Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering ‘deep’ reality or God. In addition to symptom relief, (...) psychedelic experiences often lead to significant changes in a patient’s personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process–one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry. (shrink)

Debates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical (...) research, and treatment of patients’ religious views in doctor–patient encounters. Given that no sound set of guiding principles yields precise solutions for every policy dispute, we explore how morally sound democracies might deliberatively resolve such policy issues, following our proposed principles. Taken together and carefully interpreted, these principles may help in guiding difficult decision making in the indefinitely large realm where government, medical providers, and patients encounter problems concerning religion and medicine. (shrink)

Skepticism about ethical expertise has grown common, raising concerns that bioethicists’ roles are inappropriate or depend on something other than expertise in ethics. While these roles may depend on skills other than those of expertise, overlooking the role of expertise in ethics distorts our conception of moral advising. This paper argues that motivations to reject ethical expertise often stem from concerns about elitism: either an intellectualist elitism, where some privileged elite have supposedly special access in virtue of expertise in moral (...) theory; or an authoritarian elitism, where our reliance on experts in ethics risks violation of autonomy and democracy. The paper sketches an anti-elitist conception of ethics expertise in bioethics as continuous with an anti-elitist conception of ethics expertise in common moral practice, undercutting the intellectualism, and then uses this anti-elitist conception to reject arguments that ethical expertise violates autonomy or democracy. An anti-elitist picture of ethical expertise both renders it consistent with our general moral practice and allows us to resist skeptical concerns. (shrink)

Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholders. Yet, the process described by this view contrasts with the actual processes involved in creating the Affordable Care Act and in attempting to pass the Health Securities Act. Since the ACA seems to be legitimate, (...) as the HSA would have been had it passed, there seem to be counterexamples to this view. In this essay, I clarify the concept of legitimacy as employed in bioethics discourse. I then use that clarification to develop these examples into a criticism of the orthodox view–that it implies that legitimacy requires counterintuitively large sacrifices of justice in cases where important advancement of healthcare rights depends on violations of publicity. Finally, I reply to three responses to this challenge: that some revision to the orthodox view salvages its core commitments, that its views of publicity and substantive considerations do not have the implications that I claim and that arguments for it are strong enough to support even counterintuitive results. My arguments suggest a greater role for substantive considerations than the orthodox view allows. (shrink)

Volume 19, Issue 9, September 2019, Page 64-66.

In late January of 1987, the State Treasurer of Pennsylvania, R. Budd Dwyer, shot himself to death in front of a dozen reporters and camera crews during a news conference in his office. Much was subsequently made in the popular press, and within the profession, about the difficult ethical decision television journalists were faced with in determining how much of the very graphic suicide tape to air. A review of the literature in this area suggests, however, that journalists have established (...) a set of relatively detailed conventions for dealing with events involving graphic depictions of death. Analysis of the Dwyer tape and interviews conducted with Pennsylvania television news directors show that eighteen of the twenty stations in the state that carry news used basically the same type and amount of footage in their evening newscasts. One decided to use no tape. One showed the moment of death. When the story broke around noon, two additional stations showed the moment of suicide, but they revised their story for the evening program. In addition, the wide majority of news directors interviewed said they had little difficulty in deciding how to edit the tape. The processing of the Dwyer story suggests that any ethical dilemmas faced by journalists during decision making were put aside for later consideration. The material was edited quickly and according to similar patterns, or conventions, around the state. The study suggests greater attention be given to the definition and interaction of personal professional values, in the ethical sense, and norms of news processing, in the sociological sense. (shrink)

Gabriele Badano offers three criticisms of my challenge to the orthodox family of theories of legitimacy in bioethics. First, I assumed an ‘oversimplified version of the orthodoxy’. Second, I failed to appreciate its domain of application. Third, I only addressed the ways in which orthodox theorists incorporate substance as an ‘afterthought’—and, even then, only by rehashing Gopal Sreenivasan’s argument. Here, I respond to each, taking up the first and third before ending with reflections on the second. The first underestimates the (...) insight that criticism of the simplified version provides to that of the more complex relatives. The third misunderstands the relationship between my view and Sreenivasan’s and neglects an entire argument of my paper. The second fails in light of these two, but raises interesting questions about how the method I suggest might be extended to other domains. (shrink)

