Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

The dominant paradigm of experiments in the social and behavioral sciences views an experiment as a test of a theory, where the theory is assumed to generalize beyond the experiment's specific conditions. According to this view, which Alan Newell once characterized as “playing twenty questions with nature,” theory is advanced one experiment at a time, and the integration of disparate findings is assumed to happen via the scientific publishing process. In this article, we argue that the process of integration is (...) at best inefficient, and at worst it does not, in fact, occur. We further show that the challenge of integration cannot be adequately addressed by recently proposed reforms that focus on the reliability and replicability of individual findings, nor simply by conducting more or larger experiments. Rather, the problem arises from the imprecise nature of social and behavioral theories and, consequently, a lack of commensurability across experiments conducted under different conditions. Therefore, researchers must fundamentally rethink how they design experiments and how the experiments relate to theory. We specifically describe an alternative framework, integrative experiment design, which intrinsically promotes commensurability and continuous integration of knowledge. In this paradigm, researchers explicitly map the design space of possible experiments associated with a given research question, embracing many potentially relevant theories rather than focusing on just one. Researchers then iteratively generate theories and test them with experiments explicitly sampled from the design space, allowing results to be integrated across experiments. Given recent methodological and technological developments, we conclude that this approach is feasible and would generate more-reliable, more-cumulative empirical and theoretical knowledge than the current paradigm – and with far greater efficiency. (shrink)

Much contemporary nanotoxicology, nanotherapeutic and nanoregulatory research has been characterised by a focus on investigating how delivery of engineered nanoparticles (ENPs) to cells is dictated primarily by components of the ENP surface. An alternative model, some implications of which are discussed here, begins with fundamental physicochemical research into the interaction of a dynamic nanoparticle-protein corona (NPC) with biological systems. The proposed new model also requires, however, that any such fresh NPC physicochemical research approach should involve integration and targeted collaboration from (...) the earliest stages with nanotoxicology, nanotherapeutics and nanoregulatory expertise. The justification for this integrated approach, we argue, relates not just to efficiency and promotion of innovation, but to an acknowledgement that public-funded basic physicochemical research in particular should now be accepted to incorporate strong higher order public goods elements from its inception, not merely after product development at the technology transfer stage. Issues, in other words, such as university research co-operation, commercialization and intellectual property (IP) protection, safety and cost-effectiveness regulatory assessment, as well as technology transfer should not be viewed as second tier considerations even in a ‘blue sky’ NPC basic research agenda. (shrink)

This article address the issue of employee safety and the social responsibility of multinational apparel retailers who contract with Bangladesh manufacturers in their global supply chain. Both the Alliance for Bangladesh Worker Safety and the Accord on Fire and Building Safety in Bangladesh have been identified as the two primary facilitators for global apparel industry efforts to actively address this serious human rights issue; thus, they have the potential to help drive the success of the industry's corporate citizenship efforts to (...) successfully manage the issue of fire and building safety in Bangladesh. The article further explores these relationships within the context of the “global corporate citizenship” concept, and develops a rationale for the limits of a socially responsible supply chain. In the context of global corporate citizenship, the article describes the existing state of these two industry organizations remediation efforts to ensure a stable supply chain in Bangladesh, and offers an analysis of existing industry nonmarket strategy approaches to improving contractor's factory fire and building safety environments for their employees. Lastly, a comprehensive set of nonmarket strategies for multinational apparel retailers is recommended when addressing their global corporate citizenship commitments to a safe working environment for Bangladesh garment manufacturing employees. (shrink)

Commentaries on the target article offer diverse perspectives on integrative experiment design. Our responses engage three themes: (1) Disputes of our characterization of the problem, (2) skepticism toward our proposed solution, and (3) endorsement of the solution, with accompanying discussions of its implementation in existing work and its potential for other domains. Collectively, the commentaries enhance our confidence in the promise and viability of integrative experiment design, while highlighting important considerations about how it is used.

