be sure nobody knows your secret.” So that’s what I did. I was a “good girl” and took my pills, didn’t ask questions and did what the men in white coats asked me to do. There was no support provided for either my parents or me. No social workers, no therapists. Perhaps most shockingly, there was no true informed consent.A few years ago I was diagnosed with post-traumatic stress syndrome caused by anxiety I had been harboring for over two decades about my past surgery and fear of getting cancer. I decided to obtain my medical records from the hospital and discover the truth.Covering several pages of... (shrink)

We argue that, under certain plausible assumptions, de Sitter space settles into a quiescent vacuum in which there are no dynamical quantum fluctuations. Such fluctuations require either an evolving microstate, or time-dependent histories of out-of-equilibrium recording devices, which we argue are absent in stationary states. For a massive scalar field in a fixed de Sitter background, the cosmic no-hair theorem implies that the state of the patch approaches the vacuum, where there are no fluctuations. We argue that an analogous conclusion (...) holds whenever a patch of de Sitter is embedded in a larger theory with an infinite-dimensional Hilbert space, including semiclassical quantum gravity with false vacua or complementarity in theories with at least one Minkowski vacuum. This reasoning provides an escape from the Boltzmann brain problem in such theories. It also implies that vacuum states do not uptunnel to higher-energy vacua and that perturbations do not decohere while slow-roll inflation occurs, suggesting that eternal inflation is much less common than often supposed. On the other hand, if a de Sitter patch is a closed system with a finite-dimensional Hilbert space, there will be Poincaré recurrences and dynamical Boltzmann fluctuations into lower-entropy states. Our analysis does not alter the conventional understanding of the origin of density fluctuations from primordial inflation, since reheating naturally generates a high-entropy environment and leads to decoherence, nor does it affect the existence of non-dynamical vacuum fluctuations such as those that give rise to the Casimir effect. (shrink)

A study was conducted to investigate the perceptions of academic dishonesty in fifth-grade students. Two methods were used to gather data: a sorting task, which was used to indirectly assess the students' perceptions, and a rating scale task, which was used to externally validate the results of the sorting task. Results of the multidimensional scaling analysis yielded two dimensions, the first being tests/homework and papers, and the second, more ambiguous appearing to differentiate based on seriousness.

Increased emphasis has been placed on teaching ethics in business schools. A recent meta-analysis of business ethics instruction indicated that instructional programs have a minimal impact on improving ethical behaviors (Waples et al. 2008). One of the newest trends in MBA education is gamification which allows instructors to employ video game concepts to engage students in serious business problems. Educators are attempting to harness a similar sort of power exhibited by games like FarmVille or Call of Duty and translate this (...) power into improved educational outcomes. This trend leads to the question; can gamification improve ethical learning outcomes? Using a single cohort of MBA students, ethics instruction in the MBA program was gamified and then operationalized in the students’ first required class and last required class. Although the sample was limited to a single cohort of students, results were promising, indicating improvement in ethical decision making and warranting further study. (shrink)

When a provocateur intentionally provokes a deadly affray, the law of self-defense holds that the provocateur may not use deadly force to defend himself. Why is this so? Provocateurs are often seen as just one example of the problem of actio libera in causa, the causing of the conditions of one’s defense. This article rejects theories that maintain a one-size-fits-all approach to actio libera in causa, and argues that provocateurs need specific rules about why they forfeit their defensive rights. This (...) article further claims that provocateurs need to be distinguished from their cousins, initial aggressors, as initial aggressors engage in conduct that grounds the permissibility of the defender’s behavior whereas the provocateur’s behavior does not justify the respondent’s use of force against him. In addition, this article rejects that the basis of this forfeiture can be found in the doctrines surrounding when and why mitigation for provocation is appropriate for the respondent. Provocateurs forfeit their defensive rights for the very simple reason that they start the fight. This forfeiture occurs when they behave culpably, meaning that they subjectively appreciate that they are running the risk of causing force to be used against them and they engage in this behavior without justification or excuse. The question of when the provocateur’s behavior is justified is incredibly complex. It requires analysis of when it is that one is justified in increasing the risk of another’s wrongdoing. Any analysis of this justification must take seriously the liberty rights of the potential provocateur to engage in otherwise permissible behavior. Moreover, the determination of whether the provocateur is justified will turn on whether the later acts that he puts into motion are themselves justified. Thus, when Charles Bronson in the movie Death Wish presents himself as a victim so that muggers will attack him, the justifiability of his conduct in appearing as a vulnerable victim will turn on whether he is entitled to engage in this conduct, intending to later defend himself. This article argues that in Death Wish-type cases, the reason that the provocateur is not justified is because he becomes a vigilante, thereby usurping the role of the state and undermining rule of law values. (shrink)

