The patient wished to receive an experimental drug that she was instrumental in developing. After her diagnosis, she had investigated treatments that might help her condition and discovered that a specific compound could be beneficial. To further the development of this potential drug, she obtained preclinical data, founded a company, and sought investment from venture capitalists. The company was about to begin phase I testing, but the clinical trial had not yet opened. In addition, she would not have been a (...) candidate for the study, as it excluded patients with advanced disease. To be able to administer this drug to her, the patient's team of oncologists was in the process of drafting an individual patient investigational new drug application, including the protocol for the drug's delivery, to the Food and Drug Administration. The company developing the drug had preliminarily agreed to provide it. This protocol was also under review by the institutional review board of the university, and the ethics committee was consulted to determine whether she should receive the drug. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Moral Distress in Academic Medicine: My Brother’s Keeper?Lauren B. SmithAs a member of the hospital ethics committee, I’ve become the go–to person for any ethical issues that arise in our Department. Being a pathologist who is interested in ethics, I’m a rare bird. In this role, I get the occasional curbside consult when anyone has a question or concern. Shortly after an ethics lecture to our trainees, one (...) of the junior residents approached me and asked to speak privately. We headed to the cafeteria and found a private table where we could talk. She hesitated, running her fingers through her hair and gazing around the room before speaking.She told me that the trainees were concerned because they had noticed that the pathologists at another institution were not grading one type of cancer the way that they had learned to do this at our hospital. This type of cancer grading is a surrogate for aggressiveness, and, while somewhat flawed, it often determines the staging and adjuvant therapy that the patient will receive. The resident argued that at this hospital, patients were getting assigned cancer grades that were higher than the ones they would receive at our institution. Therefore, a cancer presenting at the other hospital would be considered more aggressive by the clinicians treating the patient.The resident and many of her colleagues had tried to broach this subject with the pathologists. [End Page E18] Many had been brave enough to voice their confusion and concern over the practices. Their efforts, she explained, had been rebuffed. The pathologists assured the residents that they were grading their cases correctly and cited a reference that they used for this purpose. Due to the hierarchical nature of medicine, it is understandably difficult for trainees to confront attending physicians when they have concerns about their clinical cases and diagnostic acumen. Residents and fellows often do not express their concerns for fear of overstepping their roles. In spite of this, many trainees felt that their concerns for the patient made them set aside their own best interest and they spoke up. Moral distress and genuine concern trumped self–interest in this case, which was admirable.At the time of our meeting, I wondered what I could do to help. I am a hematopathologist who specializes in diagnosing leukemias and lymphomas. I know very little about solid tumor diagnosis and treatment. I have not looked at many solid tumors since I was a trainee six years ago. I do not read the literature in that area and I’m not up–to–date on any controversies regarding grading. In summary, I am far from an expert.However, the problem, on a broader scale, was familiar. As pathologists, we may disagree with or question the diagnoses of our colleagues. What is the appropriate course of action when this occurs? This question is an interesting and infinitely complex issue in the realm of pathological diagnosis. If you aren’t a pathologist or a physician, it may be difficult to grasp why there isn’t a right answer in every case. Diagnosing cancer, in many ways, is truly an art as much as a science. Many intersecting variables are at play, including the size and quality of the sample, the experience and training of the pathologist, and the clinical information available at the time of the diagnosis. Some areas are fraught with subjectivity and inter–observer reliability. Some pathologists are more skilled than others. These are realities that no one wishes to freely admit.It is important, however, to differentiate between systematic and random errors. There are many errors that are difficult to predict or avoid. However, systematic errors are the ones that we most want to uncover as they can be fixed with education and awareness. This case appeared to represent a systematic error in which the pathologists at the other hospital were all performing grading in a way that differed from usual practice.I wondered if it would be overstepping my role to speak to the pathologists. I ran the situation by some of the senior pathologists that I know. Many understood my concern but subtly discouraged any action. Many felt... (shrink)

When a gynecologist asks a twenty-one-year-old patient about her use of contraception, he is surprised that she would like to have a tubal ligation. The patient says that she would “never want to bring a child into this screwed up world.” She has discussed tubal ligation with her boyfriend of one year, and he has told her that he accepts her decision. She asks her doctor if she can schedule the procedure as soon as possible. Her gynecologist mentions that he (...) is concerned that she is very young and may eventually change her mind about having children. She insists that she has thought about it carefully and is certain that she wants the procedure. Her doctor feels very uncomfortable about this request. He consults the hospital ethics committee. Should he do as the patient asks or suggest that she wait at least six months and reconsider? (shrink)

Volume 20, Issue 7, July 2020, Page 77-80.

Disputes between those holding differing political views are ubiquitous and deep-seated, and they often follow common, recognizable lines. The supporters of tradition and stability, sometimes referred to as conservatives, do battle with the supporters of innovation and reform, sometimes referred to as liberals. Understanding the correlates of those distinct political orientations is probably a prerequisite for managing political disputes, which are a source of social conflict that can lead to frustration and even bloodshed. A rapidly growing body of empirical evidence (...) documents a multitude of ways in which liberals and conservatives differ from each other in purviews of life with little direct connection to politics, from tastes in art to desire for closure and from disgust sensitivity to the tendency to pursue new information, but the central theme of the differences is a matter of debate. In this article, we argue that one organizing element of the many differences between liberals and conservatives is the nature of their physiological and psychological responses to features of the environment that are negative. Compared with liberals, conservatives tend to register greater physiological responses to such stimuli and also to devote more psychological resources to them. Operating from this point of departure, we suggest approaches for refining understanding of the broad relationship between political views and response to the negative. We conclude with a discussion of normative implications, stressing that identifying differences across ideological groups is not tantamount to declaring one ideology superior to another. (shrink)

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases’ powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro‐organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical‐ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)

William H. Simon, The Practice of Justice: A Theory of Lawyers? Ethics Cambridge, MA: Harvard University Press, 1998, viii + 253 pp.

