Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive, to name a surrogate to make those decisions, or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes (...) and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion. (shrink)

A major shift has taken place since the 1960s concerning disclosure to patients that they have a diagnosis of cancer and that their disease is considered terminal. Full disclosure is now considered the patient's right in the United States. However, there remain many countries in which nondisclosure is still the norm. When patients from those countries are diagnosed with cancer in America, differences in attitudes and expectations can cause conflict and misunderstanding.

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

Herder: Philosophy and Anthropology is an important and refreshing contribution to the growing literature in English on the philosophy of Johnann Gottfried Herder. Anik Waldrow and Nigel DeSouza have brought together an impressive array of contributors—a number who are well-established within Herder scholarship and others newer to his thought—to produce an interesting collection of essays exploring Herder's philosophical anthropology.The implications of Herder's attempt to place the human agent at the core of philosophy is a broad theme, with the collection offering (...) reflections on his metaphysics, his philosophy of language, his philosophy of history, his philosophy of science, his hermeneutics, as well as the role... (shrink)

This collection of essays explores conceptions of toleration and tolerance in Asia and the West. It tests the assumption in contemporary Western political discourse and theory that toleration is a uniquely Western virtue and finds that many other traditions have comparable ideas and practices in grappling with religious and cultural diversity.

Western Political Thought in Dialogue with Asia is a unique collection of essays that examines the exchange of political ideas between Western Europe and Asia from the Middle Ages to the early twentieth century. The contributors to the volume call for globalizing the scope of research and teaching in the history of political thought.

The main aim of the present study was to examine the relationships between four psychopathy dimensions as well as childhood exposure to violence and reactive aggression in men and women. Participants were a sample of working adults recruited from the University of Security in Poznan. Results indicated that reactive aggression among males formed significant associations with Erratic Lifestyle, Interpersonal Manipulation, and childhood exposure to violence. Only one variable, Erratic Lifestyle, was a significant correlate of reactive aggression in females. These findings (...) are discussed in light of theory and previous research findings. (shrink)

A self-fulfilling prophecy in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the (...) problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma. (shrink)

Miscreants, in the form of deviants and dark personalities, impact organizations more than we realize. Most management instruction on ethics issues focuses on helping students to understand how to evaluate difficult situations, make ethical decisions, and engage in ethical actions. While this approach works well for the individual decision maker, it fails to help students learn how to anticipate and proactively prevent the unethical actions of others. Using ethical codes as a backdrop, “Thinking Like a Bad Guy” is a provocative (...) classroom activity to elicit critical and creative thinking among business students. The goal of this exercise is to facilitate student learning so they can anticipate the behaviors of bad actors and alter organizational processes and procedures to mitigate the ability of others to violate organizational ethical standards. (shrink)

