Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United (...) States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (shrink)

Little is known about health care professionals’ perceptions regarding what it means to treat patients and families with respect and dignity in the intensive care unit (ICU) setting. To address this gap, we conducted nine focus groups with different types of health care professionals (attending physicians, residents/fellows, nurses, social workers, pastoral care, etc.) working in either a medical or surgical ICU within the same academic health system. We identified three major thematic domains, namely, intrapersonal (attitudes and beliefs), interpersonal (behaviors), and (...) system (contextual) factors that influence treatment with respect and dignity. Participants suggested strategies for improving treatment of patients and families in the ICU with respect and dignity, as well as the related need for enhancing respect among the multidisciplinary team of clinicians. Implementing these strategies will require innovative educational interventions and leadership. Future research should focus on the design and evaluation of such interventions on the quality of care. (shrink)

Biomedical science is usually framed for the public in terms of its “promise.” When a breakthrough results from scientific inquiry, that promise is translated into a hope for a cure. The “promise” of such advances in biomedical research can have a paradoxical effect. In the case of pediatric neuromuscular disease, rather than reducing suffering, the expectation of cure can be a burden—both physically and emotionally—for affected children and their families. If a family expects a cure, it is likely to do (...) everything possible to help the child live as long as possible, in the hope that the child will eventually receive it. I am not arguing that the appropriate response to the paradox of promise is to impede scientific progress. What is needed, however, is a broader conception of hope—one that values hope for a good day, a good quality of life, good relationships, or even a good death—alongside the hope for a cure. (shrink)

Cancer susceptibility testing is likely to become routine in medical practice, despite many limitations and unanswered questions. These uncertainties greatly complicate the process of informed consent, creating an excellent opportunity to reconsider exactly how it should be conducted. Research with women's reactions to the availability of genetic susceptibility testing for breast cancer dramatically underscores that informed consent ought to be highly individualized, taking care to discern what patients believe about the disease and its causes and what role they want their (...) physician to play. (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might (...) inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might (...) inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women’s healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case wherein a pregnant (...) obstetrician’s personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women’s health professionals’ self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed. (shrink)

We have never been so aware of masks. They were in short supply in the early days of COVID-19, resulting in significant risk to health care workers. Now they are highly politicized with battles about mask-wearing protocols breaking out in public. Although masks have obtained a new urgency and ubiquity in the context of COVID-19, people have thought about both the literal and metaphorical role of masks in medicine for generations. In this paper, we discuss three such metaphors—the masks of (...) objectivity, of infallibility, and of benevolence—and their powerful role in medicine. These masks can be viewed as inflexible barriers to communication, contributing to the traditional authoritarian relationship between doctor and patient and concealing the authenticity and vulnerability of physicians. COVID masks, by contrast, offer a more nuanced and morally complex metaphor for thinking about protecting people from harm, authentic and trustworthy communication, and attention to potential inequities both in and beyond medical settings. We highlight the morally relevant challenges and opportunities that masks evoke and suggest that there is much to be gained from rethinking the mask metaphor in medicine. (shrink)

When there have been substantial failures by institutional leadership in their oversight responsibility to protect research integrity, the public should demand that these be recognized and addressed by the institution itself, or the funding bodies. This commentary discusses a case of research failures in developing genomic predictors for cancer risk assessment and treatment at a leading university. In its review of this case, the Office of Research Integrity, an agency within the US Department of Health and Human Services, focused their (...) report entirely on one individual faculty member and made no comment on the institution’s responsibility and its failure to provide adequate oversight and investigation. These actions missed an important opportunity to emphasize the institution’s critical responsibilities in oversight of research integrity and the importance of institutional transparency and accountability. (shrink)

Despite wide recognition of the importance of treating patients with respect and dignity, little is known about what constitutes treatment in this regard. The intensive care unit (ICU) is a unique setting that can pose specific threats to treatment with respect and dignity owing to the critical state of patients, stress and anxiety amongst patients and their family members, and the highly technical nature of the environment. In attempt to understand various stakeholders’ perspectives of treatment with respect and dignity, patients (...) and family members were interviewed, a wide range of health care professionals participated in focus groups, and third party observers took field notes of interactions in the ICU. This paper compares and contrasts the data that were generated using these different methods. Triangulating the data in this way contributes to a more complete and nuanced understanding of treatment with respect and dignity in the ICU. (shrink)