Lloyd Weinreb, Oedipus at Fenway Park: What Rights There Are and Why There Are Any Cambridge, MA: Harvard University Press, 1994, viii, 221 pp.

Judith Jarvis Thomson, The Realm Of Rights Harvard University Press, 1990, viii, 383pp.

Kent Greenawalt, Conflicts of Law and Morality New York: Oxford University Press, 1987; xii, 383pp.

Traditional views separate cognitive processes from sensory–motor processes, seeing cognition as amodal, propositional, and compositional, and thus fundamentally different from the processes that underlie perceiving and acting. These were the ideas on which cognitive science was founded 30 years ago. However, advancing discoveries in neuroscience, cognitive neuroscience, and psychology suggests that cognition may be inseparable from processes of perceiving and acting. From this perspective, this study considers the future of cognitive science with respect to the study of cognitive development.

This chapter contains sections titled: The Prima Facie Duty to Obey: A Brief History Implications of Catechistic Metaethics for the Duty of Obedience Implications of Commonalist Metaethics for the Duty of Obedience Conclusion References.

Criminologists have long acknowledged the link between a number of cognitive deficits, including low intelligence and impulsivity, and crime. A new wave of research has demonstrated that pharmacological intervention can restore or improve cognitive function, particularly executive function, and restore neural plasticity. Such restoration and improvement can allow for easier acquisition of new skills and as a result, presents significant possibilities for the criminal justice system. For example, studies have shown that supplements of Omega-3, a fatty acid commonly found in (...) food such as tuna, can decrease frequency of violent incidents in an incarcerated population. Research has also begun to explore the use of selective serotonin reuptake inhibitors to reduce impulsivity in some violent offenders. However, there are significant legal and ethical implications when moving from dietary supplements to prescription pharmaceuticals and medical devices for cognitive intervention. This paper will explore the legal and ethical issues surrounding the use of pharmacological intervention on prisoners as an effort to reduce crime and recidivism. (shrink)

In this volume, Randall B. Smith provides a revisionist account of the scholastic culture that flourished in Paris during the High Middle Ages. Exploring the educational culture that informed the intellectual and mental habits of Thomas Aquinas and Bonaventure, he offers an in-depth study of the prologues and preaching skills of these two masters. Smith reveal the intricate interrelationships between the three duties of the master: lectio (reading), disputatio (debate), and praedicatio (preaching). He also analyzes each of Aquinas and Bonaventure's (...) prologues from their student days to their final works, revealing both their artistry and their instructional character. Written in an engaging style, this book serves as an invaluable resource that will enable scholars and students to read thirteenth-century sermons, prologues, and biblical commentaries with greater understanding and ease. (shrink)

Joint attention has been extensively studied in the developmental literature because of overwhelming evidence that the ability to socially coordinate visual attention to an object is essential to healthy developmental outcomes, including language learning. The goal of this study was to understand the complex system of sensory-motor behaviors that may underlie the establishment of joint attention between parents and toddlers. In an experimental task, parents and toddlers played together with multiple toys. We objectively measured joint attention—and the sensory-motor behaviors that (...) underlie it—using a dual head-mounted eye-tracking system and frame-by-frame coding of manual actions. By tracking the momentary visual fixations and hand actions of each participant, we precisely determined just how often they fixated on the same object at the same time, the visual behaviors that preceded joint attention and manual behaviors that preceded and co-occurred with joint attention. We found that multiple sequential sensory-motor patterns lead to joint attention. In addition, there are developmental changes in this multi-pathway system evidenced as variations in strength among multiple routes. We propose that coordinated visual attention between parents and toddlers is primarily a sensory-motor behavior. Skill in achieving coordinated visual attention in social settings—like skills in other sensory-motor domains—emerges from multiple pathways to the same functional end. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be disenfranchised (...) from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

Infants' own activities create and actively select their learning experiences. Here we review recent models of embodied information seeking and curiosity-driven learning and show that these mechanisms have deep implications for development and evolution. We discuss how these mechanisms yield self-organized epigenesis with emergent ordered behavioral and cognitive developmental stages. We describe a robotic experiment that explored the hypothesis that progress in learning, in and for itself, generates intrinsic rewards: The robot learners probabilistically selected experiences according to their potential for (...) reducing uncertainty. In these experiments, curiosity-driven learning led the robot learner to successively discover object affordances and vocal interaction with its peers. We explain how a learning curriculum adapted to the current constraints of the learning system automatically formed, constraining learning and shaping the developmental trajectory. The observed trajectories in the robot experiment share many properties with those in infant development, including a mixture of regularities and diversities in the developmental patterns. Finally, we argue that such emergent developmental structures can guide and constrain evolution, in particular with regard to the origins of language. (shrink)

Minkoff et al. (2024) discuss the potential deprivation of medical liberties against pregnant persons following Dobbs v. Jackson Women’s Health. Another consideration is how Dobbs may impact physic...

Learning depends on attention. The processes that cue attention in the moment dynamically integrate learned regularities and immediate contextual cues. This paper reviews the extensive literature on cued attention and attentional learning in the adult literature and proposes that these fundamental processes are likely significant mechanisms of change in cognitive development. The value of this idea is illustrated using phenomena in children's novel word learning.