The U.S. National Institute of Allergies and Infectious Diseases and the National Institute of Mental Health have a new research priority: inclusion of terminally ill persons living with HIV in HIV cure-related research. For example, the Last Gift is a clinical research study at the University of California San Diego for PLWHIV who have a terminal illness, with a prognosis of less than 6 months. As end-of-life HIV cure research is relatively new, the scientific community has a timely opportunity to (...) examine the related ethical challenges. Following an extensive review of the EOL and HIV cure research ethics literature, combined with deliberation from various stakeholders and our experience with the Last Gift study to date, we outline considerations to ensure that such research with terminally ill PLWHIV remains ethical, focusing on five topics: 1) protecting autonomy through informed consent, 2) avoiding exploitation and fostering altruism, 3) maintaining a favorable benefits/risks balance, 4) safeguarding against vulnerability through patient-participant centeredness, and 5) ensuring the acceptance of next-of-kin/loved ones and community stakeholders. EOL HIV cure-related research can be performed ethically and effectively by anticipating key issues that may arise. While not unique to the fields of EOL or HIV cure-related research, the considerations highlighted can help us support a new research approach. We must honor the lives of PLWHIV whose involvement in research can provide the knowledge needed to achieve the dream of making HIV infection curable. (shrink)

Often a single question can spark a meaningful, fun exchange-- like "Would you apply for a job you know your friend is applying for?" Or "Should voting be mandatory?" Or what about police using facial recognition technology? Questions like these spur us to consider: What would I have done? Is there one correct answer? And ultimately: How can ethics help us navigate these situations to find the best outcome for ourselves and others? An ethicist who advises leaders and organizations worldwide, (...) Susan Liautaud asks intriguing questions that encourage lively discussion across a range of subjects, from family and friends to health and technology to politics, work, and consumer choices. She then walks through the way you might approach each situation to find the best answer for you. Grab the book, gather a few friends, and dive in!"--back cover. (shrink)

BackgroundOne of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it.MethodsWe conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the (...) United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable.ResultsAll four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants’ comfort and needs at the EOL.ConclusionBecause of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research’s impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings. (shrink)

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...) condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations. (shrink)

The active debate about the return of incidental or secondary findings in research has primarily focused on return to research participants, or in some cases, family members. Particular attention has been paid to return of genomic findings. Yet, research may generate other types of findings that warrant consideration for return, including findings related to the pathology of donated biospecimens. In the case of deceased biospecimen donors who are also organ and/or tissue transplant donors, pathology incidental findings may be relevant not (...) to family members, but to potential organ or tissue transplant recipients. This paper will describe the ethical implications of pathology incidental findings in the Genotype-Tissue Expression project, the process for developing a consensus approach as to if/when such findings should be returned, possible implications for other research projects collecting postmortem tissues and how the scenario encountered in GTEx fits into the larger return of results/incidental findings debate. (shrink)

A defendant’s failure to show remorse is one of the most powerful factors in criminal sentencing, including capital sentencing. Yet there is currently no evidence that remorse can be accurately evaluated in a courtroom. Conversely there is evidence that race and other impermissible factors create hurdles to evaluating remorse. There is thus an urgent need for studies about whether and how remorse can be accurately evaluated. Moreover, there is little evidence that remorse is correlated with future law-abiding behavior or (...) other legitimate penal purposes, and, in fact, there is evidence that remorse is often conflated with shame, which is correlated with increased future criminality. More accurate information on the nature and evaluation of remorse can be used to reform the criminal justice system. (shrink)

Background Dynamic consent has been proposed as a process through which participants and patients can gain more control over how their data and samples, donated for biomedical research, are used, resulting in greater trust in researchers. It is also a way to respond to evolving data protection frameworks and new legislation. Others argue that the broad consent currently used in biobank research is ethically robust. Little empirical research with cohort study participants has been published. This research investigated the participants’ (...) opinions of adding a dynamic consent interface to their existing study. Methods Adult participants in the Extended Cohort for E-health, Environment and DNA longitudinal cohort study who are members of the EXCEED Public and Participant Engagement Group were recruited. Four focus groups were conducted and analysed for thematic content. Discussion topics were derived from a review of the current literature on dynamic consent. Results Participants were in favour of many aspects of a dynamic consent interface, such as being able to update their information, add additional data to their records and choose withdrawal options. They were supportive provided it was simple to use and not intrusive. Participants expressed a markedly high level of trust in the study and its investigators and were unanimously happy with their current participation. No strong support was found for adding a dynamic consent interface to EXCEED. Conclusions Trust in the study researchers was the strongest theme found. Openness and good data security were needed to retain their trust. While happy to discuss dynamic consent, participants were satisfied with the current study arrangements. There were indications that changing the study might unnecessarily disturb their trust. This raised the question of whether there are contexts where dynamic consent is more appropriate than others. This study was limited by the small number of participants who were committed to the study and biased towards it. More research is needed to fully understand the potential impact of adding a dynamic consent interface to an existing cohort study. (shrink)

The term conceptual simulation refers to a type of everyday reasoning strategy commonly called “what if” reasoning. It has been suggested in a number of contexts that this type of reasoning plays an important role in scientific discovery; however, little direct evidence exists to support this claim. This article proposes that conceptual simulation is likely to be used in situations of informational uncertainty, and may be used to help scientists resolve that uncertainty. We conducted two studies to investigate the (...) relationship between conceptual simulation and informational uncertainty. Study 1 was an in vivo study of expert scientists; the results suggest that scientists do use conceptual simulation in situations of informational uncertainty, and that they use conceptual simulation to make inferences from their data using the analogical reasoning process of alignment by similarity detection. Study 2 experimentally manipulated experts' level of uncertainty and provides further support for the hypothesis that conceptual simulation is more likely to be used in situations of informational uncertainty. Finally, we discuss the relationship between conceptual simulation and other types of reasoning using qualitative mental models. (shrink)

Bioethics has paid surprisingly little attention to the special problems faced by women and to feminist analyses of current health care issues other than ...

