Xenotransplantation pits clinical research ethics against public health needs because recipients must undergo long-term, perhaps life-long, surveillance for infectious diseases. This surveillance requirement is effectively an abrogation of the right to withdraw from a clinical trial. Ulysses contracts, which are advance directives for future care, may be an ethical mechanism by which to balance public health needs against limitation of individual rights.

Xenotransplantation is defined as “any procedure that involves the transplantation, implantation, or infusion into a human recipient of either live cells, tissues, or organs from a nonhuman animal source, or human body fluids, cells, tissues or organs that have had ex vivo contact with live nonhuman animal cells, tissues, or organs.” Xenotransplantation has been viewed by desperate patients and their surgeons as a solution to the problem of the paucity of human organs available for transplantation. Foes of xenotransplantation argue that (...) the use of animal organs degrades the human race and should be avoided.In this paper, we briefly review the cultural context of xenotransplantation and explore the infectious disease risk of xenotransplantation. The United States Code of Federal Regulations requires life-long surveillance of a xenotransplantation recipient due to the largely unknown risk of novel infectious disease transmitted across species, known as xenogeneic infectious disease. We argue that despite being in the interest of protecting the public health, the imposition of lifelong surveillance requirements on xenotransplant recipients effectively abrogates the right to withdraw from a clinical trial after the transplantation has taken place. Moreover, we argue that a waiver of the right to withdraw should be made explicit in the interest of full disclosure, out of respect for the research subject’s right of self-determination. (shrink)

Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health (...) care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly. (shrink)

Ayudha Puja, a South Indian festival translated as “worship of the machines,” is a dramatic example of how religion and science intertwine in political life. Across South India, but especially in the state of Karnataka, scientists and engineers celebrate the festival in offices, laboratories, and workshops by attending a puja led by a priest. Although the festival is noteworthy in many ways, one of its most immediate valences is political. In this article, we argue that Ayudha Puja normalizes Brahminical Hinduism (...) within scientific culture through the inclusion of non-Hindus and through scientists' description of the festival as “cultural” rather than “religious.”. (shrink)

Volume 20, Issue 5, June 2020, Page 40-42.

In “Bioethics and the Whole: Pluralism, Consensus, and the Transmutation of Bioethical Methods into Gold,” Patricia Martin identifies themes common to three emerging approaches to clinical bioethics--clinical pragmatism, ethics facilitation, and mediation-in order to develop an “ethical consensus method” that can serve as a “practical, step-by-step guide” for decision making She is to be applauded both for her identification of themes common to these three approaches and for her contribution to what we hope will be a growing literature on practical (...) methods for problem solving in clinical bioethics that take seriously the ideal of consensus. After a few preliminary remarks concerning Martin's working model, we focus the majority of our commentary on the notion of “consensus,” which is at the heart of her “ethical consensus method,” and the three approaches from which it is drawn. (shrink)

In “Bioethics and the Whole: Pluralism, Consensus, and the Transmutation of Bioethical Methods into Gold,” Patricia Martin identifies themes common to three emerging approaches to clinical bioethics--clinical pragmatism, ethics facilitation, and mediation-in order to develop an “ethical consensus method” that can serve as a “practical, step-by-step guide” for decision making She is to be applauded both for her identification of themes common to these three approaches and for her contribution to what we hope will be a growing literature on practical (...) methods for problem solving in clinical bioethics that take seriously the ideal of consensus. After a few preliminary remarks concerning Martin's working model, we focus the majority of our commentary on the notion of “consensus,” which is at the heart of her “ethical consensus method,” and the three approaches from which it is drawn. (shrink)

In “Bioethics and the Whole: Pluralism, Consensus, and the Transmutation of Bioethical Methods into Gold,” Patricia Martin identifies themes common to three emerging approaches to clinical bioethics--clinical pragmatism, ethics facilitation, and mediation-in order to develop an “ethical consensus method” that can serve as a “practical, step-by-step guide” for decision making She is to be applauded both for her identification of themes common to these three approaches and for her contribution to what we hope will be a growing literature on practical (...) methods for problem solving in clinical bioethics that take seriously the ideal of consensus. After a few preliminary remarks concerning Martin's working model, we focus the majority of our commentary on the notion of “consensus,” which is at the heart of her “ethical consensus method,” and the three approaches from which it is drawn. (shrink)

Andrew Bailey's highly-regarded introductory anthology has been revised and updated in this new concise edition. First Philosophy : Knowing and Being brings together over thirty classic and contemporary readings in epistemology and metaphysics. Mindful of the intrinsic difficulty of the material, the editors provide comprehensive introductions both to each topic and to each individual selection. By presenting a detailed discussion of the historical and intellectual background to each piece, the editors enable readers to approach the material without unnecessary barriers to (...) understanding. A brief introduction to arguments is included, as are appendices on terminology and philosophical puzzles and paradoxes. (shrink)

