As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

While the phenomenon of ‘moral distress’ has been of interest to the nursing community since Jameton first described it in 1984, moral distress is now understood to effect healthcare professionals...

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

Herrera-Ferrá et al.’s (2023) attention to the cultural context of the neurorights movement contributes to the growing conversation on establishing neurorights in response to advancements in neuros...

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward “solution.” Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, (...) rather than evidencing identification of the “right” course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient’s values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action. (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

What happens at the end of a clinical trial for an investigational neural implant? It may be surprising to learn how difficult it is to answer this question. While new trials are initiated with increasing regularity, relatively little consensus exists on how best to conduct them, and even less on how to ethically end them. The landscape of recent neural implant trials demonstrates wide variability of what happens to research participants after an neural implant trial ends. Some former research participants (...) continue to receive support for their devices (e.g., battery and component replacements, software updates, etc.). Others, when safe, have their neural implants removed through surgical explantation. Still others continue to live with a deactivated neural implant embedded in their body. In the United States, there are no uniform requirements to provide services, of any kind, after an neural implant study ends, and other nations are similarly facing this challenge. The existence of a post-trial gap in an expanding neural implant research ecosystem invites obvious questions: What is owed to neural implant research participants post-trial, and why has providing it been so difficult to accomplish in practice? To take a step forward on this difficult issue, we assembled one group of stakeholders – researchers funded for neuroethics grants by the National Institutes of Health – to explore possible starting points on one topic: ethical guidance for post-trial care of research participants in neural implant trials. Based on shared concerns discussed in the expert workshop the current paper is a call to action. It reports the key areas of convergence from the meeting and highlights important next steps towards developing much needed guidance. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Russell articulates compelling reasons that bioethicists and health care professionals should take individual responsibility for deconstructing structural injustices in healthcare through in...

On Advaita philosophy; Sanskrit text with commentary and translation.

The Essay In This Book Deal With Such Topics As Silence As A Constituent Of Language, Justification Of Kant`S Antological Principles, Hegel`S Concept Of Reason, Total Man And The Role Of Revolution, A Meta-Physical Analysis Of Freedom, Dimensions Of Self-Expression, Love As A Form Of Authentic Expression, Radical Education In Institutionalized Surroundings Etc. In Honour Of S.N. Ganguly.

The year 2020 has yielded twin crises in the United States: a global pandemic and a public reckoning with racism brought about by a series of publicized instances of police violence toward Black men and women. Current data indicate that nationally, Black Americans are three times more likely than White Americans to contract Covid-19, a pattern that underscores the more general phenomenon of health disparity among Black and White Americans. Once exposed, Black Americans are twice as likely to die of (...) the virus. Unsurprisingly, Black Americans report higher levels of fear of Covid-19 than their White peers, but they also report higher levels of hesitancy toward a Covid-19 vaccine. This paper explores why this apparent discrepancy exists. It also provides practical recommendations for how government and public health leaders might address vaccine hesitancy in the context of the twin crises of 2020. (shrink)

In this paper, I identify a form of epistemic insensitivity that occurs when someone fails to make proper use of the epistemic tools at their disposal in order to bring their beliefs in line with epistemically relevant evidence that is available to them. I call this kind of insensitivity agential insensitivity because it stems from the epistemic behavior of an individual agent. Agential insensitivity can manifest as a failure to either attend to relevant and available evidence, or appropriately interpret evidence (...) that is attended to. The concept of agential insensitivity allows us to conceptualize the kind of not-knowing involved in forms of ignorance that are cultivated and maintained by individual agents, especially when this ignorance is enabled or encouraged by social structures. I use the skepticism about racial disparities in policing practices that is displayed by many white Americans as a lens for exploring this connection. Understanding agential insensitivity thus provides insight into both social and epistemic phenomena. (shrink)

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein (...) the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