Re-consent in research, the asking for a new consent if there is a change in protocol or to confirm the expectations of participants in case of change, is an under-explored issue. There is little clarity as to what changes should trigger re-consent and what impact a re-consent exercise has on participants and the research project. This article examines applicable policy statements and literature for the prevailing arguments for and against re-consent in relation to longitudinal cohort studies, tissue banks and (...) biobanks. Examples of re-consent exercises are presented, triggers and non-triggers for re-consent discussed and the conflicting attitudes of commentators, participants and researchers highlighted. We acknowledge current practice and argue for a greater emphasis on ‘responsive autonomy,’ that goes beyond a one-time consent and encourages greater communication between the parties involved. A balance is needed between respecting participants' wishes on how they want their data and samples used and enabling effective research to proceed. (shrink)

The core of the language of thought program is the claim that thinking is the manipulation of symbols according to rules. Yet LOT has said little about symbol natures, and existing accounts are highly controversial. This is a major flaw at the heart of the LOT program: LOT requires an account of symbol natures to naturalize intentionality, to determine whether the brain even engages in symbol manipulations, and to understand how symbols relate to lower-level neurocomputational states. This paper provides (...) the much-needed theory of symbols, and in doing so, alters the LOT program in significant respects. (shrink)

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties (...) including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

Past studies have shown that women’s volunteer work benefits communities but that women themselves tend to minimize their efforts. Most of these studies, however, have been limited to women volunteering in suburban and urban contexts. Drawing on a study of women volunteers in rural Iowa, the authors find that women frame their volunteer experiences in three ways: as an expression of their maternal nature, as a way to socialize, and as a contribution to the local economy. The authors’ findings depart (...) from past research in that the women in their sample do not downplay the importance of their volunteer work; rather, they recognize the importance of their unpaid labor for the social and economic vitality of the community. The authors argue this recognition stems from the particular context in which their volunteerism takes place, namely, in a devastated rural economy in which future economic potential rests on women’s hospitality work. (shrink)

Canada’s population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who (...) usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs’ experiences of ethically challenging situations is warranted.We conducted a phenomenological study to access the lived experience of HCAs (N=12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care. (shrink)

How do our personalities and mental processes, our " states of consciousness" , derive from a gray mass of tissue with the consistency of a soft-boiled egg? How can mere molecules constitute an idea or emotion? Some of the most important questions we can ask are about our own consciousness. Our personalities, our individuality, indeed our whole reason for living, lie in the brain and in the elusive phenomenon of consciousness it generates. Thinkers in many disciplines have long struggled with (...) such questions, often in ways that have seemed incompatible, if not downright contradictory. Philosophers have meditated on the subjective experience of consciousness, with little attention to the physical realm, while scientists have sought to establish a causal relation between brain function and mind, often ignoring the qualitative aspects of experience. In Journey to the Centers of the Mind, neuroscientist Susan Greenfield offers an intriguing, unifying theory of consciousness that encompasses both phenomenological mental events and physical aspects of brain function. Using information gathered from clues in animal behavior, human brain damage, computer science, neurobiology, and philosophy, Greenfield offers a " concentric theory" of consciousness, and shows how certain events in the brain correspond to our qualitative experience of the world. Demonstrating the ways in which we can interpret the experience of consciousness in terms of interactions among neurons, she explores how much we can learn by continuing to find the links between our physical and mental inner worlds. (shrink)

The historical antecedents of Garrett Hardin’s “tragedy ofthe commons” are generally understood to lie in the common grazing lands of medieval and post-medieval England. The concept of the commons current in medieval England is significantly different from the modem concept; the English common was not available to the general public but rather only to certain individuals who inherited or were granted the right to use it, and use of the common even by these people was not unregulated. The types and (...) in some cases the numbers of animals each tenant could pasture were limited, based at least partly on a recognition of the limited carrying capacity of the land. The decline of the commons system was the result of a variety of actors having little to do with the system’s inherent worth. Among these factors were widespread abuse of the rules governing the commons, land “reforms” chiefly designed to increase the holdings of a few landowners, improved agricultural techniques, and the effects of the industrial revolution. Thus, the traditional commons system is not an example of an inherently flawed land-use policy, as is widely supposed, but of a policy which succeeded admirably in its time. (shrink)

The human sensory system is continuously engaged in experiencing and interpreting every interaction with other living beings, objects, and the environment. The purpose of this article is to describe the impact limited opportunities for rich sensory experiences have on students with severe disabilities in two middle school classrooms situated in a public separate school in the southeastern USA. The study employed a postcritical ethnographic approach and grounded theory thematic analysis of fieldnotes gathered over a two-year period. Three major themes supported (...) by the data are presented and discussed in depth. They are: students are afforded limited sensory rich experiences, everyday routines make students passive recipients to school, and instructional approaches result in little interaction with extended periods of waiting. The implications of the findings for improved sensory experiences and possible future directions are described. (shrink)

Suppose it is 2025 and being a technophile, you purchase brain enhancements as they become readily available. First, you add a mobile internet connection to your retina, then, you enhance your working memory by adding neural circuitry. You are now officially a cyborg. Now skip ahead to 2040. Through nanotechnological therapies and enhancements you are able to extend your lifespan, and as the years progress, you continue to accumulate more far-reaching enhancements. By 2060, after several small but cumulatively profound alterations, (...) you are a “posthuman.” To quote philosopher Nick Bostrom, posthumans are possible future beings, “whose basic capacities so radically exceed those of present humans as to be no longer unambiguously human by our current standards” (Bostrom 2003c). At this point, your intelligence is enhanced not just in terms of speed of mental processing; you are now able to make rich connections that you were not able to make before. Unenhanced humans, or “naturals,” seem to you to be intellectually disabled—you have little in common with them—but as a transhumanist, you are supportive of their right to not enhance (Bostrom 2003c; Garreau 2005; Kurzweil 2005). (shrink)