Much existing literature in anthropology suggests that teaching is rare in non-Western societies, and that cultural transmission is mostly vertical (parent-to-offspring). However, applications of evolutionary theory to humans predict both teaching and non-vertical transmission of culturally learned skills, behaviors, and knowledge should be common cross-culturally. Here, we review this body of theory to derive predictions about when teaching and non-vertical transmission should be adaptive, and thus more likely to be observed empirically. Using three interviews conducted with rural Fijian populations, we (...) find that parents are more likely to teach than are other kin types, high-skill and highly valued domains are more likely to be taught, and oblique transmission is associated with high-skill domains, which are learned later in life. Finally, we conclude that the apparent conflict between theory and empirical evidence is due to a mismatch of theoretical hypotheses and empirical claims across disciplines, and we reconcile theory with the existing literature in light of our results. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.3 (2003) 177-188 [Access article in PDF] Chaïm Perelman's "First Philosophies and Regressive Philosophy":Commentary and Translation David A. Frank Michelle K. Bolduc Chaïm Perelman's 1949 article, "First Philosophies and Regressive Philosophy," has remained unavailable to readers unable to read French. Our commentary and translation is intended to provide English readers access to the context, influences, and themes that make the article an extraordinarily important work in (...) the history of twentieth-century rhetoric. In this article, Perelman offers a powerful critique of first philosophies and anticipates the problems of radical postmodernity. "First Philosophies" remains a strikingly elegant attempt to foil what Foucault (1984, 41-42) has called the "Enlightenment blackmail of reason," the assumption held by logical positivists and radical skeptics that if reason does not yield absolute and eternal Enlightenment knowledge, there can be no knowledge.Perelman and Lucie Olbrechts-Tyteca's New Rhetoric project avoids Enlightenment blackmail by charting a third way between logical positivism and radical relativism, and "First Philosophies" sets forth the project's philosophical blueprint. Commencing in 1947 and culminating in 1958 with the publication of Traité de l'argumentation: La nouvelle rhétorique, Perelman and Olbrechts-Tyteca sought, discovered, and developed a philosophical system designed as a rapprochement between dialectic (reason and logic) and rhetoric (the art of adapting arguments to audiences). Historians of rhetoric judge the work a "grand revolution" (Meyer 1999, 259), believing it marks a rhetorical renaissance in Europe, and suggest nothing like it will appear for another 100 years after its publication (Johnstone 1971). The New Rhetoric project influenced Gadamer and a host of post-war European and American thinkers (Mootz 1998). Michael Leff calls the 1970 English translation of Traité a "bombshell" (1994, 510). Beyond its historical importance, Crosswhite suggests that the New Rhetoric project is "the single most important event in contemporary rhetorical theory" (1996, 35)and "First Philosophies" marks Perelman's turn from logical [End Page 177] positivism to rhetoric, offering prescient answers to the post-World War II crises of reason, and the ideas in the article provide the Traité'sphilosophical glue (see in particular the English translation, 62).Perelman joined many post-war theorists, including Horkheimer and Adorno (1972), in the resistance to the reign of a disembodied Enlightenment rationality. However, Perelman identified what Habermas (1987, 119) would later call the "performative contradiction" in the conclusion that radical skepticism was the only alternative to Enlightenment rationality. In "First Philosophies," Perelman responds directly to Sartre's 1943 Being and Nothingness (198; see translation below) by exposing the failure of radical skeptics to see that they had been held hostage by Enlightenment blackmail in accepting the Enlightenment criterion for truth, rejecting it, and then making skepticism an absolute. Indeed, "First Philosophies" navigates from this performative contradiction to chart a third way between Enlightenment rationality and radical skepticism with an approach that he labels regressive philosophy. Regressive philosophy, Perelman argues, provides the human community with a mode of philosophical reasoning located between the extremes of Enlightenment rationality and radical skepticism. In this space between extremes, Perelman identifies contingent truths and values dependent on a rhetorical mode of reasoning, one making moral judgments possible.To best understand "First Philosophies," we recognize the importance of historical context in the development of social theories of knowledge (see Delacampagne 1999; Kennedy 1999). The intellectual networks in which philosophers operate also influence the development of philosophical systems, as Randall Collins has aptly documented. In addition to historical context and intellectual networks, Frederick Beiser has recently noted: "[t] he best introduction to any philosophy is the biography of the person who created it" (1999, 5). He argues that textual analysis alone cannot illuminate the motivation or meaning of a philosophy. A sense of Perelman's biography and the cultural influences that gave rise to "First Philosophies" are necessary for a proper understanding of its themes. For Perelman, the primary intellectual exigencies of the post-war period were the interrelated crises of justice, philosophical reasoning, and responsibility to which "First Philosophies" is a... (shrink)

An examination of the relation between war and politics, by one of the twentieth century’s most influential thinkers From 1971 until 1984 at the College de France, Michel Foucault gave a series of lectures ranging freely and conversationally over the range of his research. In Society Must Be Defended , Foucault deals with the emergence in the early seventeenth century of a new understanding of war as the permanent basis of all institutions of power, a hidden presence within society that (...) could be deciphered by an historical analysis. Tracing this development, Foucault outlines the genealogy of power and knowledge that had become his dominant concern. (shrink)