At least four different frameworks — psychiatric, cognitive, functional and decision-making — are used in the evaluation of competence, all of which remain more or less unrelated in the literature. In the first section of this paper we consider various meanings of competence, in order to arrive at a definition of the term relevant to the medical and legal setting. Patient or client competence, we conclude, refers to the practical abilities that individuals employ in pursuing their own autonomous goals in (...) life. We then show how a systematic categorization of these practical abilities — which we call a taxonomy of practical judgment — allows us to show when the traditional frameworks for the evaluation of competence may or may not be useful in the evaluation of a particular competence.In the final section we explore some of the normative considerations underlying the taxonomy. For instance, competence is not only related to intrinsic abilities but to resources available in the community. Here we touch on questions related to the fair distribution of community resources. (shrink)

Democratic societies that separate church and state face major challenges in accommodating religious convictions. This applies especially to determining healthcare policies. Building on our prior work on the demands and limits of religious accommodation in democratic societies, we propose a set of ethical standards that can guide societies in meeting this challenge. In applying and defending these standards, we explore three topics: vaccine resistance, abortion, and concerns about rights to healthcare. We clarify these and other issues of religious accommodation and (...) propose ethical standards for approaching these and other problems. (shrink)

Here we present what we believe is a novel account of what languages are, along with an axiomatically rich representation of languages and language-related data that is based on this account. We propose an account of languages as aggregates of dispositions distributed across aggregates of persons, and in doing so we address linguistic competences and the processes that realize them. This paves the way for representing additional types of language-related entities. Like demographic data of other sorts, data about languages may (...) be of use to researchers in a number of areas, including biomedical research. Data on the languages used in clinical encounters are typically included in medical records, and capture an important factor in patient-provider interactions. Like many types of patient and demographic data, data on a person’s preferred and primary languages are organized in different ways by different systems. This can be a barrier to data integration. We believe that a robust framework for representing language in general and preferred and primary language in particular – which has been lacking in ontologies thus far – can promote more successful integration of language-related data from disparate data sources. (shrink)

Psychiatric research often poses special ethical concerns. This chapter first provides historical context, including scandals that stoked public concern about psychiatric research and led to the promulgation of canonical documents and bioethics scholarship, and then explores issues related to the decision-making capacity and safety of participants—including the use of placebos and washout periods, the design of suicide prevention studies, and research in emergency psychiatry. The chapter then describes how shifting models of psychiatric nosology have precipitated conflicts in the determination of (...) research priorities. Finally, the chapter attends to emerging issues related to research in psychedelic psychiatry and the use of artificial intelligence and social media by investigators. (shrink)

The translational research community, in general, and the Clinical and Translational Science Awards (CTSA) community, in particular, share the vision of repurposing EHRs for research that will improve the quality of clinical practice. Many members of these communities are also aware that electronic health records (EHRs) suffer limitations of data becoming poorly structured, biased, and unusable out of original context. This creates obstacles to the continuity of care, utility, quality improvement, and translational research. Analogous limitations to sharing objective data in (...) other areas of the natural sciences have been successfully overcome by developing and using common ontologies. This White Paper presents the authors’ rationale for the use of ontologies with computable semantics for the improvement of clinical data quality and EHR usability formulated for researchers with a stake in clinical and translational science and who are advocates for the use of information technology in medicine but at the same time are concerned by current major shortfalls. This White Paper outlines pitfalls, opportunities, and solutions and recommends increased investment in research and development of ontologies with computable semantics for a new generation of EHRs. (shrink)

Abstract:What makes a leader ethical? This paper critically examines the answer given by developmental theory, which argues that individuals can develop through cumulative stages of ethical orientation and behavior (e.g. Hobbesian, Kantian, Rawlsian), such that leaders at later developmental stages (of whom there are empirically very few today) are more ethical. By contrast to a simple progressive model of ethical development, this paper shows that each developmental stage has both positive (light) and negative (shadow) aspects, which affect the ethical behaviors (...) of leaders at that stage. It also explores an unexpected result: later stage leaders can have more significantly negative effects than earlier stage leadership. (shrink)

Abstract:What makes a leader ethical? This paper critically examines the answer given by developmental theory, which argues that individuals can develop through cumulative stages of ethical orientation and behavior (e.g. Hobbesian, Kantian, Rawlsian), such that leaders at later developmental stages (of whom there are empirically very few today) are more ethical. By contrast to a simple progressive model of ethical development, this paper shows that each developmental stage has both positive (light) and negative (shadow) aspects, which affect the ethical behaviors (...) of leaders at that stage. It also explores an unexpected result: later stage leaders can have more significantly negative effects than earlier stage leadership. (shrink)