The capacity of a work of fictional literature to elicit emotional responses is part of what is valuable about it, and having emotional responses is part of appreciating it. These claims are not very controversial; perhaps they are even common sense. But philosophy rushes in where common sense fears to tread, raising questions and looking for explanations.Are the emotions we have in appreciating fictional works of art, what I call art emotions, of the same sort as those which occur in (...) ‘real life’? Which emotions are appropriate to the work, and why: what justifies having one emotion rather than another? And why should we think emotionally responding to fiction is desirable, something which should be respected and encouraged, rather than looked at as a little weird or a waste of time? (shrink)

For quite some time the indispensability arguments of Quine and Putnam were considered a formidable obstacle to anyone who would reject the existence of mathematical objects. Various attempts to respond to the indispensability arguments were developed, most notably by Chihara and Field. Field tried to defend mathematical fictionalism, according to which the existential assertions of mathematics are false, by showing that the mathematics used in applications is in fact dispensable. Chihara suggested, on the other hand, that mathema­tics makes true existential (...) assertions, but that these can be interpreted so as to remove the commitment to abstract objects. More recently, there have been various attempts to show that the indispensability arguments contain assumptions that are conceptually misguided in ways having little to do with mathematical content. All of this work is of considerable interest, and the result has been a gathering consensus that the indispensability arguments, as put forth by Quine and Putnam, do not provide convincing reason to accept mathematical realism. The focus here will be on the ways of responding to the indispensability arguments, and in particular on the obstacles to fictionalism that remain after the versions of Quine and Putnam are undercut. (shrink)

BackgroundGenealogical research and ancestry testing are popular recreational activities but little is known about the impact of the use of these services on clients’ biological and social families. Ancestry databases are being enriched with self-reported data and data from deoxyribonucleic acid analyses, but also are being linked to other direct-to-consumer genetic testing and research databases. As both family history data and DNA can provide information on more than just the individual, we asked whether companies, as a part of the (...) consent process, were informing clients, and through them clients’ relatives, of the potential implications of the use and linkage of their personal data.MethodsWe used content analysis to analyse publically-available consent and informational materials provided to potential clients of ancestry and direct-to-consumer genetic testing companies to determine what consent is required, what risks associated with participation were highlighted, and whether the consent or notification of third parties was suggested or required.ResultsWe identified four categories of companies providing: 1) services based only on self-reported data, such as personal or family history; 2) services based only on DNA provided by the client; 3) services using both; and 4) services using both that also have a research component. The amount of information provided on the potential issues varied significantly across the categories of companies. ‘Traditional’ ancestry companies showed the greatest awareness of the implications for family members, while companies only asking for DNA focused solely on the client. While in some cases companies included text recommending clients inform their relatives, showing they recognised the issues, often it was located within lengthy terms and conditions or privacy statements that may not be read by potential clients.ConclusionsWe recommend that companies should make it clearer that clients should inform third parties about their plans to participate, that third parties’ data will be provided to companies, and that that data will be linked to other databases, thus raising privacy and issues on use of data. We also suggest investigating whether a ‘generational consent’ should be created that would include more than just the individual in decisions about participating in genetic investigations. (shrink)

Given that one of the major goals of the practice of Philosophy for Children (P4C) is the development of critical thinking skills (Sharp 1987/2018, pp. 4 6), an urgent question that emerged for one of the authors, who is of Chinese Heritage and a novice practitioner at a P4C summer camp was whether this emphasis on critical thinking might make this practice incompatible with the fabric of Chinese culture. Filial piety (孝), which requires respect for one’s parents, elders, and ancestors (...) is considered an important virtue in Asian culture, as is the preservation of harmony. But if one of the goals of P4C is to teach youngsters to courageously pursue reasoned dialogue, does this not set-up young Asians for serious conflict when they come face-to-face with positions that are articulated by elders, but which are ones to which they are diametrically opposed; a racist grandmother, for instance, or an uncle who insists that those at the Tiananmen Square uprising were nothing but hooligan’s. It is this question that we will explore in this presentation. In the process, we will come to the conclusion that, when positions seem irreconcilable, rather than continuing to pursue rigorous critical interchange that may do little other than escalate insult, the facilitator, rather, ought to move toward creating a deeper understanding of each position juxtaposed against its opposing view (a process that we refer to as ‘collaborative caring’), so as to produce side-by-side understanding, knowing that communal bonds have been maintained and, hence, that the opportunity for genuine reasoned collaborative inquiry on other issues and at future times remains open. (shrink)

Of the generation of post-1960s artists who looked to photography for a new set of conceptual tools, Gerhard Richter stands apart because he has uniquely professed a desire to “use painting as a means to photography,” that is, to bring painting to the structure and sensibility of the photograph.2 To ascribe sensibility or perceptive acuity to a process so mechanical as photography may strike the reader as either romantically fey or even offensively anthropomorphizing, given that the aesthetic questions at stake (...) have exactly to do with philosophy's “mind-independent” designation of the medium. But the metaphor has pedigree among historians of photography, having been articulated by Walter Benjamin in his “Little History of Photography,” where he characterizes photography as a medium possessed of an “optical unconscious,” a nature specifically “other” in its ability to present the “spark of contingency, of the here and now, with which reality has seared the subject.”3 It is precisely on the basis of this picture making outside of human agency, Benjamin insists, that “the dubious project of authenticating photography in terms of painting” fails, for it is an attempt to “legitimize the photographer before the very tribunal he was in the process of overturning.”4 Certainly, it is from this premise of photography's revolutionary capacity that the first critical assessments of the work of “artists using photography” proceeded in the 1970s and continued through the 1980s into the present decade.5 This is particularly important to keep in mind when assessing what has been called the recent turn to the pictorial in photographic practices because this move has been accompanied by, on one hand, a general pulling away from easily legible, unambivalent documentary content in photographic practices—a tendency that may itself be considered part of a quietly growing, renewed interest in the critical capacity of painting among a new generation of artists—and, on the other, a nuanced exploration of the appropriative lessons of postmodernism, manifested in recent interest in the repurposing of found, or what Benjamin might call “other-determined,” imagery.6. (shrink)

