In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to (...) determine how members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

Bringing together Luce Irigaray's early psychoanalytically orientated writings with her more recent and more explicitly political writings, Irigaray and Politics weaves together the ontological, political and ethical dimensions of Irigaray's philosophy of sexuate difference in imaginative ways.

This article documents our collaborative ongoing struggle to disrupt the reproduction of the coloniality of knowledge in the teaching of Gender Studies. We document how our decolonial feminist activism is actualised in our pedagogy, which is guided by feminist interpretations of ‘wonder’ (Irigaray, 1999; Ahmed, 2004; hooks, 2010) read alongside decolonial theory, including that of Ramón Grosfoguel, Walter D. Mignolo and María Lugones. Using notions of wonder as pedagogy, we attempt to create spaces in our classrooms where critical self-reflection and (...) critical intellectual and embodied engagement can emerge. Our attempts to create these spaces include multiple aspects or threads that, when woven together, might enable other ways of knowing-being-doing that works towards disrupting feminist complicity with coloniality in the Australian context. (shrink)

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire (...) for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics. (shrink)

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants. The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols. Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about (...) participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics. (shrink)

The health care needs of rural populations often differ from those of their urban counterparts. And the ethical dilemmas that caregivers face are distinctively shaped in rural settings, not only by resource constraints, but by the nature of life in small, close-knit communities as well.

Luce Irigaray argues that the way to overcome the culture of narcissism in the Western tradition is to recognize sexuate difference and to refigure subjectivity as sexuate. This article is an attempt to unpack how Irigaray's philosophical refiguring of love as an intermediary works in this process of reimagining subjectivity as sexuate. If we trace the moments in Irigaray's philosophy where she engages with Hegel's dialectic, and rethinks this dialectical process via the question of sexual difference and a refiguring of (...) love, a clearer reading of her work as groundbreaking and ultimately refiguring our ontological structures becomes possible. Consequently, if we do not understand Irigaray's radical reformulation of love, we will miss her larger ontological project and fail to properly appreciate her comments on other types of difference—for example, differences of race, tradition, religion. This article argues that as we begin to appreciate the ways in which Irigaray refigures both love and thought as the intermediary, an intermediary that fundamentally disrupts phallocentric binary logic, we can begin to imagine how refiguring the most intimate human experience of love can lead us toward the realization of an ethical political community in which difference in all forms is nourished. (shrink)

Luce Irigaray argues that the way to overcome the culture of narcissism in the Western tradition is to recognize sexuate difference and to refigure subjectivity as sexuate. This article is an attempt to unpack how Irigaray's philosophical refiguring of love as an intermediary works in this process of reimagining subjectivity as sexuate. If we trace the moments in Irigaray's philosophy where she engages with Hegel's dialectic, and rethinks this dialectical process via the question of sexual difference and a refiguring of (...) love, a clearer reading of her work as groundbreaking and ultimately refiguring our ontological structures becomes possible. Consequently, if we do not understand Irigaray's radical reformulation of love, we will miss her larger ontological project and fail to properly appreciate her comments on other types of difference—for example, differences of race, tradition, religion. This article argues that as we begin to appreciate the ways in which Irigaray refigures both love and thought as the intermediary, an intermediary that fundamentally disrupts phallocentric binary logic, we can begin to imagine how refiguring the most intimate human experience of love can lead us toward the realization of an ethical political community in which difference in all forms is nourished. (shrink)

Professionalism and Ethics in Medicine: A Study Guide for Physicians and Physicians-in-Training is a unique self-study guide for practitioners and trainees covering the core competency areas of professionalism, ethics, and cultural sensitivity. This novel title presents real-world dilemmas encountered across the specialties of medicine, offering guidance and relevant information to assist physicians, residents, and medical students in their decision-making. The text is divided into two parts: Foundations and Questions with Answers. The first part provides a substantive foundation of knowledge in (...) the principles, scholarship, policy guidelines, and decision-making strategies of the modern health professions. The second part assists practitioners and trainees in preparing for the complex issues that arise each day in the settings where health professionals work and train – clinics, research centers, educational contexts, and communities. Developed by renowned leaders in a broad range of clinical fields, Professionalism and Ethics in Medicine: A Study Guide for Physicians and Physicians-in-Training is a major, invaluable contribution to the literature and an indispensable reference for clinicians at all levels. (shrink)

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This article describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant to encourage (...) increased participation by special populations and narrow the parity gap in effective mental health treatment and services delivery. (shrink)

Human research is accepted in our society because it is seen as generating valuable new knowledge that may alleviate suffering and bring benefit to ill persons now and in the future (Brody 1998; Fa...

