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The fact that vocabulum appears with far more frequency in Tacitus' texts than in any other author except for the encyclopaedists argues for his idiosyncratic usage of the term. This article argues that imperial discourse, nearly identical in structure and expression to that of the Republic but divorced from Republican connotations, provided an empty site where Roman fantasies of self-definition took strong hold, and that Tacitus uses vocabulum to indicate words and concepts that illustrate this process, particularly with reference to (...) representations of the foreign and the past. Such a discourse was congenial for the concentration of power in the hands of one person, as it no longer expressed the conflicting desires of a community engaged in public affairs, but collectivized the public desire for an image of Roman superiority. Thus Germany and the old Republican past were easily mythologized as what Rome desired to be, but feared it was not. Tacitus' use of vocabulum highlights the words in imperial discourse that betray the gap in the political unconscious between Romans' idea of themselves as masters of the Empire and as slaves to one ruler. Nor does he position himself as an outside observer of this process, but creates an experience of it for the reader through gaps and inconsistencies within his narrative. (shrink)

In Letter 5.8 Pliny shows that in the post-Domitianic era historia has become an impossible genre, both as a vehicle for conventional moral wisdom and because of the authoritative narrative voice it necessitates. The letter's literary strategies of deferral express these problems even as its content appears to argue positively the merits of historia and compare it with those of oratio. Pliny emphasizes the insufficiency of the narrative “I”, suggesting instead the importance of dialogue as the means both toward the (...) ethical reconstruction of post-tyrannical discourse and the literary fame for which Pliny also hopes. (shrink)

Background Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons’ perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.Methods We surveyed IRB chairpersons leading U.S. boards registered (...) with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).Results Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.Conclusions Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets. (shrink)

A long-standing position in philosophy, law, and theology is that a person can be held morally responsible for an action only if they had the freedom to choose and to act otherwise. Thus, many philosophers consider freedom to be a necessary condition for moral responsibility. However, empirical findings suggest that this assumption might not be in line with common sense thinking. For example, in a recent study we used surveys to show that – counter to positions held by many philosophers (...) – lay people consider actions to be free when they are spontaneous rather than being based on reasons. In contrast, responsibility is often considered to require that someone has thought about the alternative options. In this study we use an online survey to directly test to which degree lay judgements of freedom and responsibility match. Specifically, we test whether manipulations of deliberation affect freedom and responsibility judgements in the same way. Furthermore, we also test the dependency of these judgements on a person’s belief that their decision had consequences for their personal life. We find that people are generally considered to be more responsible for their actions than they are considered free, across most of the conditions tested. Furthermore, we found that deliberation had an opposite effect on freedom and responsibility judgements. People were considered more free when they acted spontaneously, whereas they were considered more responsible when they deliberated about their actions. These results seem to suggest that deliberating about reasons is crucially important for the lay concept of responsibility, while it is not obviously …. (shrink)

Punishing groups raises a difficult question, namely, how their punishment can be justified at all. Some have argued that punishing groups is morally problematic because of the effects that the punishment entails for their members. In this paper we argue against this view. We distinguish the question of internal justice—how punishment-effects are distributed—from the question of external justice—whether the punishment is justified. We argue that issues of internal justice do not in general undermine the permissibility of punishment. We also defend (...) the permissibility of what some call “random punishment.” We argue that, for some kinds of collectives, there is no general obligation to internally distribute the punishment-effects equally or in proportion to individual contribution. (shrink)

In this paper we develop a new methodology for normative theorising, which we call Directed Reflective Equilibrium. Directed Reflective Equilibrium is based on a taxonomy that distinguishes between a number of different functions of hypothetical cases, including two dimensions that we call representation and elicitation. Like its predecessor, Directed Reflective Equilibrium accepts that neither intuitions nor basic principles are immune to revision and that our commitments on various levels of philosophical enquiry should be brought into equilibrium. However, it also offers (...) guidance about how different types of cases ought to be sequenced to achieve this result. We argue that this ‘directional’ approach improves, in various ways, upon the non-directional approach of traditional Reflective Equilibrium. (shrink)

Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

Exploring the Illusion of Free Will and Moral Responsibility is an edited collection of new essays by an internationally recognized line-up of contributors. It is aimed at readers who wish to explore the philosophical and scientific arguments for free will skepticism and their implications.