On September 23, 1949, President Harry Truman announced that the Soviet Union had successfully detonated an atomic bomb. The news that the Soviet Union had done this came as little surprise to a number of American scientists and to some members of the intelligence community who had predicted that the Soviets would quickly acquire this advanced weapons technology. But for many Americans this news was disturbing. Truman’s announcement was taken up by, among others, a young Baptist evangelist named Billy (...) Graham. Opening a tent revival in Los Angeles just two days after the President’s report, Graham preached how the news of the Soviet bomb test had “startled the world” and launched an “arms race unprecedented in the history of the world.” President Truman, he informed his listeners, said that we “must be prepared for any eventuality at any hour….” Perhaps even more ominously he asked the crowd, “Do you know the area that is marked out for the enemy’s first atomic bomb? New York! Secondly, Chicago; and thirdly, the city of Los Angeles!” It was not only evangelical preachers who foresaw catastrophic implications from a growing arsenal of atomic weapons. (shrink)

In museum settings, caregivers support children's learning as they explore and interact with exhibits. Museums have developed exhibit design and facilitation strategies for promoting families' exploration and inquiry, but these strategies have rarely been contrasted. The goal of the current study was to investigate how prompts offered through staff facilitation vs. labels printed on exhibit components affected how family groups explored a circuit blocks exhibit, particularly whether children set and worked toward their own goals, and how caregivers were involved in (...) children's play. We compared whether children, their caregivers, or both set goals as they played together, and the actions they each took to connect the circuits. We found little difference in how families set goals between the two conditions, but did find significant differences in caregivers' actions, with caregivers in the facilitation condition making fewer actions to connect circuits while using the exhibit, compared to caregivers in the exhibit labels condition. The findings suggest that facilitated and written prompts shape the quality of caregiver-child interactions in distinct ways. (shrink)

Philosophy has a dirty little secret and it is this: a whole lot of philosophers have swallowed the mechanistic billiard ball deterministic view of human action—presumably because philosophy assumes that science demands it, and/or because modern attempts to articulate in what free will consists seem incoherent. This below-the-surface-purely-academic commitment to mechanistic determinism is a dirty little secret because an honest public commitment would render virtually all that is taught in philosophy departments incomprehensible. Can “lovers of wisdom” really continue (...) to tolerate such a heavy burden of hypocrisy? For it is maximally hypocritical, is it not, to teach ethics, or existentialism, or political philosophy, or critical thinking, or indeed to teach anything at all if one views the bodies of humans as entities determined by forces that are describable entirely under the auspices of physical/chemical laws. The only option, it would seem, to avoid such hypocrisy is to go out of business. After all, either base metal can be turned into gold, or it cannot. We found out long ago that it cannot, and so alchemy was rightly banished into the dustbin of history. Likewise, either philosophy can enhance the wisdom quotient of its disciples as its name implies, and thus override billiard ball mechanics, or it cannot. And if it cannot, it deserves to follow alchemy to an ignominious end. (shrink)

Little is known about the lives of the never married. Demographic data show that rates of nonmarriage have increased significantly across racial and ethnic groups. Among women, African Americans have the highest rates of nonmarriage, followed by Asian Americans and European Americans. This research used in-depth interviews with native- and foreign-born Chinese American and Japanese American never married women to explore why these women are delaying or rejecting heterosexual marriage. Respondents were asked a series of open- and closed-ended questions (...) about their attitudes, experiences, and decisions concerning marriage and family life. Questions also focused on how their family backgrounds and occupational plans affected their decisions to marry. Preliminary findings reveal that Chinese American and Japanese American women express a number of reasons for being never married. The four most consistent factors were their parents' marriages, their status as the eldest or only daughter, their educational goals, and the perceived lack of suitors. (shrink)

The grammatical manipulation and production of language is a great deceiver. We have become habituated to accept the use of well-constructed language to indicate intelligence, understanding and, consequently, intention, whether conscious or unconscious. But we are not always right to do so, and certainly not in the case of large language models (LLMs) like ChapGPT, GPT-4, LLaMA, and Google Bard. This is a perennial problem, but when one understands why it occurs, it ceases to be surprising that it so stubbornly (...) persists. This paper will have three main sections. In the Introduction I will say a little about language, its aetiology, and useful sub-divisions into natural and cultural. In the second section I will explain the current situation with regard to large language models and fill in the background debates which set the problem up as one of increased complexity rather than one of a qualitatively different kind from narrow or specific AI. In the third section I will present the case for the missing phenomenological background and why it is necessary for the co-creation of shared meaning in both natural and cultural language, and I will conclude this section by presenting a rationale for why this situation arises and will continue to arise. Before we do any of this, I need to clarify one point: I do not wish to challenge the ascription of artificial general intelligence (AGI) to LLMs, indeed I think agnosticism is best in this respect, but I do challenge the more serious, and erroneous, ascription of understanding, intention, reason, and consciousness to them. And so, I am making two points: an epistemological one about why we fall into error in our ascription of a mental life to LLMs, and an ontological one about the impossibility of LLMs being or becoming conscious. (shrink)