Supererogation has gained attention as a means of explaining the voluntary behaviours of individuals and organizations that are done for the benefit of others and which go above what is required of legislation and what may be expected by society. Whilst the emerging literature has made some significant headway in exploring supererogation as an ethical lens for the study of business there remain several important issues that require attention. These comprise, the lack of primary evidence upon which such examinations have (...) been made, attention has been given to only singular pro-social acts of organizations, and the focus has been upon the actions of large organizations. Furthermore, Heyd’s (Supererogation, Cambridge University Press, 1982) original taxonomy of six supererogatory acts, comprising Moral Heroism, Beneficence, Volunteering, Favour, Forgiveness and Forbearance, has been considered to be complete and other forms of supererogatory acts have not yet been explored. In order to address these gaps this study poses the research questions: First, it studies how a single, contemporary SME performs multiple supererogatory acts in its attempts to address its social and environmental goals that go beyond CSR. Second, it seeks to gain a deeper theoretical understanding of Heyd’s (Supererogation, Cambridge University Press, 1982) taxonomy of six forms of supererogation through the capture of primary data. This research makes a three-year case study examination of a single SME that has been formally recognized for its work in addressing social and environmental issues at local, national and global levels. Primary data are acquired of the supererogatory acts that it performs through a three-year participant observation case study, utilizing 61 interviews and 3 focus groups with internal and external stakeholders. In doing so, it addresses the empirical limitations of the extant research, substantiates each of the forms that supererogatory acts may take, and makes a contribution to the theory of supererogation by identifying a further class of act that is ‘Sharing’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beauty, Transcendence, and the Inclusive Hierarchy of Creation1Thomas Joseph White, O.P.Interpreters of Thomas Aquinas have long argued about whether he holds that beauty is a “transcendental,” a feature of reality coextensive with all that exists, like unity, goodness, and truthfulness.2 In the first part of this article, I will argue that Aquinas can [End Page 1215] be read to affirm in an implicit way that beauty is a (...) transcendental. In the second part, I will consider what it might mean from a Thomistic point of view to speak of a transcendent divine beauty, given Aquinas’s metaphysical commitments, particularly with respect to his doctrine of divine simplicity. In the final part, I will treat the question of how the beauty of the creation both manifests and conceals divine beauty.Beauty as a Transcendental Feature of RealityAquinas does not list beauty as a transcendental term in texts on transcendental notions. Perhaps, then, one should simply exclude it from a responsible account of his teaching on this subject. However, at least two well-known texts should give us reason to pause before reaching such a conclusion. One is found in his Commentary on Dionysius’ Divine Names, chapter 4, lectio 5. The other is in his discussion of the beauty of the eternal Son of God in a discussion of the Holy Trinity in the Summa theologiae I, q. 39, a. 8.In the first of these texts, Aquinas is commenting on Dionysius. The extended text is analytically dense. Aquinas is discussing ways in which one might say that God is beautiful and in what ways one might not say so. I will return to his topic below. Here, however, it is pertinent to consider Aquinas’s discussion of the presence of beauty in all that exists. He makes six main points.3 First, all beauty comes [End Page 1216] from God insofar as God is the cause of all that exists. Second, he gives a first definition of beauty: beauty can be defined ontologically as the splendor (claritas) that results from form; everything has a formal determination of some kind insofar as it has existence (esse); therefore, insofar as anything exists (and has some formal ontological content) it has some degree of beauty. Third, the splendor of the form in created things is a participation in the divine splendor from which it originates. The divine nature is the transcendent exemplar of beauty in diverse finite created realities. Fourth, then (and perhaps most importantly), “ex divina pulchritudine esse omnium derivatur”: literally, the existence of everything originates from divine beauty. Fifth, a second definition of beauty is considered: beauty can be defined ontologically as a property of being that emerges from proportion or harmony (consonantia). For example, authentic relationships of personal friendship imply spiritual harmony or concord and are beautiful and noble in this respect. Sixth, then, the concord or beautiful harmonies we find in the created order are expressive of the wisdom of God, who is the author of creation.Evidently, if the existence of everything derives from divine beauty, and if everything that has existence is in some way beautiful by virtue of its intrinsic form, then it would seem to follow logically that beauty, for Aquinas, is a characteristic of being that is coextensive with all that exists. We see a similar idea expressed in the aforementioned passage of ST. Here, however, Aquinas gives a more synthetic definition of beauty in things that combines both the definitions found in our previous discussion, claritas and proportio, but it also adds a third, integritas: ontological integrity or wholeness.Species or beauty has a likeness to the property of the Son. For beauty includes three conditions, “integrity” or “perfection,” [End Page 1217] since those things which are impaired are by the very fact ugly; due “proportion” or “harmony”; and lastly, “brightness” or “clarity,” whence things are called beautiful which have a bright color.4The implication of this point of view is readily apparent. God is essentially beautiful, and God has created all that exists in light of the eternal Word and Wisdom of God, who is the Son. Consequently, all that exists and that... (shrink)

ABSTRACTAlthough attention bias toward threat has been associated with Social Anxiety Disorder, concerns regarding the ability of current measures to detect change in AB following treatm...