Pragmatic language competence plays a central role in how aviation flight crews perform crew resource management ; this competence significantly affects aviation safety. This paper contributes to existing literature on interventionist applications of conversation analysis by defining and evaluating a novel collaborative transcription and repair based learning method for aviation CRM learning. CTRBL was evaluated using a quantitative quasi-­experimental repeated-measure design with 42 novice, university pilots. Results support that CTRBL is an effective, low-resource CRM learning method that will benefit from (...) exploratory applications and further study in pragmatics, aviation, and other sociotechnical domains. The views in this article were the result of independent research of the authors. Views herein do not necessarily represent the views of the National Transportation Safety Board or the United States. (shrink)

We introduce the Vital Sign Ontology (VSO), an extension of the Ontology for General Medical Science (OGMS) that covers the consensus human vital signs: blood pressure, body temperature, respiratory rate, and pulse rate. VSO provides a controlled structured vocabulary for describing vital sign measurement data, the processes of measuring vital signs, and the anatomical entities participating in such measurements. VSO is implemented in OWL-DL and follows OBO Foundry guidelines and best practices. If properly developed and extended, we believe the VSO (...) will find applications for the EMR, clinical informatics, and medical device communities. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

This article leverages insights from the body of Adam Smith’s work, including two lesser-known manuscripts—the Theory of Moral Sentiments and Lectures in Jurisprudence —to help answer the question as to how companies should morally prioritize corporate social responsibility (CSR) initiatives and stakeholder claims. Smith makes philosophical distinctions between justice and beneficence and perfect and imperfect rights, and we leverage those distinctions to speak to contemporary CSR and stakeholder management theories. We address the often-neglected question as to how far (...) a company should be expected to go in pursuit of CSR initiatives and we offer a fresh perspective as to the role of business in relation to stakeholders and to society as a whole. Smith’s moral insights help us to propose a practical framework of legitimacy in stakeholder claims that can help managers select appropriate and responsible CSR activities. (shrink)

Scientific authorship serves to identify and acknowledge individuals who “contribute significantly” to published research. However, specific authorship norms and practices often differ within and across disciplines, labs, and cultures. As a consequence, authorship disagreements are commonplace in team research. This study aims to better understand the prevalence of authorship disagreements, those factors that may lead to disagreements, as well as the extent and nature of resulting misbehavior. Methods include an international online survey of researchers who had published from 2011 to (...) 2015. Of the 6673 who completed the main questions pertaining to authorship disagreement and misbehavior, nearly half reported disagreements regarding authorship naming; and discipline, rank, and gender had significant effects on disagreement rates. Paradoxically, researchers in multidisciplinary teams that typically reflect a range of norms and values, were less likely to have faced disagreements regarding authorship. Respondents reported having witnessed a wide range of misbehavior including: instances of hostility, undermining of a colleague’s work during meetings/talks, cutting corners on research, sabotaging a colleague’s research, or producing fraudulent work to be more competitive. These findings suggest that authorship disputes may contribute to an unhealthy competitive dynamic that can undermine researchers’ wellbeing, team cohesion, and scientific integrity. (shrink)

Authorship is commonly used as the basis for the measurement of research productivity. It influences career progression and rewards, making it a valued commodity in a competitive scientific environment. To better understand authorship practices amongst collaborative teams, this study surveyed authors on collaborative journal articles published between 2011 and 2015. Of the 8364 respondents, 1408 responded to the final open-ended question, which solicited additional comments or remarks regarding the fair distribution of authorship in research teams. This paper presents the analysis (...) of these comments, categorized into four main themes: disagreements, questionable behavior, external influences regarding authorship, and values promoted by researchers. Results suggest that some respondents find ways to effectively manage disagreements in a collegial fashion. Conversely, others explain how distribution of authorship can become a “blood sport” or a “horror story” which can negatively affect researchers’ wellbeing, scientific productivity and integrity. Researchers fear authorship discussions and often try to avoid openly discussing the situation which can strain team interactions. Unethical conduct is more likely to result from deceit, favoritism, and questionable mentorship and may become more egregious when there is constant bullying and discrimination. Although values of collegiality, transparency and fairness were promoted by researchers, rank and need for success often overpowered ethical decision-making. This research provides new insight into contextual specificities related to fair authorship distribution that can be instrumental in developing applicable training tools to identify, prevent, and mitigate authorship disagreement. (shrink)