Morality is so steeped in the quotidian details of praise and blame, of do’s and don’t’s, and of questions about the justifiability of certain practices it is no wonder that philosophers and psychologists have devoted relatively little effort to investigating what makes moral life possible in the first place. In making this claim, I neither ignore Kant and his intellectual descendants, nor the large literature in developmental moral psychology from Piaget on. My charge has to do with this fact: (...) morality is an ineliminable feature of human life and human beings are biological creatures. Hence, what wants explaining is how a biological creature – a creature with an evolved mind/brain – can be a normative creature of a particular kind – a creature that cannot help but engage in moral appraisal and evaluation. It does no good to try to wring such an explanation from the ‘very concept’ of agency, as some philosophers attempt to do. Such a strategy merely delays the inevitable: how is it that biological creatures are agents? And while we can understand the practical value of charting the trajectory of babbling infants to toddlers to adolescents to adults, absent an account of the foundations of the capacities whose emergence constitutes this trajectory, we will still not have addressed the central question. Sociobiology and evolutionary ethics fare no better. The apparent puzzle of cooperation amidst competition can and has been addressed via the notions of kin selection and reciprocal altruism. But these accounts are motivated by and hence pitched at the level of overt behavior. However, being a moral creature, in the sense that makes such entities apt subjects for deep intellectual investigation, has very little to do with whether they behave well and everything to do with being capable of a certain kind of cognition. (shrink)

Abstractβ1,4‐galactosyltransferase is unusual among the glycosyltransferases in that it is found in two subcellular compartments where it performs two distinct functions. In the trans‐Golgi complex, galactosyltransferase participates in oligosaccharide biosynthesis, as do the other glycosyltransferases. On the cell surface, however, galactosyltransferase associates with the cytoskeleton and functions as a receptor for extracellular oligosaccharide ligands. Although we now know much regarding galactosyltransferase function in these two compartments, little is known about how it is targeted to these different sites. By cloning (...) the galactosyltransferase gene products, certain features of the protein have been identified that may be critical for its expression on the cell surface or retention within the Golgi complex. This article discusses recent studies which suggest that a cytoplasmic sequence unique to one galactosyltransferase isoform is required for targeting a portion of this protein to the plasma membrane, enabling it to function as a cell adhesion molecule. These findings allow one to manipulate surface galactosyltransferase expression, either positively or negatively, and perturb galactosyltransferase‐dependent cellular interactions during fertilization and development. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Secrecy and Autonomy in Lewis CarrollSusan ShererVictorian novels quiver with morbid secrets and threatening discoveries. Unseen rooms, concealed doors, hidden boxes, masked faces, buried letters, all appear (and disappear) with striking regularity in the fiction of Victorian England. So many of these secret spaces contain children, and especially little girls, little girls in hidden spaces. The young Jane Eyre sits behind a curtain in the hidden window (...) seat, escaping the vindictive wrath of John Reed. Repulsed by her angry brother, Maggie Tulliver flees to the house attic, fantasizing that her family will fear that she has died. Little Dorrit withdraws from the common space of the Marshalsea into her private room above the prison, and Little Nell hides behind trees and walls, silently observing clandestine meetings. Finally the seven-year-old Alice falls down a rabbit-hole into a Wonderland, the dreamspace of her own psyche.Of these images, none can be more embedded in our cultural imagination than the child Alice dropping into the subterranean well of Wonderland. Indeed, of the many celebrated scenes in the Alice narratives, the most memorable, most potent, most quoted is Alice’s initial descent to the bottom of the rabbit-hole. The lastingness of this scene seems even greater when we realize that, although neither Carroll in Alice’s Adventures Underground nor Tenniel in the first edition of Wonderland illustrated the moment with a picture, it still became (along with the Mad Hatter’s tea party) one of the signature images of the Alice stories. Why, we must ask, did the Victorians retain, with a powerful tenacity, this vision of a little girl moving through a tight space toward the hidden world of Wonderland?The answer to this question is not—at least not wholly—that the scene simply represents a child’s metaphorical progress through the [End Page 1] birth canal 1 and that this, in turn, symbolizes some kind of rite of passage, a movement towards some deeper knowledge. For then how do we explain Alice’s conspicuous lack of internal development in both stories? Indeed, for a narrative that thematizes motion, Alice’s psychical growth remains disturbingly static. Throughout both narratives, Alice displays little emotional variation, for when she is not frustrated or anxious, she is, for the most part, vapid or expressionless. In fact, one is immediately struck by her coolness and indifference as she drops through the rabbit-hole. 2 Thus, because scene changes in Wonderland and Looking-Glass rarely betoken any emotional or intellectual modulations, Alice’s falling into Wonderland signals no internal transition.But the image does relocate her body and within this fictive world, location is everything. The scene gestures Alice’s departure, her separation, her movement towards an autonomy of which every child dreams when, in play, retreating to a hidden space. A child’s impulse to hide, to create a secret space, is one of the most compelling of all human wishes, the wish for autonomy and autarchy—“to be cut off from the word and yet owner of the world.” 3 Throughout Victorian literature, the fantasy of autonomy sets children dreaming of far-away worlds and hidden gardens. The young Cathy and Heathcliff flee to the isolated moors, filling the open, empty space with dreams of unrestricted freedom. Little Dorrit envisages the locked garden behind the Marshalsea as an alternative world to the foul prison atmosphere. And what are the Brontës’s Angria and Gondol but disconnected, self-governing realms imagined from the standpoint of childhood powerlessness? The image, then, of Alice’s fall begins to fulfill this powerful wish for autonomy, which culminates, finally, in Alice’s self-coronation at the end of Looking-Glass. Yet it is only within the child’s willing imagination that a secret space can encroach so closely upon autonomy, for as we shall see, secrecy and autonomy are irreconcilable not only in the demanding world of realism, but even in the more elastic world of Carrollian fantasy.IAlice’s descent into Wonderland and her entrance into the Looking-Glass kingdom would seem like ripe metaphors for Carroll to explore the thoughts and fantasies of Alice’s psyche. What could be more... (shrink)