It has been argued that infants possess a rich, sophisticated theory of mind that is only revealed with tasks based on spontaneous responses. A mature theory of mind implies the understanding that mental states are person-specific. Previous studies on infants’ understanding of motivational mental states such as goals and preferences have revealed that, by 9 months of age, infants do not generalize these motivational mental states across agents. However, it remains to be determined if infants also perceive epistemic states as (...) person-specific. Therefore, the goal of the present study was to use a switch agent paradigm with the classic false belief violation-of-expectation task. Results revealed that 16-month-old infants attributed true and false beliefs to a naïve agent—they did not perceive beliefs as person-specific. These findings indicate that infants’ understanding of beliefs is not as sophisticated as the rich mentalistic view suggests. (shrink)

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

This study investigates the reactions of graduate students to perceived gender bias in their classes, using survey data from 254 social science graduate students in seven Ph.D.-granting departments in three universities. In addition to summarizing reported rates of gender-biased behavior in classrooms, we test hypotheses connecting perceptions of sexist behavior with students' emotional reactions, levels of distraction, and subsequent performance. Results are mixed, depending on students' perceptions of professors as either sensitive or insensitive to gender issues. Second, we use a (...) model of social influence to test for negative effects of reported sexist behavior on students' perceptions of professors' expertness, attractiveness, and trustworthiness. Strong support is demonstrated for these hypotheses. (shrink)

During his life time, the famed 16th century astronomer Tycho Brahe made a convincing case for what came to be known as the Tychonic System. It was a picture of the heavens as he saw it from his observational complex Uraniborg. Yet despite the scientific prowess that marked everything Brahe did, the design of his system was powerfully influenced by a beliefs that had been in place since Ancient Greece.

Though many have recently attempted either to locate Arendt within feminism or feminism within the great body of Arendt's work, these efforts have proven only modestly successful. Even a cursory examination of Arendt's work should suggest that these efforts would prove frustrating. None of her voluminous writings deal specifically with gender, though some of her work certainly deals with notable women. Her interest is not in gender as such, but in woman as assimilated Jew or woman as social and political (...) revolutionary. In this paper, I argue that Arendt recognized that what frequently passes for a gender question is not essentially a matter of gender at all, but rather an idiosyncratic form of loneliness that typically affects, though is by no means limited to, women. In her work one finds the conceptual tools necessary to understand the “woman problem” rather than an explicit argument or a solution to it. (shrink)

In “Potential Subjects’ Responses to an Ethics Questionnaire in a Phase I Study of Deep-Brain Stimulation in Early Parkinson’s Disease,” Finder, Bliton, Gill, Davis, Konrad, and Charles undertake informed consent research on what they describe as a Phase I trial of deep brain stimulation (DBS) for Parkinson’s disease. We argue that the authors should have more carefully characterized the nature of the DBS study at the start of their clinical study.

The relationship between technology, philosophy, and politics is both contentious and vital to our understanding of human nature and the ways human beings interact with one another in society; Francis Bacon outlined the wild potential and great danger of this relationship. Francis Bacon's New Atlantis in the Foundation of Modern Political Thought explores Bacon’s role as a founder of modern political science and the place of his New Atlantis in the founding of modern political thought.

This book explores the relationship between modern technological progress and classical liberalism. The compatibility of classical liberalism and technology is questioned, using fiction and film as a window into Western society’s views on politics, economics, religion, technology, and the family.

Philosophy has long been concerned with ‘moral status’. Discussions about the moral status of children, however, seem often to promote confusion rather than clarity. Using the creation of ‘savior siblings’ as an example, this paper provides a philosophical critique of the moral status of children and the moral relevance of parenting and the role that formative experience, regret and relational autonomy play in parental decisions. We suggest that parents make moral decisions that are guided by the moral significance they attach (...) to children, to sick children and most importantly, to a specific sick child (theirs). This moral valorization is rarely made explicit and has generally been ignored by both philosophers and clinicians in previous critiques. Recognizing this, however, may transform not only the focus of bioethical discourse but also the policies and practices surrounding the care of children requiring bone marrow or cord blood transplantation by better understanding the values at stake behind parental decision making. (shrink)

Boiger and Mesquita (2012) present a social constructionist perspective on emotion that argues for its multilevel contextualization through social interactions, relationships, and culture. The present comments offer a response to the authors’ call for input from other disciplines. We provide a sociological perspective on emotion construction at each of the contextual levels discussed by Boiger and Mesquita, and discuss a model that can address interdependencies between these levels. Our remarks are intended to identify additional literature that can be brought to (...) bear on multilevel emotion construction and to put forward some ideas for future research on the subject. (shrink)

Volume 20, Issue 7, July 2020, Page 114-116.