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential ethical principles and concepts, the professional (...) obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

This book is derived from the author's Concise guide to ethics in mental health care, published in 2004. It has been revised, updated, and rewritten with new chapters, topics and data.

Little is known about how researchers view ethically salient aspects of human studies. As part of a National Institutes of Mental Health-funded study, the authors performed a confidential written survey to assess the attitudes, views, and experiences of researchers with institutional review board approved protocols at the University of New Mexico. A total of 363 researchers (57% response rate) participated. Investigators overall held favorable views of general ethical aspects of research and ethics-based safeguards, and they identified a positive role of (...) ethics training. Investigators with more experience encountering ethical problems (p < .001), more ethics training (p = .001), and a PhD or MD/PhD (p = .003) held more favorable general ethical perspectives. Women investigators (p < .03), nonphysician investigators (p < .001), those whose training had been helpful in resolving ethical dilemmas (p = .006), and those for whom spirituality is important (p = .008) more strongly endorsed ethical safeguards. Investigators perceive the scientific and ethical aspects of their work as valuable and linked, and they affirm the role of safeguards in human studies. Formal ethics preparation and training initiatives were also viewed positively by investigators. (shrink)

Recent studies show that psychiatry residents express a relatively greater need for ethics curricula than their colleagues in other specialties. Such studies have been limited in their generalizability because they were conducted at one site. This study of 151 psychiatry residents at seven U.S. psychiatry programs aims to address that limitation. Residents were surveyed on issues pertaining to ethics and professionalism education. Participants were found to support such curricula during training and to value its relevance to the practice of psychiatry. (...) Gender differences and the influence of the “hidden curriculum” on such results merit further study. (shrink)

The definitive book on ethics for chemical dependency treatment professionals.

Background: Empirical ethics inquiry works from the notion that stakeholder perspectives are necessary for gauging the ethical acceptability of human studies and assuring that research aligns with societal expectations. Although common, studies involving different populations often entail comparisons of trends that problematize the interpretation of results. Using graphical model selection—a technique aimed at transcending limitations of conventional methods—this report presents data on the ethics of clinical research with two objectives: (1) to display the patterns of views held by ill and (...) healthy individuals in clinical research as a test of the study's original hypothesis and (2) to introduce graphical model selection as a key analytic tool for ethics research. Methods: In this institutional review board (IRB)-approved, National Institutes of Health-funded project, data were collected from 60 mentally ill and 43 physically ill clinical research protocol volunteers, 47 healthy protocol-consented participants, and 29 healthy individuals without research protocol experience. Respondents were queried on the ethical acceptability of research involving people with mental and physical illness (i.e., cancer, HIV, depression, schizophrenia, and posttraumatic stress disorder) and non-illness-related sources of vulnerability (e.g., age, class, gender, ethnicity). Using a statistical algorithm, we selected graphical models to display interrelationships among responses to questions. Results: Both mentally and physically ill protocol volunteers revealed a high degree of connectivity among ethically salient perspectives. Healthy participants, irrespective of research protocol experience, revealed patterns of views that were not highly connected. Conclusions: Between ill and healthy protocol participants, the pattern of views was vastly different. Experience with illness was tied to dense connectivity, whereas healthy individuals expressed views with sparse connections. In offering a nuanced perspective on the interrelation of ethically relevant responses, graphical model selection has the potential to bring new insights to the field of ethics. (shrink)