Peer review and publication is one of the factors proposed in Daubert v. Merrell Dow Pharmaceuticals, Inc. as indicia of the reliability of scientific testimony. This Article traces the origins of the peer-review system, the process by which it became standard at scientific and medical journals, and the many roles it now plays. Additionally, the Author articulates the epistemological rationale for pre-publication peer-review and the inherent limitations of the system as a scientific quality-control mechanism. The Article explores recent changes in (...) science, in scientific publishing, and in the academy that have put the system under strain. The Author argues that Justice Blackmun's advice to courts - that peer-reviewed publication is relevant, but is not dispositive - is of little practical help. Instead, the Author suggests questions that courts should ask in assessing the significance of the fact that testimony is, or is not, based on peer-reviewed publication and illustrates with reference to another Bendectin case, Blum v. Merrell Dow Pharmaceuticals, Inc., where some of these questions were asked. (shrink)

That various legal orders preside in any one jurisdiction has long been seen as evidence of legal pluralism; however, this approach lacks a systematic understanding of history in general, and as such, tells us little about the inner machinations of law’s relation to capitalist development in particular. What is needed instead is a dialectical materialist approach to legal development; for this reason, I tender an uneven and combined development theory of law. Law flexes in concert with ever-changing social relations, (...) or more plainly, law evolves in an uneven and combined manner. More than being mired in the contradictions that are the driving force of the UCD of capitalism, however, law also boasts its own set of contradictions that, if carefully accounted for, helps distinguish the historical evolution of capitalism as a social totality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sympathy in Mind (1876–1900)Susan LanzoniIn the April 1884 issue of Mind, William James published his influential account of emotion, which stressed the bodily and physiological constitution of various feeling-states.1 The article reflected new trends in physiological psychology, but came under attack by numerous respondents in the journal who argued that there was more to the emotions than physiology.2 As the evolutionary psychologist Hiram Stanley intoned, "emotions in the (...) higher stages are filled out by knowledge and will."3 Many noted that the higher emotions—aesthetic sentiments, sympathy, pity, envy, love—were not marked by clear physiological changes. Charles Darwin had observed that love was not discernable by prominent facial expressions.4 There was also little agreement as to how to divide sentiments from appetites, affections, and passions. What came to be known as the James-Lange theory [End Page 265] of emotion, then, was only one of a variety of theories of emotion circulating in Anglo-American intellectual culture of the late nineteenth century.5In debates about the nature of emotion, the higher emotions—particularly that of sympathy—played a crucial role. Sympathy was most often understood to be a kind of tenderheartedness linked to, but distinct from love. At the same time, sympathy was tethered to a variety of moral and epistemological ends—as a cornerstone in evolutionary ethics, an element in aesthetic appreciation, and even as a source for knowledge of other minds. Sympathy had had a prominent place in eighteenth-century theories of aesthetics, moral sentiments and taste, in the writings of Adam Smith and Edmund Burke. In the late Victorian period, theories of sympathy drew on this lineage and increasingly became tinged with evolutionary and developmental features.Although sympathy in the Victorian period has gained the attention of literary scholars, historians of the mind sciences have not paid it much due, even though its psychological origins and moral correlates were of sustained interest in this period.6 Stefan Collini has argued that British intellectual culture was intrigued by the interplay of egoistic and altruistic tendencies, and the birth of a number of ethical societies in the final two decades of the century attests to the increased emphasis on the moral dimensions of sympathy.7 Anti-vivisection movements and societies for the prevention of cruelty to animals and children, often with appeals to sympathy, gained adherents in this period in Britain and America.8 In one study, [End Page 266] psychologists distributed scientific questionnaires in order to assess the experiences of sympathy and pity of nearly four hundred subjects.9 There was no underestimating the importance of sympathy for Anglo-American intellectuals, who confidently claimed it was becoming more refined and more widely diffused in their era. Darwin believed that sympathy had been extended to those of the same nation, and prescriptively wrote that it should extend to all nations and races, as well as the imbecile and the maimed. Darwin was echoing here the broader enlightenment sentimentalist tradition that linked the feeling of sympathy to a conception of humanity.10In the pages of the British professional psychological and philosophical journal Mind, sympathy was under scrutiny by scholars in evolutionary and developmental psychology, ethics, and aesthetics. This journal, first published in 1876, and funded by Alexander Bain, examined new trends in physiological and scientific psychology and sought a broad philosophical framework for the understanding of mental life.11 It played a mediating role in the overlapping discussions of science and philosophy and published on a diverse array of topics. Although Mind saw itself as a specialized journal for psychology and philosophy, it was founded at an historical moment when discussions of the mind were not narrowly portioned out to the psychological sciences, as would increasingly be the case after 1900. Indeed, the experimental psychological laboratory emerged as a new scientific institution [End Page 267] only in 1879 with Wilhelm Wundt's Leipzig laboratory, and then in 1897 at the Universities of London and Cambridge. Specialization in the late Victorian age on topics relating to the mind was downright eclectic: during the editorships of George Croom Robertson (1876–1892) and of G.F. Stout (1892–1920), Mind published on physiological... (shrink)

