Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents’ perceptions of their child’s projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of (...) parental refusal based upon an infant’s projected quality of life. (shrink)

I have Crohn's disease. This essay is about how my experiences with this disease have shaped my perceptions of boundaries in medicine, particularly around the issue of self‐disclosure. I became a pediatrician first, then a parent, and now a patient, and with each new role, I have become increasingly confused on where boundaries regarding self‐disclosures in medicine lie. I'd like to make the case for more of a reframing and a blurring of personal and professional boundaries regarding physicians’ disclosures about (...) their own health. Although historically thought of as a way to strengthen the physician‐patient relationship and therefore encouraged, physician disclosure has recently become more controversial, and boundary discussions that include it seem to increasingly begin from the edict, “Don't do it.” But why not capitalize on the shared experience of physicians and patients? It offers an opportunity to deepen our therapeutic relationship with our patients, to build trust, to help understanding, and maybe even to improve patient outcomes. (shrink)

Parental confidence in vaccines is waning. To sustain and improve childhood vaccine coverage rates, insights from multiple disciplines are needed to understand and address the socio-cultural factors contributing to decreased vaccine confidence and uptake.

Richard Thaler and Cass Sunstein define a nudge as “any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates’ decision‐making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision‐making in the context of (...) pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well‐known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics. We argue that there is an even stronger ethical justification for nudging in parental decision‐making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision‐making authority; (2) nudging can help fulfill pediatric clinicians’ obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents’ decisional burden regarding what is best for their child, particularly with decisions that have implications for public health. (shrink)

The ethical principle of ‘respect for persons’ in clinical research has traditionally focused on protecting individuals’ autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals’ rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English or Spanish (...) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female, identified as Hispanic/Latino or non-Hispanic white, reported annual household income under US$60 000 and did not have a Bachelor’s degree ; 30% had limited health literacy. We identified four key domains for demonstrating respect: personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; study communication processes, including following up and sharing results with participants; inclusion, particularly ensuring materials are understandable and procedures are accessible; and consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research. (shrink)

As a well-established service offered at many hospitals internationally, clinical ethics consultation (CEC) is increasingly recognized as a tool to improve patient care quality (Fox et al. 2022; Ta...

In Aristotle’s On the Soul he considers and refutes two versions of the harmonia theory of the soul’s relation to the body. According to the harmonia theory, the soul is to the body what the tuning of a musical instrument is to its material parts. Though he believes himself to have entirely dismissed the view, he has not. I argue that Aristotle’s hylomorphic account is, in fact, an instance of the harmonia theory.

The progressive in English appears to be inherently modal, due to what Dowty (Word meaning and Montague grammar: The semantics of verbs and times in generative semantics and in Montague’s PTQ, 1979) terms the imperfective paradox. In truth-conditional accounts, the literal truth of a clause with the modal progressive hinges on the possibility of the described outcome. The clause’s truth under such accounts has also been tacitly assumed to describe its felicitous use. Two challenges for this strategy are discussed. First, (...) a progressive clause exhibiting the imperfective paradox can occur felicitously even when the described outcome is not possible. Second, a progressive clause exhibiting the paradox can occur felicitously with an accompanying unless-clause, yet the analysis of unless-clauses directly contradicts the modal analysis of the truth-conditional behavior of the progressive clause in such cases. If the analysis of unless is not flawed, then the modal progressive will require reanalysis. (shrink)

Journal Name: Apeiron Issue: Ahead of print.

In order to improve our understanding of the components that reflect functionally important processes during reward anticipation and consumption, we used principle components analyses (PCA) to separate and quantify averaged ERP data obtained from each stage of a modified monetary incentive delay (MID) task. Although a small number of recent ERP studies have reported that reward and loss cues potentiate ERPs during anticipation, action preparation, and consummatory stages of reward processing, these findings are inconsistent due to temporal and spatial overlap (...) between the relevant electrophysiological components. Our results show three components following cue presentation are sensitive to incentive cues (N1, P3a, P3b). In contrast to previous research, reward‐related enhancement occurred only in the P3b, with earlier components more sensitive to break‐even and loss cues. During feedback anticipation, we observed a lateralized centroparietal negativity that was sensitive to response hand but not cue type. We also show that use of PCA on ERPs reflecting reward consumption successfully separates the reward positivity from the independently modulated feedback‐P3. Last, we observe for the first time a new reward consumption component: a late negativity distributed over the left frontal pole. This component appears to be sensitive to response hand, especially in the context of monetary gain. These results illustrate that the time course and sensitivities of electrophysiological activity that follows incentive cues do not follow a simple heuristic in which reward incentive cues produce enhanced activity at all stages and substages. (shrink)

This reader-friendly book examines philosophies and philosophers using an engaging, non-condescending approach that speaks to you at your level.

Pharmacists, physicians, and other health care personnel practice within an integrated system of laws and regulations that influence many treatment modalities. Capitation, managed care, and other controls strain these relationships by mandating greater oversight of how health care is delivered. From a pharmacists’s perspective, any use of medication requites knowledge of three omnipresent factors: regulatory control, formularies, and economic decision making. My objective is to raise awareness of these issues as they relate to the prescription of pain medication and to (...) pain management generally.All practice-oriented drug law and regulation is based on the federal Controlled Substances Act of 1970. The Act, also known as Title II, is part of a much larger piece of legislation, the Comprehensive Drug Abuse Prevention and Control Act of 1970. CSA was enacted to regulate the manufacturing, distribution, dispensing, and delivery of drugs or substances that are subject to, or have the potential for, abuse or physical or psychological dependence. (shrink)