A substantial body of evidence suggests that autobiographical recollection and simulation of future happenings activate a shared neural network. Many of the neural regions implicated in this network are affected in patients with bipolar disorder , showing altered metabolic functioning and/or structural volume abnormalities. Studies of autobiographical recall in BD reveal overgeneralization, where autobiographical memory comprises primarily factual or repeated information as opposed to details specific in time and in place and definitive of re-experiencing. To date, no study has examined (...) whether these deficits extend to future event simulation. We examined the ability of patients with BD and controls to imagine positive, negative and neutral future events using a modified version of the Autobiographical Interview that allowed for separation of episodic and non-episodic details. Patients were selectively impaired in imagining future positive, negative, and neutral episodic details; simulation of non-episodic details was equivalent across groups. (shrink)

This latest volume of BACAP Proceedings contains some innovative research by international scholars on Plato, Aristotle, and Sophocles. It covers such themes as Plato on the philosopher ruler, and Aristotle on essence and necessity in science. This publication has also been published in paperback, please click here for details.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

William Lane Craig has claimed that Platonism is incompatible theologically with Christian theism in that it undermines God’s aseity. He develops three main objections to Platonism, as well as his own nominalist theory of reference, for which he draws from philosophy of language. However, I rebut his arguments. I argue that, unlike on Platonism, his view will not preserve a real essence of intentionality. Without that, his view undermines our abilities to know reality. As an implication, I also will (...) highlight the importance methodologically of approaching this issue from the primacy of the ontology of knowledge, not philosophy of language. (shrink)

William Lane Craig maintains that propositions and properties are not real. Yet, if we examine his proposed nominalism and his appeal to Rudolf Carnap’s linguistic frameworks, we can find that his view depends upon their reality, even as abstract objects. By drawing upon phenomenological insights, I argue that if we pay close attention to what can be before our minds in conscious awareness, we can become aware that there is more to what is real than simple, concrete particulars, even (...) in his linguistic examples. We can become aware of the reality of Platonic, ante rem universals, including propositions and properties. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

Though William Lane Craig believes his anti-Platonism is compatible with objective, Christian morality, I argue that it is not. First, I survey the main contours of his nominalism. Second, I discuss how he sees those points in relation to objective, Christian morality. Then, I argue that his view cannot sustain the qualitative aspects of moral virtues or principles, or even human beings. Moreover, Craig’s view loses any connection between those morals and humans, thereby doing great violence to objective, Christian (...) morals. Finally, I sketch two advantages of a Platonic realism in regards to Christian morals. (shrink)

William Lane Craig rejects Platonism (the view that uncreated abstract objects (AOs) exist) in favor of nominalism because he believes Platonism fatally compromises God’s aseity. For Craig, concrete particulars (including essences) exist, but properties do not. Yet, we use property-talk, following Carnap’s “linguistic frameworks.” There is, however, a high cost to Craig’s view. I survey his views and then explore the importance of essences. But, next, I show that his nominalism undermines them. Thus, we have just interpretations of reality. (...) Worse, nominalism undermines creation’s determinacy. Last, I suggest AOs are created, but in a more fundamental sense than Craig considers. (shrink)

This paper examines a topic already much discussed in Royce’s time, namely the debate between Royce and James over the absolute. However, the occasion for taking up this topic again is John E. Smith’s article in which it is claimed that Royce’s own intellectual development moves away from his earlier conception of the absolute and toward the concept of community. This is not so much a conceptual development on Royce’s part, but rather a gradual clarification of Royce’s basic concepts (...) and position. Nevertheless, the ultimate import of Smith’s article is ambiguous in that the impression is created that Royce abandons not only the term “absolute” but the very concept as well, in favor of the concept of community. This seems to mean that Royce abandons the position he defended against James’s criticism and ends in a Feuerbach-style substitution of the concept of human community for the traditional concept of the absolute. However, Smith has vigorously denied that such is the case. Hence a perplexity: Does Royce abandon the concept of the absolute in favor of the concept of community? If, as Smith contends, Royce merely modifies rather than abandons his early position altogether, is the modified position a consistent one? Are the concepts of the absolute and community compatible or antithetical? (shrink)