In several recent publications, Professor Adolf Grünbaum has inveighed against the conventionalism of writers like Einstein, Poincaré, Quine and especially Duhem. Specifically, Grünbaum has assailed the view that a single hypothesis can never be conclusively falsified. Grünbaum claims that the conventionalists’ insistence on the immunity of hypotheses from falsification is neither logically valid nor scientifically sound. Directing the weight of his argument against Duhem, Grünbaum launches a two-pronged attack. He insists, first, that conclusive falsifying experiments are possible, suggesting that Duhem's (...) denial of such experiments is a logical non-sequitur. He then proceeds to show that, more than being merely possible, crucial falsifying experiments have occurred in physics. I do not intend to make a logical point against Grünbaum's critique so much as an historical and exegetical one. Put briefly, I believe that he has misconstrued Duhem's views on falsifiability and that the logical blunder which he discusses should not be ascribed to Duhem, but rather to those who have made Duhem's conventionalism into the doctrine which Grünbaum attacks. Whether there are any writers who accept the view he imputes to Duhem, or whether he is exploiting “straw-men” to give weight to an otherwise trivial argument is an open question. For now, I simply want to suggest that his salvos are wrongly directed against Duhem. (shrink)

A fundamental goal of research in neuroscience is to uncover the causal structure of the brain. This focus on causation makes sense, because causal information can provide explanations of brain function and identify reliable targets with which to understand cognitive function and prevent or change neurological conditions and psychiatric disorders. In this research, one of the most frequently used causal concepts is ‘mechanism’ — this is seen in the literature and language of the field, in grant and funding inquiries that (...) specify what research is supported, and in journal guidelines on which contributions are considered for publication. In these contexts, mechanisms are commonly tied to expressions of the main aims of the field and cited as the ‘fundamental’, ‘foundational’ and/or ‘basic’ unit for understanding the brain. Despite its common usage and perceived importance, mechanism is used in different ways that are rarely distinguished. Given that this concept is defined in different ways throughout the field — and that there is often no clarification of which definition is intended — there remains a marked ambiguity about the fundamental goals, orientation and principles of the field. Here we provide an overview of causation and mechanism from the perspectives of neuroscience and philosophy of science, in order to address these challenges. (shrink)

The role of emotions in mental life is the subject of longstanding controversy, spanning the history of ethics, moral psychology, and educational theory. This paper defends an account of love’s cognitive power. My starting point is Plato’s dialogue, the Symposium, in which we find the surprising claim that love aims at engendering moral virtue. I argue that this understanding affords love a crucial place in educational curricula, as engaging the emotions can motivate both cognitive achievement and moral development. I first (...) outline the state of the challenge between dominant rival theories regarding emotions in learning. Next, I demonstrate how Platonic virtue ethics offers the most tenable prospect for an education of reason and emotion. Third, I sketch three practical ways educators might constructively engage emotions in the classroom. I conclude that love’s virtue is its peerless power to motivate the creative and lateral thinking which leads to moral development. (shrink)

Causal selection has to do with the distinction we make between background conditions and “the” true cause or causes of some outcome of interest. A longstanding consensus in philosophy views causal selection as lacking any objective rationale and as guided, instead, by arbitrary, pragmatic, and non-scientific considerations. I argue against this position in the context of causal selection for disease traits. In this domain, causes are selected on the basis of the type of causal control they exhibit over a disease (...) of interest. My analysis clarifies the principled rationale that guides this selection and how it involves both pragmatic and objective considerations, which have been overlooked in the extant literature. (shrink)

The work of the French philosopher Jean-Luc Nancy shares with the thinkers of the ‘theological turn in phenomenology’ the programmatic desire to place the ‘theological’, in the broad sense of rethinking the religious traditions in our secular time, back on the agenda of critical thought. Like those advocating a theological turn in phenomenology, Nancy’s deconstructive approach to philosophical analysis aims to develop a new sensibility for the other, for transcendence, conceptualized as the non-apparent in the realm of appearing phenomena. This (...) is why Nancy launches a project looking for the ‘unthought’ and unexpected within the Christian traditions, called deconstruction of Christianity. However, the deconstructive approach to the non-apparent differs fundamentally from that of the thinkers of the turn (1) in its being non-apologetic and non-restorative with regard to religion, because it starts from a problematization of the—typically modern, that is romantic—desire to defend and protect what would be ‘lost’ and possibly to restore this, (2) in its focus on the complex difference-at-work (différance) between religion and secularism, a difference that can be termed entanglement and complicity between these two, (3) in its hypothesis that this entanglement is essentially one between (the meaning and experience of, the rituality around) presence and absence in modern culture, (4) in its conviction that the philosophy and history of culture must join, support, complete and maybe even turn around phenomenology when dealing with the difficult task of determining what exactly would be ‘left’ of the ‘theological’ in our time. In this article, both positions are compared and confronted further, leading to an account of Nancy’s re-readings of the Christian legacy (its theology, doctrine, art, rituals etc.), and ending in a more detailed, exemplary inquiry into the tension between distance and proximity, characteristic of the Christian God. (shrink)

