This book offers an in-depth analysis of the cognitive and ethical role of emotion, particularly empathy, in medical practice. The author explains how doctors can use empathy in diagnosing and treating patients without jeopardizing their objectivity or projecting their own values on to patients.

What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal parameter (...) adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored. (shrink)

Unrealistic therapeutic beliefs are very common—the majority of patient-subjects enrol in phase 1 trials seeking and expecting significant medical benefit, even though the likelihood of such benefit has historically proven very low. The high prevalence of therapeutic misestimation and unrealistic optimism in particular has stimulated debate about whether unrealistic therapeutic beliefs in early-phase clinical trials preclude adequate informed consent. We seek here to help resolve this controversy by showing that a crucial determination of when such therapeutic beliefs are ethically problematic (...) turns on whether they are causally linked and instrumental to the motivation to participate in the trial. Thus, in practice, it is ethically incumbent on researchers to determine which understanding and beliefs lead to the participant’s primary motivation for enrolling, not to simply assess understanding, beliefs and motivations independently. We further contend that assessing patient-subjects’ appreciation as a component of informed consent—it is already an established component of decision-making capacity assessments—can help elucidate the link between understanding-beliefs and motivation; appreciation refers to an individual’s understanding of the personal significance of both the medical facts and the experience of trial participation. Therefore, we recommend that: in addition to the usual question, ‘Why do you want to participate in this trial?’, all potential participants should be asked the question: ‘What are you giving up by participating in this trial?’ and researchers should consider the settings in which it may be possible and practical to obtain ‘two-point consent’. (shrink)

There is an important gap in philosophical, clinical and bioethical conceptions of decision-making capacity. These fields recognize that when traumatic life circumstances occur, people not only feel afraid and demoralized, but may develop catastrophic thinking and other beliefs that can lead to poor judgment. Yet there has been no articulation of the ways in which such beliefs may actually derail decision-making capacity. In particular, certain emotionally grounded beliefs are systematically unresponsive to evidence, and this can block the ability to deliberate (...) about alternatives. People who meet medico-legal criteria for decision-making capacity can react to health and personal crises with such capacity-derailing reactions. One aspect of this is that a person who is otherwise cognitively intact may be unable to appreciate her own future quality of life while in this complex state of mind. This raises troubling ethical challenges. We cannot rely on the current standard assessment of cognition to determine decisional rights in medical and other settings. We need to understand better how emotionally grounded beliefs interfere with decision-making capacity, in order to identify when caregivers have an obligation to intervene. (shrink)

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide (...) care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians. (shrink)

Volume 20, Issue 8, August 2020, Page 1-4.

the recent announcement of the claimed births of CRISPR-edited babies has prompted both widespread condemnation and calls by leading scientists for a moratorium on any further germline genome editing for reproductive purposes. Concurrently, national and international bodies are calling for the development of robust guidelines and requirements that will identify permissible conditions under which such GGE efforts may proceed. As detailed recommendations to navigate this unique terrain are under development, we suggest an approach that begins with identifying serious concerns about (...) social exclusion and social justice that arise... (shrink)

Principles are static; narratives move. They show us how people change; they depict character development and moral growth (or decline). They do this by pulling us inside lived time, where we empathize with a character's dilemmas about, and responsibility for, his or her future. This feature of narratives fits well with ethics, for ethics begins with practical questions about what to do or how to be (or even whether to be). Such questions require that one view the future as something (...) one has some freedom to shape. Narrative and principle‐based ethics support each other, and both are necessary, but in this essay I will focus on one side and consider how narrative dynamism enlivens a static bioethical principle, opening up new possibilities for moral action. (shrink)

In response to the article by Baum-Baicker and Sisti, I will consider the kind of wisdom involved in therapeutic listening; the role of life wisdom; and the challenge of imparting clinical wisdom to young health professionals’ education.