Schizophrenia affects more than 1% of the world's population, causing great personal suffering and socioeconomic burden. These costs associated with schizophrenia necessitate inquiry into the causes and treatment of the illness but generate ethical challenges related to the specific nature and deficits of the illness itself. In this article, we present a systematic analysis of narrative data from 63 people living with the illness of schizophrenia collected through semistructured interviews about their attitudes, beliefs, and experiences related to psychiatric research. In (...) the comments of these individuals, half of whom had had prior personal experience in research protocols, we identified factors influencing openness toward research involvement as well as deterrents that appear to lessen interest in participation. Clear response pattern differences emerged between those with prior research experience and those without such experience. In the discussion, we explore these key findings and outline the implications for safeguards in mental illness research. (shrink)

Background: Genetic research involving racial/ethnic populations has novel ethical implications for various stakeholders, but ethical acceptability among stakeholders regarding such research is not clear. Methods: As part of a multifaceted National Institute of Mental Health (NIMH)/National Human Genome Research Institute (NHGRI) funded survey, we used repeated-measures factorial multivariate analysis of variance (MANOVA) to compare the perspectives of institutional review board (IRB) chairs (n = 203), investigators (n = 183), and community members (n = 192) on the ethical acceptability of participating (...) in and reporting of psychiatric genetic research focused on racial/ethnic minority groups. Stakeholder views were assessed with two sets of three questions. Results: All stakeholder groups perceived participation in genetic studies focused on racial/ethnic groups as ethically acceptable and endorsed as ethical any decisions by racial/ethnic minorities to decline to participate in such studies if concerned about possible discrimination/stigmatization based on the study findings. Stakeholders disagreed considerably on the ethical acceptability of researchers or journal editors choosing not to publish genetic study results focused on racial/ethnic minority groups based on potential harm of the study findings. Conclusion: Findings show community and professional stakeholders support participation in genetic research focused on specific racial/ethnic groups but recognize that the results of such studies may contribute to discrimination or stigmatization. Stakeholders differed in their perspectives of investigators and editors in balancing ethical issues intrinsic to advancing science versus minimizing harm to potentially vulnerable populations. (shrink)

Little is known about how individuals with and without mood disorders perceive the inherent risks and helpfulness of participating in innovative psychiatric research, or about the factors that influence their willingness to participate. We conducted an online survey with 80 individuals (self-reported mood disorder [n = 25], self-reported good health [n = 55]) recruited via MTurk. We assessed respondents’ perceptions of risk and helpfulness in study vignettes associated with two innovative research projects (intravenous ketamine therapy and wearable devices), as well (...) as their willingness to participate in these projects. Respondents with and without mood disorders perceived risk similarly across projects. Respondents with no mood disorders viewed both projects as more helpful to society than to research volunteers, while respondents with mood disorders viewed the projects as equally helpful to volunteers and society. Individuals with mood disorders perceived ketamine research, and the two projects on average, as more helpful to research volunteers than did individuals without mood disorders. Our findings add to a limited empirical literature on the perspectives of volunteers in innovative psychiatric research. (shrink)

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues of therapeutic boundaries, diagnosis, treatment choice, (...) confidentiality and informed consent, and the just distribution of limited health care resources. (shrink)

Surrogate (proxy) decision makers must make research decisions for people with dementia who lack decision-making capacity. Proxies’ decision-making processes are minimally understood. We randomly assigned 82 proxies of AD patients to informed consent for one of three hypothetical protocols with differing levels of risk and benefit. Proxies answered questions about potential benefits of the described research to the patient and society, as well as about whether they would enroll their relative and why or why not. Proxies interested in enrolling their (...) relative cited the potential for direct benefit to their relative, altruism, and trust in researchers. Those declining cited risks, inconvenience, and stage of illness. Proxies weighed numerous factors, incorporating both substituted judgment and best interests standards in their decision-making processes. Although further empirical work is needed to understand the influences on and adequacy of proxies’ decision making regarding research, these findings can help inform policy regarding surrogate consent. (shrink)