Poor Eliza -- Pax Americana : the case of Show boat -- National brands, national body : Imitation of life -- Uncle Sam needs a wife : citizenship and denegation -- Remembering love, forgetting everything else : Now, voyager -- "It's not the tragedies that kill us, it's the messes" : femininity, formalism, and Dorothy Parker -- The compulsion to repeat femininity : Landscape for a good woman and The life and loves of a she-devil.

Social scientists appeal to various “structures” in their explanations including public policies, economic systems, and social hierarchies. Significant debate surrounds the explanatory relevance of these factors for various outcomes such as health, behavioral, and economic patterns. This paper provides a causal account of social structural explanation that is motivated by Haslanger (2016). This account suggests that social structure can be explanatory in virtue of operating as a causal constraint, which is a causal factor with unique characteristics. A novel causal framework (...) is provided for understanding these explanations–this framework addresses puzzles regarding the mysterious causal influence of social structure, how to understand its relation to individual choice, and what makes it the main explanatory (and causally responsible) factor for various outcomes. (shrink)

Recent philosophical work has explored the distinction between causal and non-causal forms of explanation. In this literature, topological explanation is viewed as a clear example of the non-causal variety–it is claimed that topology lacks temporal information, which is necessary for causal structure. This paper explores the distinction between topological and causal forms of explanation and argues that this distinction is not as clear cut as the literature suggests. One reason for this is that some explanations involve both topological and causal (...) information. In these “borderline” cases scientists explain some outcome by appealing to the causal topology of the system of interest. These cases help clarify a type of topological explanation that is genuinely causal, but that differs from standard topological and interventionist accounts of explanation. (shrink)

This article examines the multiple realizability thesis within a causal framework. The beginnings of this framework are found in Elliott Sober’s “Multiple Realizability Argument against Reduction,”...

In several recent publications, Professor Adolf Grünbaum has inveighed against the conventionalism of writers like Einstein, Poincaré, Quine and especially Duhem. Specifically, Grünbaum has assailed the view that a single hypothesis can never be conclusively falsified. Grünbaum claims that the conventionalists’ insistence on the immunity of hypotheses from falsification is neither logically valid nor scientifically sound. Directing the weight of his argument against Duhem, Grünbaum launches a two-pronged attack. He insists, first, that conclusive falsifying experiments are possible, suggesting that Duhem's (...) denial of such experiments is a logical non-sequitur. He then proceeds to show that, more than being merely possible, crucial falsifying experiments have occurred in physics. I do not intend to make a logical point against Grünbaum's critique so much as an historical and exegetical one. Put briefly, I believe that he has misconstrued Duhem's views on falsifiability and that the logical blunder which he discusses should not be ascribed to Duhem, but rather to those who have made Duhem's conventionalism into the doctrine which Grünbaum attacks. Whether there are any writers who accept the view he imputes to Duhem, or whether he is exploiting “straw-men” to give weight to an otherwise trivial argument is an open question. For now, I simply want to suggest that his salvos are wrongly directed against Duhem. (shrink)

We argue that Koch’s postulates are best understood within an interventionist account of causation, in the sense described in Woodward. We show how this treatment helps to resolve interpretive puzzles associated with Koch’s work and how it clarifies the different roles the postulates play in providing useful, yet not universal criteria for disease causation. Our paper is an effort at rational reconstruction; we attempt to show how Koch’s postulates and reasoning make sense and are normatively justified within an interventionist framework (...) and more difficult to understand within alternative frameworks for thinking about causation. (shrink)