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models (...) of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

In response to increasing use of practice guidelines in medicine, physicians have focused their attention on how these guidelines can restrict their medical practices. However, guidelines not only restrict physician discretion, but they also limit the treatment options available to patients. As a result, treatments which patients consider beneficial may not be recommended; for example, some hysterectomies for abnormal uterine bleeding, and cataract surgery in patients with dementia. When guidelines are used to determine which medical treatments a health care organization (...) or insurer will cover, these recommendations become restrictions. Thus far, guidelines have been developed without adequate attention to the impact that their restrictive use has on diverse patient values.Two significant tensions in current medical ethics relate to the inclusion of patient values in practice guidelines. First, a tension exists between the traditional paternalistic model of care, in which the physician judges unilaterally which treatments will benefit the patient, and the more recent autonomy model, in which the physician elicits the individual patient's health values to determine which treatments will be beneficial. (shrink)

In response to increasing use of practice guidelines in medicine, physicians have focused their attention on how these guidelines can restrict their medical practices. However, guidelines not only restrict physician discretion, but they also limit the treatment options available to patients. As a result, treatments which patients consider beneficial may not be recommended; for example, some hysterectomies for abnormal uterine bleeding, and cataract surgery in patients with dementia. When guidelines are used to determine which medical treatments a health care organization (...) or insurer will cover, these recommendations become restrictions. Thus far, guidelines have been developed without adequate attention to the impact that their restrictive use has on diverse patient values.Two significant tensions in current medical ethics relate to the inclusion of patient values in practice guidelines. First, a tension exists between the traditional paternalistic model of care, in which the physician judges unilaterally which treatments will benefit the patient, and the more recent autonomy model, in which the physician elicits the individual patient's health values to determine which treatments will be beneficial. (shrink)

Walter and Ross rightfully argue that healthcare providers need to employ a less authoritarian, more empowering approach if they want to support patients’ behavioral changes. They show how motivational interviewing (MI), informed by self-determination theory, engages patients and thus may inspire enduring changes. They ground these interventions in an important, new model of relational autonomy, emphasizing the patient’s self-respect and self-cohesion as well as self-determination, and they show how patient–provider interactions influence these three aspects of autonomy. It may be surprising (...) then, that in the first part of this essay, I argue that it is problematic for them to ground their empowerment model in the .. (shrink)

Metaphors used to describe new technologies mediate public understanding of the innovations. Analyzing the linguistic, rhetorical, and affective aspects of these metaphors opens the range of issues available for bioethical scrutiny and increases public accountability. This article shows how such a multidisciplinary approach can be useful by looking at a set of texts about one issue, the use of a newly developed technique for genetic modification, CRISPRcas9.

Empathy is an extensively studied construct, but operationalization of effective empathy is routinely debated in popular culture, theory, and empirical research. This article offers a process-focused approach emphasizing the relational functions of empathy in interpersonal contexts. We argue that this perspective offers advantages over more traditional conceptualizations that focus on primarily intrapsychic features. Our aim is to enrich current conceptualizations and empirical approaches to the study of empathy by drawing on psychological, philosophical, medical, linguistic, and anthropological perspectives. In doing so, (...) we highlight the various functions of empathy in social interaction, underscore some underemphasized components in empirical studies of empathy, and make recommendations for future research on this important area in the study of emotion. (shrink)

Research partnerships between institutions in the Global North and institutions in the Global South have many potential benefits, including sharing of knowledge and resources. However, such partnerships are traditionally exploitative to varying degrees. In order to promote equity in South‐North research partnerships, it is necessary to learn from the experiences of researchers collaborating internationally. This study analyzed transcripts from eleven semi‐structured qualitative interviews with researchers working at Clínica de Familia La Romana, an institution in the Dominican Republic with decades of (...) experience with research and research partnerships with institutions from the Global North. The findings of this study suggest that respect for resources invested in research, as well as for the researchers and institutions themselves, are vital components to a successful global health research partnership. These findings have implications for individual research partnerships, as well as the policies of journals and institutions providing funding that affect these partnerships. (shrink)

Base of the pyramid ventures seek to create “mutual value” for themselves and poor communities, but often use business models unadapted for the BoP context, and have been less successful than hoped. Sustainable business models’ multi-stakeholder lens offers a promising alternative path to mutual value, but BoP-based SBM studies are scarce. This single case study explores whether and how SBM characteristics manifest in the business model and value outcomes of Habi, a Manila footwear company successfully creating mutual value with BoP (...) suppliers. We find SBM characteristics underpin Habi’s dual-structure business model and success in four ways: viewing profits as a tool for community development resulted in designing both product and business model around community strengths; understanding communities as systems helped Habi address the complexities of poverty; balancing short-term business needs with a long-term, slow-growth approach led to their choice of investors; and implementing community value capture mechanisms ensured enduring community benefit. (shrink)