In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; (...) the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (shrink)

Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given disease (...) can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. (shrink)

We have synthesized a 582,970-base pair Mycoplasma genitalium genome. This synthetic genome, named M. genitalium JCVI-1.0, contains all the genes of wild-type M. genitalium G37 except MG408, which was disrupted by an antibiotic marker to block pathogenicity and to allow for selection. To identify the genome as synthetic, we inserted "watermarks" at intergenic sites known to tolerate transposon insertions. Overlapping "cassettes" of 5 to 7 kilobases (kb), assembled from chemically synthesized oligonucleotides, were joined by in vitro recombination to produce intermediate (...) assemblies of approximately 24 kb, 72 kb ("1/8 genome"), and 144 kb ("1/4 genome"), which were all cloned as bacterial artificial chromosomes in Escherichia coli. Most of these intermediate clones were sequenced, and clones of all four 1/4 genomes with the correct sequence were identified. The complete synthetic genome was assembled by transformation-associated recombination cloning in the yeast Saccharomyces cerevisiae, then isolated and sequenced. A clone with the correct sequence was identified. The methods described here will be generally useful for constructing large DNA molecules from chemically synthesized pieces and also from combinations of natural and synthetic DNA segments. 10.1126/science.1151721. (shrink)

There is limited guidance on how to assess the ethical acceptability of research risks that extend beyond research participants to third parties (or “research bystanders”). Community or stakeholder engagement has been proposed as one way to address potential harms to community members, including bystanders. Despite widespread agreement on the importance of community engagement in biomedical research, this umbrella term includes many different goals and approaches, agreement on which is ethically required or recommended for a particular context. We analyse the case (...) of a potential Zika virus human challenge trial to assess whether and how community engagement can help promote the ethical acceptability of research posing risks to bystanders. We conclude that, in addition to having intrinsic value, community engagement can improve the identification of bystander risks, effective approaches to minimizing them, and transparency about bystander risks for host communities. (shrink)

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We then motivate (...) the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. (shrink)

In the mid-1990s, fairtrade-organic registration data showed that only 9 % of Oaxaca, Mexico’s organic coffee ‘farm operators’ were women; by 2013 the female farmer rate had increased to 42 %. Our research investigates the impact of this significant increase in women’s coffee association participation among 210 members of two coffee producer associations in Oaxaca, Mexico. We find that female coffee organization members report high levels of household decision-making power and they are more likely than their male counterparts to report (...) control over their coffee income. These significant advances in women’s agency within the household are offset by the fact that the women experience significant time poverty as they engage in coffee production while bearing a disproportionate share of domestic labor obligations. The women coffee producers view organizational labor as a third burden on their time, after their reproductive and productive labor. The time poverty they experience limits their ability to fully participate in coffee organizational governance and consequently there are few women leaders at all levels of the coffee producer businesses. This is problematic because it limits women’s ability to fully benefit from organizational membership: when women fully participate in governance they gain valuable business and leadership skills and producer associations with active female members may also be more likely to develop and maintain programs and policies that enhance gender equity. Our findings indicate that targeted agricultural development programs to improve gender equity among agricultural smallholders should involve creative ways to ease women’s labor burdens and reduce their time poverty in order to facilitate full organizational participation. The research findings fill a gap in existing studies of agricultural global value chains (GVCs) by demonstrating how the certified coffee GVC depends on women’s under and un-paid labor not only within the household but also within producer organizations. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Volume 20, Issue 9, September 2020, Page W1-W4.

Previous research indicates that individuals with depressive disorders have aberrant resting state functional connectivity and may experience memory dysfunction. While resting state functional connectivity may be affected by experiences preceding the resting state scan, little is known about this relationship in individuals with DD. Our study examined this question in the context of object memory. 52 individuals with DD and 45 healthy controls completed clinical interviews, and a memory encoding task followed by a forced-choice recognition test. A 5-min resting state (...) fMRI scan was administered immediately after the forced-choice task. Resting state networks were identified using group Independent Component Analysis across all participants. A network modeling analysis conducted on 22 networks using FSLNets examined the interaction effect of diagnostic status and memory accuracy on the between-network connectivity. We found that this interaction significantly affected the relationship between the network comprised of the medial prefrontal cortex, posterior cingulate cortex, and hippocampal formation and the network comprised of the inferior temporal, parietal, and prefrontal cortices. A stronger positive correlation between these two networks was observed in individuals with DD who showed higher memory accuracy, while a stronger negative correlation was observed in individuals with DD who showed lower memory accuracy prior to resting state. No such effect was observed for HC. The former network cross-correlated with the default mode network, and the latter cross-correlated with the dorsal attention network. Considering that the DMN and DAN typically anticorrelate, we hypothesize that our findings indicate aberrant reactivation and consolidation processes that occur after the task is completed. Such aberrant processes may lead to continuous “replay” of previously learned, but currently irrelevant, information and underlie rumination in depression. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Conflict over who belongs in women-only spaces is now part of mainstream political debate. Some think women-only spaces should exclude on the basis of sex, and others think they should exclude on the basis of a person’s self-determined gender identity. Many who take the latter view appear to believe that the only reason for taking the former view could be antipathy towards men who identify as women. In this paper, we’ll revisit the second-wave feminist literature on separatism, in order to (...) uncover the reasons for women-only spaces as feminists originally conceived them. Once these reasons are understood, those participating in debates over women-only spaces will be in a better position to adjudicate on whether shifting from sex to gender identity puts any significant interests at stake. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in (...) the event of pneumonia. (shrink)