Arguably the biggest challenge in analyzing English tense is to account for the double access interpretation, which arises when a present tensed verb is embedded under a past attitude—e.g., "John said that Mary is pregnant". Present-under-past does not always result in a felicitous utterance, however—cf. "John believed that Mary is pregnant". While such oddity has been noted, the contrast has never been explained. In fact, English grammars and manuals generally prohibit present-under-past. Work on double access, on the other hand, has (...) either disregarded the oddity (e.g., Abusch 1997: 39) or treated it as a reflex of a particular dialect (e.g., Kratzer 1998: 14). The goal of the paper is to argue—based on a corpus study—that a present-under-past sentence is grammatical, but modulated by two, interacting pragmatic phenomena: cessation and parentheticality. (shrink)

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas (...) as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment. (shrink)

The work of Thomas White represents a systematic attempt to combine the best of the new science of the seventeenth century with the best of Aristotelian tradition. This attempt earned him the criticism of Hobbes and the praise of Leibniz, but today, most of his attempts to navigate between traditions remain to be explored in detail. This paper does so for his ontology of accidents. It argues that his criticism of accidents in the category of location as entities over (...) and above substances was likely aimed at Francisco Suárez, and shows how White’s worries about the analysis of location were linked with his broader cosmological views. White rejects real qualities, but holds that the quantity of a substance is somehow distinct from its bearer. This reveals a common ground with some of his scholastic interlocutors, but lays bare a deep disagreement with thinkers like Descartes on the nature of matter. (shrink)

Is it possible for an individual that has gone out of being to come back into being again? The English Aristotelian, Thomas White, argued that it is not. Thomas Hobbes disagreed, and used the case of the Ship of Theseus to argue that individuals that have gone out of being may come back into being again. This paper provides the first systematic account of their arguments. It is doubtful that Hobbes has a consistent case against White. Still his (...) criticism may have prompted White to clarify his views on identity over time in his later work. (shrink)

This article contends that James Baldwin’s exploration of racism and resistance to it in The Fire Next Time may be put into conversation with Ludwig Wittgenstein’s consideration of fundamental epistemic commitments in On Certainty. Out of this constructive engagement, I argue that white supremacism in the United States may be interpreted as being like a Wittgensteinian grounding or "hinge" commitment and that this viewpoint illuminates some of the ways in which white supremacism may interact with various kinds of religious commitments. (...) This combined analysis depicts the extent to which fundamental commitments about race deeply affect people, including the formation of their ethical and civic values, existential and religious commitments, and range of empathetic capacity and also details similarities between Baldwin and Wittgenstein when it comes to their contentions that there is ethical value in the clarification of language and work on oneself. (shrink)

ABSTRACTPrior research on attention bias in anxious youth, often utilising a visual dot probe task, has yielded inconsistent findings, which may be due to how bias is assessed and/or variability in the phenomenon. The present study utilises eye gaze tracking to assess attention bias in socially anxious adolescents, and explores several methodological and within-subject factors that may contribute to variability in attention bias. Attention bias to threat was measured in forty-two treatment-seeking adolescents diagnosed with Social Anxiety Disorder. Bias scores toward (...) emotional stimuli and bias scores away from emotional stimuli were explored. Bias scores changed between vigilance and avoidance within individuals and over the course of stimulus presentation. These differences were not associated with participant characteristics nor with self-reported social anxiety symptoms. However, clinician rated severity of social anxiety, explained a signific... (shrink)

Thomas Hobbes. CHAPITRE IV LE TEXTE DU MANUSCRIT DE PARIS (Fonds latin 6566 A) Le manuscrit Ce manuscrit est un petit in-folio dont la reliure en chagrin couvert de velours, d'un genre qui n'est pas rare à la fin du xvif siècle et au ...