This study explored the influence of personal values on destructive leader behavior. Student participants completed a managerial assessment center that presented them with ambiguous leadership decisions and problems. Destructive behavior was defined as harming organizational members or striving for short-term gains over long-term organizational goals. Results revealed that individuals with self-enhancement values were more destructive than individuals with self-transcendence values were, with the core values of power (self-enhancement) and universalism (self-transcendence) being most influential. Results also showed that individuals defined and (...) structured leadership problems in a manner that reflected their value systems, which in turn affected the problem solutions they generated. (shrink)

Background Retraction is a mechanism for alerting readers to unreliable material and other problems in the published scientific and scholarly record. Retracted publications generally remain visible and searchable, but the intention of retraction is to mark them as “removed” from the citable record of scholarship. However, in practice, some retracted articles continue to be treated by researchers and the public as valid content as they are often unaware of the retraction. Research over the past decade has identified a number of (...) factors contributing to the unintentional spread of retracted research. The goal of the Reducing the Inadvertent Spread of Retracted Science: Shaping a Research and Implementation Agenda (RISRS) project was to develop an actionable agenda for reducing the inadvertent spread of retracted science. This included identifying how retraction status could be more thoroughly disseminated, and determining what actions are feasible and relevant for particular stakeholders who play a role in the distribution of knowledge. -/- Methods These recommendations were developed as part of a year-long process that included a scoping review of empirical literature and successive rounds of stakeholder consultation, culminating in a three-part online workshop that brought together a diverse body of 65 stakeholders in October–November 2020 to engage in collaborative problem solving and dialogue. Stakeholders held roles such as publishers, editors, researchers, librarians, standards developers, funding program officers, and technologists and worked for institutions such as universities, governmental agencies, funding organizations, publishing houses, libraries, standards organizations, and technology providers. Workshop discussions were seeded by materials derived from stakeholder interviews (N = 47) and short original discussion pieces contributed by stakeholders. The online workshop resulted in a set of recommendations to address the complexities of retracted research throughout the scholarly communications ecosystem. -/- Results The RISRS recommendations are: (1) Develop a systematic cross-industry approach to ensure the public availability of consistent, standardized, interoperable, and timely information about retractions; (2) Recommend a taxonomy of retraction categories/classifications and corresponding retraction metadata that can be adopted by all stakeholders; (3) Develop best practices for coordinating the retraction process to enable timely, fair, unbiased outcomes; and (4) Educate stakeholders about pre- and post-publication stewardship, including retraction and correction of the scholarly record. -/- Conclusions Our stakeholder engagement study led to 4 recommendations to address inadvertent citation of retracted research, and formation of a working group to develop the Communication of Retractions, Removals, and Expressions of Concern (CORREC) Recommended Practice. Further work will be needed to determine how well retractions are currently documented, how retraction of code and datasets impacts related publications, and to identify if retraction metadata (fails to) propagate. Outcomes of all this work should lead to ensuring retracted papers are never cited without awareness of the retraction, and that, in public fora outside of science, retracted papers are not treated as valid scientific outputs. (shrink)

The question of whether knowledge is definable in terms of belief, which has played an important role in epistemology for the last 50 years, is studied here in the framework of epistemic and doxastic logics. Three notions of definability are considered: explicit definability, implicit definability, and reducibility, where explicit definability is equivalent to the combination of implicit definability and reducibility. It is shown that if knowledge satisfies any set of axioms contained in S5, then it cannot be explicitly defined in (...) terms of belief. S5 knowledge can be implicitly defined by belief, but not reduced to it. On the other hand, S4.4 knowledge and weaker notions of knowledge cannot be implicitly defined by belief, but can be reduced to it by defining knowledge as true belief. It is also shown that S5 knowledge cannot be reduced to belief and justification, provided that there are no axioms that involve both belief and justification. (shrink)

After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very aggressive techniques determined to be torture by many nations and organizations throughout the world. This paper explains why psychiatrists and psychologists (...) involved in coercive interrogations violate the Geneva Conventions and the laws of the United States. Whether done with ignorance of professional ethical obligations or not, these psychiatrists and psychologists have crossed an ethical barrier that may best be averted from re-occurring by teaching medical students and residents in all medical specialties about the ethics principles stemming from the 1946–1947 Nuremberg trials and the Geneva Conventions, together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively. In this way, all physicians and psychologists will clearly understand that they have an absolute moral obligation to "First, do no harm" to the human beings they professionally encounter. (shrink)