In most U.S. jurisdictions, clinicians providing informal “curbside” consults are protected from medical malpractice liability due to the absence of a doctor-patient relationship. A recent Minnesota Supreme Court case, Warren v. Dinter, offers the opportunity to reassess whether the majority rule is truly serving the best interests of patients.

The use of social media as a recruitment tool for research with humans is increasing, and likely to continue to grow. Despite this, to date there has been no specific regulatory guidance and there has been little in the bioethics literature to guide investigators and institutional review boards faced with navigating the ethical issues such use raises. We begin to fill this gap by first defending a nonexceptionalist methodology for assessing social media recruitment; second, examining respect for privacy and investigator (...) transparency as key norms governing social media recruitment; and, finally, analyzing three relatively novel aspects of social media recruitment: the ethical significance of compliance with website “terms of use”; the ethics of recruiting from the online networks of research participants; and the ethical implications of online communication from and between participants. Two checklists aimed at guiding investigators and IRBs through the ethical issues are included as appendices. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

We examine the role flexible working has for gender equality during the pandemic, focusing on arrangements that give workers control over when and where they work. We use a survey of dual-earning working parents in the United Kingdom during the peak of the first lockdown, namely, between mid-May and mid-June 2020. Results show that in most households in our survey, mothers were mainly responsible for housework and child care tasks both before and during the lockdown period, although this proportion has (...) slightly declined during the pandemic. In households where fathers worked from home during the pandemic, respondents were less likely to say that mothers were the ones solely or mostly responsible for housework and child care. Fathers who worked from home were more likely to say that they were doing more housework and child care during the lockdown period than they were before. Finally, we explore what we expect to happen in the postpandemic times in relation to flexible working and gender equality. The large expansion of flexible working we expect to happen may help reduce some of the gender inequalities that have exacerbated during the pandemic, but only if we reflect on and change our existing work cultures and gender norms. (shrink)

Twentieth century philosophers introduced the distinction between “objective rightness” and “subjective rightness” to achieve two primary goals. The first goal is to reduce the paradoxical tension between our judgments of what is best for an agent to do in light of the actual circumstances in which she acts and what is wisest for her to do in light of her mistaken or uncertain beliefs about her circumstances. The second goal is to provide moral guidance to an agent who may be (...) uncertain about the circumstances in which she acts, and hence is unable to use her standard moral principle directly in deciding what to do. This paper distinguishes two important senses of “moral guidance”; proposes criteria of adequacy for accounts of subjective rightness; canvasses existing definitions for “subjective rightness”; finds them all deficient; and proposes a new and more successful account. It argues that each comprehensive moral theory must include multiple principles of subjective rightness to address the epistemic situations of the full range of moral decision-makers, and shows that accounts of subjective rightness formulated in terms of what it would reasonable for the agent to believe cannot provide that guidance. (shrink)

Many individuals have experienced a multitude of chronic stressors and diminished psychological functioning during COVID-19. The current study examined whether biases towards positive social media or positive autobiographical memories was related to increases in psychological functioning during COVID-19. Participants were 1071 adults (Mage = 46.31; 58% female; 78% White) recruited from MTurk. Participants reported on their social media consumption and autobiographical recall, positive and negative affect, and dysphoria symptoms. Results indicated that, at the first assessment collected in the spring and (...) summer of 2020, positively biased social media consumption was cross-sectionally related to higher levels of positive affect, and positively biased autobiographical recall was cross-sectionally related to lower levels of negative affect and dysphoria symptoms. Sensitivity analyses examined cross-sectional relations from a second assessment collected in fall 2020, and prospective cross-lagged analyses. The findings point to potential psychological benefits of positive biases during chronic stressors. (shrink)