Appraising the worth of others’ testimony is always complex; appraising the worth of expert testimony is even harder; appraising the worth of expert testimony in a legal context is harder yet. Legal efforts to assess the reliability of expert testimony—I’ll focus on evolving U.S. law governing the admissibility of such testimony—seem far from adequate, offering little effective practical guidance. My purpose in this paper is to think through what might be done to offer courts more real, operational help. The (...) first step is to explain why the legal formulae that have evolved over the years may seem reassuring, but aren’t really of much practical use. The next is to suggest that we might do better not by amending evidentiary rules but by helping judges and attorneys understand what questions they should ask about expert evidence. I focus here on (i) epidemiological testimony, and (ii) the process of peer review. (shrink)

Throughout the history ofthe U.S. national park system, park advocates and managers have changed both acquisition priorities and internal management policies. The park movement began with the establishment of large, spectacular natural areas, primarily in the West. As the movement developed there was more emphasis on the biological, on recreation, and on parks near population centers. GraduaIly, scenic wonders and uniqueness have become less necessary to designation and the types of sites eligible have diversified. Early managers treated the parks as (...) relatively unchanging, threatenedby little other than human vandalism. Initially managers removed “bad” animals, such as wolves, and suppressed disturbances, such as fire. Modem management values processes as weIl as objects and recognizes change and disturbance as integral to park maintanence. A conversion to an ecosystem mode of management does not answer all questions concerning values, however, and may present some disadvantages, such as a tendency to treat nature as aseries of functions and energy equations, thus weakening aesthetic values. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Secrecy and Autonomy in Lewis CarrollSusan ShererVictorian novels quiver with morbid secrets and threatening discoveries. Unseen rooms, concealed doors, hidden boxes, masked faces, buried letters, all appear (and disappear) with striking regularity in the fiction of Victorian England. So many of these secret spaces contain children, and especially little girls, little girls in hidden spaces. The young Jane Eyre sits behind a curtain in the hidden window (...) seat, escaping the vindictive wrath of John Reed. Repulsed by her angry brother, Maggie Tulliver flees to the house attic, fantasizing that her family will fear that she has died. Little Dorrit withdraws from the common space of the Marshalsea into her private room above the prison, and Little Nell hides behind trees and walls, silently observing clandestine meetings. Finally the seven-year-old Alice falls down a rabbit-hole into a Wonderland, the dreamspace of her own psyche.Of these images, none can be more embedded in our cultural imagination than the child Alice dropping into the subterranean well of Wonderland. Indeed, of the many celebrated scenes in the Alice narratives, the most memorable, most potent, most quoted is Alice’s initial descent to the bottom of the rabbit-hole. The lastingness of this scene seems even greater when we realize that, although neither Carroll in Alice’s Adventures Underground nor Tenniel in the first edition of Wonderland illustrated the moment with a picture, it still became (along with the Mad Hatter’s tea party) one of the signature images of the Alice stories. Why, we must ask, did the Victorians retain, with a powerful tenacity, this vision of a little girl moving through a tight space toward the hidden world of Wonderland?The answer to this question is not—at least not wholly—that the scene simply represents a child’s metaphorical progress through the [End Page 1] birth canal 1 and that this, in turn, symbolizes some kind of rite of passage, a movement towards some deeper knowledge. For then how do we explain Alice’s conspicuous lack of internal development in both stories? Indeed, for a narrative that thematizes motion, Alice’s psychical growth remains disturbingly static. Throughout both narratives, Alice displays little emotional variation, for when she is not frustrated or anxious, she is, for the most part, vapid or expressionless. In fact, one is immediately struck by her coolness and indifference as she drops through the rabbit-hole. 2 Thus, because scene changes in Wonderland and Looking-Glass rarely betoken any emotional or intellectual modulations, Alice’s falling into Wonderland signals no internal transition.But the image does relocate her body and within this fictive world, location is everything. The scene gestures Alice’s departure, her separation, her movement towards an autonomy of which every child dreams when, in play, retreating to a hidden space. A child’s impulse to hide, to create a secret space, is one of the most compelling of all human wishes, the wish for autonomy and autarchy—“to be cut off from the word and yet owner of the world.” 3 Throughout Victorian literature, the fantasy of autonomy sets children dreaming of far-away worlds and hidden gardens. The young Cathy and Heathcliff flee to the isolated moors, filling the open, empty space with dreams of unrestricted freedom. Little Dorrit envisages the locked garden behind the Marshalsea as an alternative world to the foul prison atmosphere. And what are the Brontës’s Angria and Gondol but disconnected, self-governing realms imagined from the standpoint of childhood powerlessness? The image, then, of Alice’s fall begins to fulfill this powerful wish for autonomy, which culminates, finally, in Alice’s self-coronation at the end of Looking-Glass. Yet it is only within the child’s willing imagination that a secret space can encroach so closely upon autonomy, for as we shall see, secrecy and autonomy are irreconcilable not only in the demanding world of realism, but even in the more elastic world of Carrollian fantasy.IAlice’s descent into Wonderland and her entrance into the Looking-Glass kingdom would seem like ripe metaphors for Carroll to explore the thoughts and fantasies of Alice’s psyche. What could be more... (shrink)