Every living entity requires the capacity to defend against viruses in some form. From bacteria to plants to arthropods, cells retain the capacity to capture genetic material, process it in a variety of ways, and subsequently use it to generate pathogen-specific small RNAs. These small RNAs can then be used to provide specificity to an otherwise non-specific nuclease, generating a potent antiviral system. While small RNA-based defenses in chordates are less utilized, the protein-based antiviral invention in this phylum appears to (...) have derived from components of the same ancestral small RNA machinery. Based on recent evidence, it would seem that RNase III nucleases have been reiteratively repurposed over billions of years to provide cells with the capacity to recognize and destroy unwanted genetic material. Here we describe an overview of what is known on this subject and provide a model for how these defenses may have evolved. RNase III nuclease domains are widely used in an array of RNA metabolic functions as well as antiviral defenses. Here, we review their current usage as well as provide insight into how these domains may have shaped all major antiviral pathways over the course of evolution. (shrink)

This chapter contains section titled: Principles New Principle Learning Feng's Histories of Chinese Philosophy and New Principle Learning Problems of a Modern Confucian Rationalist.

While there is now considerable anxiety about whether the psychological theory presupposed by virtue ethics is empirically sustainable, analogous issues have received little attention in the virtue epistemology literature. This paper argues that virtue epistemology encounters challenges reminiscent of those recently encountered by virtue ethics: just as seemingly trivial variation in context provokes unsettling variation in patterns of moral behavior, trivial variation in context elicits unsettling variation in patterns of cognitive functioning. Insofar as reliability is a condition on epistemic virtue, (...) we have reason to doubt that human beings possess the cognitive materials required for epistemic virtue, and thereby reason to think that virtue epistemology is threatened by skepticism. We conclude that while virtue epistemology has resources for addressing this challenge, exploiting these resources forces tradeoffs between empirical and normative adequacy. (shrink)

In ‘Affectivity in Heidegger I: Moods and Emotions in Being and Time’, we explicated the crucial role that Martin Heidegger assigns to our capacity to affectively find ourselves in the world. There, our discussion was restricted to Division I of Being and Time. Specifically, we discussed how Befindlichkeit as a basic existential and moods as the ontic counterparts of Befindlichkeit make circumspective engagement with the world possible. Indeed, according to Heidegger, it is primarily through moods that the world is ‘opened (...) up’ and revealed to us as a world that is suffused with values and entities that already matter to us. In this companion essay, our aim is to expand our analysis of affectivity in the following ways: first, we revisit our discussion of Befindlichkeit in light of Heidegger's discussion of temporality in Division II of BT; second, we discuss the basic or fundamental mood of boredom and its ontological significance; we conclude by providing a brief characterization of how Heidegger's notion of mood changes in his later thinking. (shrink)

ABSTRACT:Corporate social responsibility has been hailed as a new means to address gender inequality, particularly by facilitating women’s empowerment. Women are frequently and forcefully positioned as saviours of economies or communities and proponents of sustainability. Using vignettes drawn from a CSR women’s empowerment programme in Ghana, this conceptual article explores unexpected programme outcomes enacted by women managers and farmers. It is argued that a feminist Foucauldian reading of power as relational and productive can help explain this since those involved are (...) engaged in ongoing processes of resistance and self-making. This raises questions about the assumptions made about women and what is it that such CSR programmes aim to empower them ‘from’ or ‘to.’ Empowerment, when viewed as an ethic of care for the self, is better understood as a self-directed process, rather than a corporate-led strategy. This has implications for how we can imagine the achievement of gender equality through CSR. (shrink)

Martin Heidegger's account of attunement [Befindlichkeit] through mood [Stimmung] is unprecedented in the history of philosophy and groundbreaking vis-à-vis contemporary accounts of emotion. On his view, moods are not mere mental states that result from, arise out of, or are caused by our situation or context. Rather, moods are fundamental modes of existence that are disclosive of the way one is or finds oneself [sich befinden] in the world. Mood is one of the basic modes through which we experience the (...) world and through which the world is made present to us. Moreover, moods are the lenses through which things, people, animals, events, and aspects in the world matter to us. In this paper, I make the case that Heidegger's insights with respect to mood can and ought to be extended beyond the narrow scope of his fundamental ontology in which they were developed. I argue that contemporary accounts of mood within psychology ought to take these Heideggerian insights seriously and use them when defining, studying, evaluating, and drawing conclusions about the nature of moods. There are three sections to my paper. In section 1, I delineate Heidegger's account of mood. In section 2, I turn to some key studies on mood in psychology, and I elaborate upon some of the main shortcomings in this literature. In section 3, I suggest how psychology might benefit from understanding and utilizing a Heideggerian-inspired phenomenology of mood. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka (...) O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)