A background assumption of this paper is that the repertoire of inference schemes available to humanity is not fixed, but subject to change as new schemes are invented or refined and as old ones are obsolesced or abandoned. This is particularly visible in areas like health and environmental sciences, where enormous societal investment has been made in finding ways to reach more dependable conclusions. Computational modeling of argumentation, at least for the discourse in expert fields, will require the possibility of (...) modeling change in a stock of schemes that may be applied to generate conclusions from data. We examine Randomized Clinical Trial, an inference scheme established within medical science in the mid-20th Century, and show that its successful defense by means of practical reasoning allowed for its black-boxing as an inference scheme that generates (and warrants belief in) conclusions about the effects of medical treatments. Modeling the use of a scheme is well-understood; here we focus on modeling how the scheme comes to be established so that it is available for use. (shrink)

In recent years, autopoietic enactivism has been used to address persistent conceptual problems in psychiatry, such as the problem of demarcating disorder, that other models thus far have failed to overcome. There appear to be three main enactive accounts of psychopathology with subtle, although not incompatible, differences: Maiesecharacterizes disorder as distinct disruptions in autonomy and agency; Nielsen characterizes disorder as behaviors that relevantly conflict with the functional norms of an individual; De Haan emphasizes patterns of disordered sense-making, that are transformed (...) through the existential dimension. Given that these accounts are intended to provide not only an ontologically richer account of psychopathology but also reduce the stigma experienced by individuals with mental disorders by accounting for lived experience, a critical analysis of these approaches is needed. I will provide a problematization of enactive accounts of mental disorder, showing that this particular framework does not, as it stands, necessarily reduce the harm and suffering experienced by individuals with mental disorder because of its ontological openness; enactivism leaves much to be interpreted and applied by the clinician (or patient) such that practical and ethical problems in its use arise. (shrink)

The present research isolates the fairness assessment of the process used by the retailer to set a price, as well as the distributive fairness of the price compared to the price that others are offered, and examines the combined effect of procedural fairness and distributive fairness on overall price fairness. Two experimental studies examine procedural and distributive fairness effects on overall price fairness. In study 1, procedural fairness and distributive fairness are manipulated and found to interact to bring about overall (...) price fairness. In study 2, suspicion toward the seller is found to mediate the relationship between procedural fairness and overall price fairness when the price is disadvantageous. (shrink)

Reasoning About Knowledge is the first book to provide a general discussion of approaches to reasoning about knowledge and its applications to distributed ...

We have conducted a home-based study of children′s dream reports in which parents used open-ended interviewing styles to collect 88 dream reports from their 4- to 10-year-old children in the comfortable and supportive environment of their own homes. Particular attention was paid to formal properties including characters , settings, self-representation, and bizarreness. In contrast to previous studies, our data indicate that young children are able to give long, detailed reports of their dreams that share many formal characteristics with adult dream (...) reports. Because this wide range of dream mentation is only revealed to trusted confidants in a familiar and comfortable environment, an important implication is that the sleep laboratory may not be the best source of naturalistic dream data. (shrink)

Most accounts of integrity agree that the person of integrity must have a relatively stable sense of who he is, what is important to him, and the ability to stand by what is most important to him in the face of pressure to do otherwise. But does integrity place any constraints on the kind of principles that the person of integrity stands for? In response to several recent accounts of integrity, I argue that it is not enough that a person (...) stand for what he believes in, nor even that he is committed to and stands for what, in his best judgement, is morally right. In our web of moral concepts integrity is internally related to a host of virtues which exclude weakness of will and dogmatism, and presuppose trustworthiness. Integrity requires that the principles stood for must be those that a morally good, morally trustworthy agent would stand for, and that the agent himself is morally trustworthy. (shrink)

Proactive policing strategies produce a range of harms to African Americans in poor urban communities. We know little, however, about how aggressive policing is experienced across gender by adolescents in these neighborhoods. The authors argue that important insights can be gained by examining the perspectives of African American youths and draw from in-depth interviews with youths in St. Louis, Missouri, to investigate how gender shapes interactions with the police. The comparative analysis reveals important gendered facets of African American adolescents' experiences (...) with and expectations of law enforcement. Young men described being treated routinely as suspects regardless of their involvement in delinquency and also reported police violence. Young women typically described being stopped for curfew violations but also expressed concerns about police sexual misconduct. This study highlights the differential harms of urban policing for African American young women and men and highlights the need for systematic attention to the intersections of race and gender in research on criminal justice practices. (shrink)