A natural language is an organic living thing; and meanings change as words take on new, and shed old, connotations. Recent philosophy of language has paid little attention to the growth of meaning; radical philosophers like Feyerabend and Rorty have suggested that meaning-change undermines the pretensions of science to be a rational enterprise. Thinkers in the classical pragmatist tradition, however -Peirce in philosophy of science and, more implicitly, Holmes in legal theory- both recognized the significance of growth of meaning, (...) and understood how it can contribute to the progress of science and to the adaptation of a legal system to changing circumstances. This paper develops these insights, and illustrates them by reference to the growth of meaning of "DNA" from the identification of "nuclein" to the discovery of mtDNA almost a century later, and the growth of meaning of "the establishment of religion" in the First Amendment to the U.S. Constitution from its ratification in 1791 to the present day. Arguing that the growth of meaning can indeed contribute to rationality, it also shows why narrowly formal models are inadequate both to science and to law. Un lenguaje natural es una cosa viviente orgánica, y los significados cambian a medida que las palabras adoptan nuevas connotaciones y abandonan viejas. La filosofía del lenguaje reciente ha prestado poca atención al desarrollo del significado; filósofos radicales, como Feyerabend y Rorty han sugerido que el cambio de significado socava las pretensiones de la ciencia de ser una empresa racional. Pensadores en la tradición pragmatista clásica, sin embargo -Peirce en la filosofía de la ciencia y, más implícitamente, Holmes en la teoría del Derecho- reconocieron la importancia del desarrollo del significado y comprendieron cómo éste puede contribuir al progreso de la ciencia y a la adaptabilidad de un sistema jurídico a las circunstancias cambiantes. Este trabajo desarrolla estas ideas, y las ilustra por medio de una referencia a el desarrollo del significado de "ADN" desde la identificación de la "nucleína" hasta el descubrimiento del ADN mitocondrial casi un siglo más tarde, y el desarrollo del significado de "el establecimiento de una religión" en la Primera Enmienda de la Constitución de los Estados Unidos desde su ratificación en 1791 hasta la actualidad. Argumentando que el desarrollo del significado puede contribuir mucho a la racionalidad, también muestra por qué los modelos estrechamente formales son inadecuados, tanto para la ciencia como para el Derecho. (shrink)

This commentary raises questions about the moral value of feeling pity. Whereas Professor Arenson asks whether an Epicurean hedonist can rightly feel pity given that feeling pity may be unpleasant, I ask whether feeling pity may be morally problematic for other reasons. In particular, I argue that feeling pity involves an endorsement of a morally problematic hierarchy between pitier and pitied. Because of this, I believe that we should draw a little-made distinction between compassion and pity and that individuals (...) should cultivate compassion rather than pity. I suggest one possible way to draw the distinction between compassion and pity. (shrink)

Because they failed to include our informed consent, guided imagery scenarios, and debriefing, the relevance of Korn, Huelsman, Reed, and Aiello's (1992) data remains unknown. The design of their Study 1 did not test the greater objectivity of role taking over involved participation. The design of their Study 2 did not demonstrate the effects of demand characteristics. The older "personal acquaintances" were not at higher risk of rape as they claimed. Properly gathered data from the University of Connecticut's laboratory demonstrated (...) that participants regarded the guided imagining of rape to be personally and scientifically beneficial, educating them about the crime and the experience of the rape victim. Prior research had demonstrated that exposure to rape stimuli in combination with debriefing had an educational effect on the decreased endorsement of rape myths. Previously published ethical principles for balancing the rights of scientists, subjects, and society explicate our ethical stance. Informed consent precludes the occurrence of wrongful harms. This poorly designed and poorly reasoned "ethical" critique was unfounded; yet, it might produce a chilling effect on both the use of guided imagery and freedom of inquiry into politically sensitive topics. (shrink)

An unlearned carpenter of my acquaintance once said in my hearing: “There is very little difference between one man and another; but what little there is, is very important.” – William James (1890) On the question of “the individual and the community in pragmatism,” most people would probably think first of Dewey’s influential ideas about the individual and society: his conception of education as preparation for responsible citizenship, perhaps, or his critique of the “ragged individualism” o...

There are two truths in this world: one of the laboratory, and the other of the media. What people perceive as the truth is truer in a democracy than some grubby little experiment in a laboratory notebook.(1).

Despite the amount of public investment in nanotechnology ventures in the developed world, research shows that there is little public awareness about nanotechnology, and public knowledge is very limited. This is concerning given that nanotechnology has been heralded as ‘revolutionising’ the way we live. In this paper, we articulate why public engagement in debates about nanotechnology is important, drawing on literature on public engagement and science policy debate and deliberation about public policy development. We also explore the significance of (...) timing in engaging the public, and we make some suggestions concerning how to effectively engage publics. Our conclusions indicate the significance of scientific researchers, policy makers and representative consumer groupings in public reasoning towards a better public policy framework for debate about technological development. (shrink)

William of Ockham (d. 1347) is well known for his commitment to parsimony and for his so-called ‘razor’ principle. But little is known about attempts among his own contemporaries to deflect his use of the razor. In this paper, I explore one such attempt. In particular, I consider a clever challenge that Ockham’s younger contemporary, Walter Chatton (d. 1343) deploys against the razor. The challenge involves a kind of dilemma for Ockham. Depending on how Ockham responds to this dilemma, (...) his razor will, Chatton argues, either prove unacceptably dull when it comes to determining ontological commitment or prove unacceptably sharp when it comes to determining commitments entailed by certain theological doctrines. While Chatton’s objection is subtle and interesting in its own right, the broader significance of the debate between these thinkers lies in the light it sheds on medieval approaches to issues surrounding metaphysical methodology. (shrink)

There is increasing global pressure to ensure that pregnant women are responsibly and safely included in clinical research in order to improve the evidence base that underpins healthcare delivery during pregnancy. One supposed barrier to inclusion is the assumption that pregnant women will be reluctant to participate in research. There is however very little empirical research investigating the views of pregnant women. Their perspective on the benefits, burdens and risks of research is a crucial component to ensuring effective recruitment. (...) The Research In Pregnancy Ethics study set out to ascertain the views of pregnant women about research participation using an inductive thematic analysis. We conducted semi-structured interviews with 20 women who had participated in a double-blind randomised placebo controlled trial in Wellington while pregnant. Our results show that at least some pregnant women recognise the value and importance of research during pregnancy. The women we interviewed were deeply invested in the research process and outcomes. Key motivations for participating were altruism, playing a valuable civic role and the importance of research. The main perceived burdens related to inconvenience and time commitment. For some women, possible randomization to the placebo arm was regarded as a burden or disadvantage. (shrink)