Historians have long since rejected the dubious assertions of the conflict model, with its narratives of perennial religion versus science combat. Nonetheless, this theory persists in various academic disciplines, and it is still presented to university students as the authoritative historical account of religion–science interactions. Cases of this can be identified within modern anthropology textbooks and reference materials, which often recapitulate claims once made by John W. Draper and Andrew D. White. This article examines 21st-century introductory anthropology publications, demonstrating how (...) such works perpetuate religion–science myths and the notion that history has been replete with inevitable religion versus science warfare. In particular, this study reveals how such introductory materials propagate discord narratives associated with the Scientific Revolution and the Enlightenment. Affiliated with these anecdotes are oversimplified accounts of religious responses to heliocentrism and evolutionary theory, as well as claims that science has invariably led to the usurpation of religious belief and secularization from Galileo onwards. (shrink)

This paper concerns the influence of gender on a firm’s moral and economic performance. It supports Thomas White’s intimation of a male gender bias in the value system underlying extant business theory. We suggest that this gender bias may be corrected by drawing on the concept of substantive rationality inherent in virtue-ethics theory. This feminine-oriented relationship-based value system complements the essential nature of the firm as a nexus of relationships between stakeholders. Not only is this feminine firm morally desirable, (...) but it is also economically more efficient in that trust becomes a more feasible implicit contractual enforcement mechanism. In an organizational context, therefore, from both a moral and an economic perspective, long established economic man is dominated by nascent economic woman. (shrink)

This paper concerns the influence of gender on a firm’s moral and economic performance. It supports Thomas White’s intimation of a male gender bias in the value system underlying extant business theory. We suggest that this gender bias may be corrected by drawing on the concept of substantive rationality inherent in virtue-ethics theory. This feminine-oriented relationship-based value system complements the essential nature of the firm as a nexus of relationships between stakeholders. Not only is this feminine firm morally desirable, (...) but it is also economically more efficient in that trust becomes a more feasible implicit contractual enforcement mechanism. In an organizational context, therefore, from both a moral and an economic perspective, long established economic man is dominated by nascent economic woman. (shrink)

Thomas Aquinas was first and foremost a Christian theologian. Yet he was also one of the greatest philosophers of the Middle Ages. Drawing on classical authors, and incorporating ideas from Jewish and Arab sources, he came to offer a rounded and lasting account of the origin of the universe and of the things to be found within it, especially human beings.

The concept of situatedness turns away from ideals of objectivity “from nowhere” and denotes the marking of the place from which a discourse or a theoretical approach takes its starting point. Theories of different traditions have emphasised the need to reflect on their own situatedness in order to avoid mere doxa. Since “situation” is one of the basic concepts of existential phenomenologies (Heidegger, Sartre, Merleau-Ponty), it can serve as a terminological foundation for a reflection of embodied standpoints. The space- and (...) perception-theoretical difference between situation and position – developed in phenomenology of perception and space orientation – can be further thought politically and expanded into “situational difference”. With the ambivalent intermediate position between the place of speaking and the space of the political, an analytical differentiation would be available that can lead to a phenomenological explication of the logic of the politics of positioning. (shrink)

This book looks at the possible research and clinical applications of psychedelic substances. Instead of considering the experiences one can have with psychedelics or their uses in psychotherapy, this book views psychedelics' implications for a number of topics "coming over the psychedelic horizon," so to speak.

This essay results from a common interest in the history of emotions shared by an academic with appointments in philosophy and psychiatry (Charland) and a literary historian (White). Where our interests converge is in the early modern concept of 'the passions,' as explanatory of what we now call mental illness. The task we have set ourselves is to see how this might: (a) be exemplified in a 'case study' of the dramatic revelation of Leontes's jealousy in the first half of (...) William Shakespeare's The Winter's Tale, and his 'cure' which takes sixteen years. Both events have troubled literary critics as implausible, lacking in realistic motivation, and clumsy as narrative devices, but can be explained in terms of theories of the passions ; and (b) open up a greater, modern understanding of irrational, pathological states, their onset and termination, by using as an explanatory model the early modern understanding of passions as revived and refined in the nineteenth century by Théodule Ribot. Janus-like, this chapter faces into the past and the future (our present) via a play written in 1610 that is still performed to receptive audiences today. We hope to show that the theory can illuminate a playtext, and that the play can revivify the theory, and to contend that historical analysis can shed light on modern clinical problems. The particular historical distinction which lies at the heart of our approach derives from early modern terminology offered by Thomas Wright in his book, The Passions of the Minde in Generall (first published in 1601; corrected, enlarged and augmented in 1604), and presented in more modern fashion in the nineteenth century by Théodule Ribot, in his La Psycholgie des sentiments * We dedicate this essay to Philippa Maddern, whose inspiration has generated so much inter-disciplinary research in the history of emotions and has brought so many like-minded scholars into fertile contact—in our cases, linking Western Ontario and Western Australia. (shrink)

The selection from Capreolus's work represented in this translation shows him defending Aquinas's conclusions on faith, hope, charity, the gifts of the Holy Spirit, and the virtues against such adversaries.