Responsibility is impossible because there is no responsibility-maker and there needs to be one if people are morally responsible. The two most plausible candidates, psychology and decision, fail. A person is not responsible for an unchosen psychology or a psychology that was chosen when the person is not responsible for the choice. This can be seen in intuitions about instantly-created and manipulated people. This result is further supported by the notion that, in general, the right, the good, and virtue rest (...) on the exercise of a capacity rather than the capacity itself. It is also supported by the notion that negligence is not a responsibility-maker. ​ A person is not responsible for a choice that does not reflect his psychology or that does reflect it when he is not responsible for the psychology. This can be seen by considering intuitions regarding acts that are unconnected or arbitrarily connected to a person’s psychology. It can also be seen intuitions about acts that result from a manipulated psychology. The problem with choice as a foundation can be further seen in that an infinite or self-created person would not be responsible despite these superhuman choice-related features. (shrink)

Richard Martin's thoroughly philosophical as well as thoroughly tech nical investigations deserve continued and appreciative study. His sympathy and good cheer do not obscure his rigorous standard, nor do his contemporary sophistication and intellectual independence obscure his critical congeniality toward classical and medieval philosophers. So he deals with old and new; his papers, in his neat self-descriptions, consist of reminders, criticisms, and constructions. They might also be seen as studies in the understanding of truth, ramifying as widely in mathematics, logic, (...) and epistemology as well as metaphysics, as such understanding has required. For us it is a pleasant occasion to welcome Richard Martin's new Boston Studies, and to note his continuously con collection to the structive and critical interventions at the Boston Colloquium for the of Science. Philosophy Boston University Center for the R. S. COHEN Philosophy and History of Science M. W. WARTOFSKY July 1979 vii TABLE OF CONTENTS EDITORIAL PREFACE vii PREFACE xi ACKNOWLEDGEMENTS xv I. Truth and Its Illicit Surrogates II. Some Reminders concerning Truth, Satisfaction, and Reference 17 III. On Disquotation and Intensionality 30 IV. On Truth, Belief, and Modes of Description 42 V. The Pragmatics of Self-Reference 55 VI. On Suppositio and Denotation 72 VII. Of Time and the Null Individual 82 VIII. Existence and Logical Form 95 IX. Tense, Aspect, and Modality 110 X. Of 'Of' 130 XI. Events and Actions: Brand and Kim 144 XII. Why I Am Not a Montague Grammarian 160 XIII. (shrink)

Sperm motility and respiration are tightly coupled processes, both activated by an increased intracellular pH (pHi). As the sperm pHi increases, the flagellar motor driving motility is activated, leading to ATP consumption. Energy for motility is provided by mitochondrial respiration; energy transport from sperm mitochondrion to tail involves distinct isozymes of creatine kinase that effect a phosphorylcreatine shuttle. The activation of sperm motility and respiration can be described as a linked series of biochemical reactions that form a cell behavioural pathway (...) analogous to the reaction sequences of intermediary metabolism. (shrink)

Sperm motility and respiration are tightly coupled processes, both activated by an increased intracellular pH (pHi). As the sperm pHi increases, the flagellar motor driving motility is activated, leading to ATP consumption. Energy for motility is provided by mitochondrial respiration; energy transport from sperm mitochondrion to tail involves distinct isozymes of creatine kinase that effect a phosphorylcreatine shuttle. The activation of sperm motility and respiration can be described as a linked series of biochemical reactions that form a cell behavioural pathway (...) analogous to the reaction sequences of intermediary metabolism. (shrink)

This investigation proposes a conceptual framework for measurement necessary for an analysis of household finance and economic development. The authors build on and, where appropriate, modify corporate financial accounts to create balance sheets, income statements, and statements of cash flows for households in developing countries, using an integrated household survey. The authors also illustrate how to apply the accounts to an analysis of household finance that includes productivity of household enterprises, capital structure, liquidity, financing, and portfolio management. The conceptualization of (...) this analysis has important implications for measurement, questionnaire design, the modeling of household decisions, and the analysis of panel data. (shrink)

The non-financial effects (NFE) antitakeover amendment addresses the duties of company directors and management when faced with a possible takeover bid. The NFE amendment either permits or requires managers to consider the interests of the company's stakeholders during takeover bids. Other types of antitakeover devices have been viewed as protecting either stockholder or management interests. The NFE amendment would appear to protect a broad spectrum of interests including those of company employees, creditors, and the community in which the company operates. (...) Positive market returns to the adoption of NFE amendments provide some evidence that investors approve. The percent of both management and institutional ownership are positively related to the market reaction to the NFE amendment adoption. To the extent that institutional ownership proxies for the broad spectrum of stakeholder interest, NFE devices, unlike some other amendments that have been studied, appear to be in the interests of more than a single interest group. (shrink)

In the United States, people may donate organs and tissues to a family member, friend, or anyone whose specific need becomes known to them. For example, in late 2003 dozens of people came forward to donate a kidney to a professional basketball player known to them only through his sports performances. People may also donate a kidney to no one in particular through a process known as nondirected donation. In nondirected donation, people donate a kidney to the organ allocation system (...) rather than to anyone known to them personally. There are limits, though, to generosity. People are usually not allowed to donate to groups of people, no matter the contours of the group, whether white, black, Catholic or Presbyterian, third-time liver recipient, and so on. As the agency that oversees national transplantation policy, the United Network for Organs Sharing does not allow this sort of restricted donation, though it appears that some regional Organ Procurement Organizations occasionally bend the rules when donors insist that their organs go to children or to first-time recipients. Those ad hoc arrangements are, however, the exception to the rule. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)