Much human adaptation depends on the gradual accumulation of culturally transmitted knowledge and technology. Recent models of this process predict that large, well-connected populations will have more diverse and complex tool kits than small, isolated populations. While several examples of the loss of technology in small populations are consistent with this prediction, it found no support in two systematic quantitative tests. Both studies were based on data from continental populations in which contact rates were not available, and therefore these studies (...) do not provide a test of the models. Here, we show that in Oceania, around the time of early European contact, islands with small populations had less complicated marine foraging technology. This finding suggests that explanations of existing cultural variation based on optimality models alone are incomplete because demography plays an important role in generating cumulative cultural adaptation. It also indicates that hominin populations with similar cognitive abilities may leave very different archaeological records, a conclusion that has important implications for our understanding of the origin of anatomically modern humans and their evolved psychology. (shrink)

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and (...) periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness. (shrink)

Despite increased focus on emotional language, research lacks for the most emotional language: Swearing. We used event-related potentials to investigate whether swear words have content dist...

In 1976 Raymond Williams commented, ‘Culture is one of the two or three most complicated words in the English language.’ Such implied difficulty has not prevented Bloomsbury Academic, since the 2000s, from publishing around forty series of their well-produced and generously illustrated Cultural Histories, with, according to their website, a further fifty in progress. Each series contains six volumes, each book covering, in theory, the same chronological period (antiquity, the Middle Ages, the Renaissance, the Enlightenment, the age of empire and (...) the modern age), though there is some variation depending on precise topic. The idea is that one can use these books not only to read ‘horizontally’ about a subject across time, but also ‘vertically’ through different subjects in the same period – a idea made easier by the e-texts of the series on Bloomsbury's website. (shrink)

It is well established that retrieval of names is harder than the retrieval of other identity specific information. This paper offers a review of the more influential accounts put forward as explanations of why names are so difficult to retrieve. A series of five experiments tests a number of these accounts.Experiments One to Three examine the claims that names are hard to recall because they are typically meaningless, or unique. Participants are shown photographs of unfamiliar people or familiar people and (...) given three pieces of information about each: a name, a unique piece of information, and a shared piece of information. Learning follows an incidental procedure, and participants are given a surprise recall test. In each experiment shared information is recalled most often, followed by unique information, followed by name. Experiment Four tests both the `uniqueness' account and an account based on the specificity of the naming response. Participants are presented with famous faces and asked to categorise them by semantic group. Results indicate that less time is needed to perform this task when the group is a subset of a larger semantic category. A final experiment examines the claim that names might take longer to access because they are less often retrieved than other classes of information. Latencies show that participants remain more efficient when categorising faces by their occupation than by their name even when they have received extra practice of naming the faces.We conclude that the explanation best able to account for the data is that names are stored separately from other semantic information and can only be accessed after other identity specific information has been retrieved. However, we also argue that the demands we make of these explanations make it likely that no single theory will be able to account for all existing data. (shrink)

The scientific study of consciousness emerged as an organized field of research only a few decades ago. As empirical results have begun to enhance our understanding of consciousness, it is important to find out whether other factors, such as funding for consciousness research and status of consciousness scientists, provide a suitable environment for the field to grow and develop sustainably. We conducted an online survey on people’s views regarding various aspects of the scientific study of consciousness as a field of (...) research. 249 participants completed the survey, among which 80% were in academia, and around 40% were experts in consciousness research. Topics covered include the progress made by the field, funding for consciousness research, job opportunities for consciousness researchers, and the scientific rigor of the work done by researchers in the field. The majority of respondents (78%) indicated that scientific research on consciousness has been making progress. However, most participants perceived obtaining funding and getting a job in the field of consciousness research as more difficult than in other subfields of neuroscience. Overall, work done in consciousness research was perceived to be less rigorous than other neuroscience subfields, but this perceived lack of rigor was not related to the perceived difficulty in finding jobs and obtaining funding. Lastly, we found that, overall, the global workspace theory was perceived to be the most promising (around 28%), while most non-expert researchers (around 22% of non-experts) found the integrated information theory (IIT) most promising. We believe the survey results provide an interesting picture of current opinions from scientists and researchers about the progresses made and the challenges faced by consciousness research as an independent field. They will inspire collective reflection on the future directions regarding funding and job opportunities for the field. (shrink)

BackgroundExtremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and (...) drew much media attention. Aim of this study was to increase insight into the health effects for the survivors, and whether they received the needed care and support.MethodsSemi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size.ResultsAt both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later.ConclusionAlthough the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves. (shrink)