Pharmacists, physicians, and other health care personnel practice within an integrated system of laws and regulations that influence many treatment modalities. Capitation, managed care, and other controls strain these relationships by mandating greater oversight of how health care is delivered. From a pharmacists’s perspective, any use of medication requites knowledge of three omnipresent factors: regulatory control, formularies, and economic decision making. My objective is to raise awareness of these issues as they relate to the prescription of pain medication and to (...) pain management generally.All practice-oriented drug law and regulation is based on the federal Controlled Substances Act of 1970. The Act, also known as Title II, is part of a much larger piece of legislation, the Comprehensive Drug Abuse Prevention and Control Act of 1970. CSA was enacted to regulate the manufacturing, distribution, dispensing, and delivery of drugs or substances that are subject to, or have the potential for, abuse or physical or psychological dependence. (shrink)

Moral judgments can occur either in settings that call for impartiality or in settings that allow for partiality. How effective are impartiality settings such as hospitals in suppressing personal biases? Portrayed as decision-makers in an emergency department, 431 college students made judgments on which of two victims of a mass shooting should receive immediate, life-saving care. Patients differed in ways that could reveal biases, e.g., age, kinship, gender, and villain/hero. Participants rated each patient’s moral deservingness to receive immediate care and (...) the likelihood they would choose the patient. Both scales showed young favored over old, cousin over stranger, and policeman over shooter. In a hospital-room scenario with high risk of injury from falling, age bias disappeared. With moderate fall risk, age bias reversed and kinship deservingness bias disappeared. Bias decreases when there is a decrease in severity of potential harm to the preferred stakeholder. Settings that call for impartiality are not reliable “boundary conditions” against expressions of bias. In the absence of explicit guidelines for allocating scarce resources, a systematic, objective method of random selection offers a potentially useful strategy. (shrink)

Globally, the COVID-19 pandemic has forced medical education toward more “online education” approaches, causing specific implications to arise for medical educators and learners. Considering an unprecedented and highly threatening, constrained, and confusing social and educational environment caused by the COVID-19 pandemic, we decided to shift the traditional focus of the Cognitive Load Theory from students to instructors. In this process, we considered recent suggestions to acknowledge the psychological environment in which learning happens. According to this fundamental fact, “Learning and instructional (...) procedures do not occur in a situational vacuum.” Following this assertion, we adapted and implemented principles of CLT to reduce the extraneous load for our faculty to facilitate continued scholarly activity and support the overall wellbeing of our faculty during these trying times. The adoption of these principles enabled our team to cultivate attitudes and skills across multiple domains, such as online presentation technologies, implementing and maintaining a “classroom atmosphere” in a virtual environment, encouraging discussion among large online groups of students, facilitating group work, providing virtual office hours, and proactively planning for subsequent sessions. (shrink)

The continuing power of racist ideology threatens liberal democracy, for racism is more than a personal bias or a social construction. It is an ideological framework that reduces human beings to an existence along a color-coded spectrum, with people designated as “white” at the top of the hierarchy and people designated as “black” at the bottom. One has to see this ideology clearly in order to choose a proper response and then act accordingly. First, the reality of “race” has been (...) exposed as unscientific and illusory, and as based not on biology or genetics, but on a legacy of empowerment for some and enslavement for others. Second, this racist ideology, part of our disenchanted, secular age, is exposed as a continuing form of enchantment in its manner of seeing the world, opening the possibility for a spiritual response. Third, dismantling this racist ideology requires a reimagining of “blackness” as a source of life and spirituality, as a way of countering and rewriting the dominant racist narrative. Fourth, a postsecular spiritualty, based on the work of Pope Francis—that emphasizes the importance of protecting our common human dignity, of caring for each other, and of “walking together”—can be engaged as a path for action in the battle against racism. (shrink)

"An Illini book." Includes bibliographical references and index.

As each individual abandons himself to the solicitous aid of the State,so, and still more, he abandons to it the fate of his fellow-citizens.Wilhelm Von Humboldt,On the Limits of State Action.

Sallust used Fortuna to. give his story specialized political meaning and to incorporate materials and judgments that extend the purview of his narrative to all of Roman history. Fortuna is a configuration of events that appears at certain moments in a state's existence and presents demands for careful application of intelligence, virtus, animus or ingenium, if things are to proceed well and a new era is to begin . If virtus is not present, fortuna rages and destroys . Admirable men (...) seek gloria through virtus, but also require an historian to reconstruct actions. Fortuna offers men of leisure the opportunity to apply intelligence to a course of events and to write and therefore to create history in a secondary but more lasting sense. (shrink)

This essay is a response to Peter E. Vedder's Fall 2007 review of the authors' book, Norms of Liberty: A Perfectionist Basis for Non-Perfectionist Politics. Vedder argues that the authors 1) have a Kantian notion of self-directedness, and 2) are inconsistent in the application of their philosophical anthropology to their view of political liberty. In denying both claims, the authors assert that Vedder both fails to define certain terms and holds them to positions they do not accept.

"An Illini book." Includes bibliographical references and index.

_ Source: _Volume 37, Issue 1, pp 1 - 15 A reconstruction is attempted of the printing process of the first edition of _De iure belli ac pacis_, and of the circumstances thereof, on the basis of a study of various copies still extant. It is argued that a distinction should be drawn between variations that resulted from a hurried printing process and those that were interventions by the author himself.

_ Source: _Volume 37, Issue 1, pp 1 - 15 A reconstruction is attempted of the printing process of the first edition of _De iure belli ac pacis_, and of the circumstances thereof, on the basis of a study of various copies still extant. It is argued that a distinction should be drawn between variations that resulted from a hurried printing process and those that were interventions by the author himself.