The Routledge Companion to Performance Philosophy is a volume of especially commissioned critical essays, conversations, collaborative, creative and performative writing mapping the key contexts, debates, methods, discourses and practices in this developing field. Firstly, the collection offers new insights on the fundamental question of how thinking happens: where, when, how and by whom philosophy is performed. Secondly, it provides a plurality of new accounts of performance and performativity as the production of ideas, bodies and knowledges in the arts and beyond. (...) Comprising texts written by international artists, philosophers and scholars from multiple disciplines, the essays engage with questions of how performance thinks and how thought is performed in a wide range of philosophies and performances, from the ancient to the contemporary. Concepts and practices from diverse geographical regions and cultural traditions are analysed to draw conclusions about how performance operates across art, philosophy and everyday life. The collection both contributes to and critiques the philosophy of music, dance, theatre and performance, exploring the idea of a philosophy from the arts. It is crucial reading material for those interested in the hierarchy of the relationship between philosophy and the arts, advancing debates on philosophical method, and the relation between Performance and Philosophy more broadly. (shrink)

This series of responses was commissioned to accompany the article by Singer et al, which can be found at http://www.biomedcentral.com/1472-6939/2/1. If you would like to comment on the article by Singer et al or any of the responses, please email us on [email protected].

This study explores corporate social responsibility (CSR) by conducting a cross-cultural analysis of communication of CSR activities in a total of 16 U.S. and European corporations. Drawing on previous research contrasting two major approaches to CSR initiatives, it was proposed that U.S. companies would tend to communicate about and justify CSR using economic or bottom-line terms and arguments whereas European companies would rely more heavily on language or theories of citizenship, corporate accountability, or moral commitment. Results supported this expectation of (...) difference, with some modification. Specifically, results indicated that EU companies do not value sustainability to the exclusion of financial elements, but instead project sustainability commitments in addition to financial commitments. Further, U.S.-based companies focused more heavily on financial justifications whereas EU-based companies incorporated both financial and sustainability elements in justifying their CSR activities. In addition, wide variance was found in both the prevalence and use of specific CSR-related terminology. Cross-cultural distinctions in this use create implications with regard to measurability and evidence of both strategic and bottom-line impact. Directions for further research are discussed. (shrink)

The paper examines the relationship between praxeology and Schutzian phenomenology. It does so by tracing and comparing the conceptualizations of sense and sensemaking in both approaches. In a first step the phenomenological concept of mental and subjective sense and meaning is discerned. Subsequently, different disengagements from this concept within interpretative sociologies are reconstructed. It is argued that those disengagements, which seek to replace the understanding of sense and meaning as private,,inner’ entities with notions of the,publicness’ of practical social sensemaking are (...) crucial for advancing a praxeological perspective in social theory. (shrink)

The relationship between construal and redundancy has not been previously explored empirically. Russian aspect allows speakers to construe situations as either Perfective or Imperfective, but it is not clear to what extent aspect is determined by context and therefore redundant. We investigate the relationship between redundancy and open construal by surveying 501 native Russian speakers who rated the acceptability of both Perfective and Imperfective verb forms in complete extensive authentic contexts. We find that aspect is largely redundant in 81% of (...) uses, and in 17% of contexts aspect is relatively open to construal. We contend that anchoring in redundant contexts likely facilitates the independence of construal in contexts with less redundancy. However further research is needed to discover what makes contexts redundant since known cues for aspect are absent in the majority of such contexts. Native speakers are fairly consistent in giving the original aspect high ratings, but less consistent in rating the non-original aspect, indicating potential problems in testing the reactions of speakers to non-authentic data. (shrink)

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

Associative learning is an essential feature of human cognition, accounting for the influence of priming and interference effects on memory recall. Here, we extend our account of associative learning that learns asymmetric item-to-item associations over time via experience by including link maturation to balance associations between longer-term stability while still accounting for short-term variability. This account, combined with an existing account of activation strengthening and decay, predicts both human response times and error rates for the fan effect for both target (...) and foil stimuli. (shrink)

This paper proposes an experimental test to evaluate the performance of the serial cost sharing rule, originally proposed by Shenker [Sigmetrics, 241–242 (1990)] and then analyzed by Moulin and Shenker [Econometrica 60, 1009–1037 (1992)]. We report measures of the performance and efficiency of the serial mechanism by comparing the choices and payoffs attained by the subjects to the expected equilibrium allocations. Experimental evidence shows that learning is needed for the subjects to converge to the equilibrium strategy. However, in terms of (...) efficiency, the serial mechanism leads to almost efficient allocations. (shrink)