Pragmatic clinical trials offer important benefits, such as generating evidence that is suited to inform real-world health care decisions and increasing research efficiency. However, PCTs also present ethical challenges. One such challenge involves the management of information that emerges in a PCT that is unrelated to the primary research question, yet may have implications for the individual patients, clinicians, or health care systems from whom or within which research data were collected. We term these findings as?pragmatic clinical trial collateral findings,? (...) or?PCT-CFs?. In this article, we explore the ethical considerations associated with the identification, assessment, and management of PCT-CFs, and how these considerations may vary based upon the attributes of a specific PCT. Our purpose is to map the terrain of PCT-CFs to serve as a foundation for future scholarship as well as policy-making and to facilitate careful deliberation about actual cases as they occur in practice. (shrink)

Respect and dignity are central to moral life, and have a particular importance in health care settings such as the intensive care unit (ICU). We conducted 15 semistructured interviews with 21 participants during an ICU admission to explore the definition of, and specific behaviors that demonstrate, respect and dignity during treatment in the ICU. We transcribed interviews and conducted thematic qualitative analysis. Seven themes emerged that focused on what it means to be treated with respect and/or dignity: treated as a (...) person; Golden Rule; acknowledgement; treated as family/friend; treated as an individual; treated as important/valuable; and treated as equal. Participants described particular behaviors or actions that were considered related to demonstrating treatment with respect and dignity: listening; honesty/giving information; attention to body/modesty/appearance; caring/bedside manner; patient and family as an information source; attention to pain; and responsiveness. These behaviors provide a framework for improving experiences with care in the ICU. (shrink)

The National Institutes of Health and other federal health agencies are considering establishing a national biobank to study the roles of genes and environment in human health. A preliminary public engagement study was conducted to assess public attitudes and concerns about the proposed biobank, including the expectations for return of individual research results. A total of 141 adults of different ages, incomes, genders, ethnicities, and races participated in 16 focus groups in six locations across the country. Focus group participants voiced (...) a strong desire to be able to access individual research results. Recognizing the wide range of possible research results from a large cohort study, they repeatedly and spontaneously suggested that cohort study participants be given ongoing choices as to which results they received. (shrink)

The pandemic of SARS-CoV-2 has led to unprecedented changes to society, causing unique problems that call for extraordinary solutions. We consider one such extraordinary proposal: ‘safer infection sites’ that would offer individuals the opportunity to be intentionally infected with SARS-CoV-2, isolate, and receive medical care until they are no longer infectious. Safer infection could have value for various groups of workers and students. Health professionals place themselves at risk of infection daily and extend this risk to their family members and (...) community. Similarly, other essential workers who face workplace exposure must continue their work, even if have high-risk household members and live in fear of infecting. When schools are kept closed because of the fear that they will be sites of significant transmission, children and their families are harmed in multiple ways and college students who are living on campus, whether or not they are attending classes in person, are contributing to high rates of transmission and experiencing high rates of exposure. We consider whether offering safer infection sites to these groups could be ethically defensible and identify the empirical unknowns that would need to resolve before reaching definitive conclusions. This article is not an endorsement of intentional infection with the coronavirus, but rather is meant to spark conversation on the ethics of out-of-the-box proposals. Perhaps most meaningfully, our paper explores the value of control and peace of mind for those among us most impacted by the pandemic: those essential workers risking the most to keep us safe. (shrink)

It is simple enough to claim that academic research institutions ought to be trustworthy. Building the culture and taking the steps necessary to earn and preserve institutional trust are, however, complex processes. The experience motivating this special report—a request for the Center for Talented Youth at Johns Hopkins University to collaborate on research regarding the genetics of intelligence—illustrates how ensuring institutional trustworthiness can be in tension with a commitment to fostering research. In this essay, we explore the historical context for (...) biomedical research institutions like Johns Hopkins that have worked to build local community trust. In so doing, we consider how the example under focus in this special report can lead to greater consideration of how research institutions balance fostering trust with their other commitments. (shrink)

Treating patients and their family members with respect and dignity is a broadly accepted goal of health care. The work presented in this article is part of a larger project aimed at better understanding what constitutes treatment with respect and dignity in the ICU to improve the care that patients and family members receive in this regard. Direct observation was selected as one of the methods to facilitate this understanding because it provides the opportunity to see and document what actually (...) occurs during encounters among patients, their families, and clinicians. This article reports seven major thematic domains and many subthemes that together create a detailed account of the interpersonal and environmental components of treatment with respect and dignity. Attention to these components might enhance the experience and treatment of patients and family members. (shrink)

Plato on Knowledge and Forms brings together a set of connected essays by Gail Fine, in her main area of research since the late 1970s: Plato's metaphysics and epistemology. She discusses central issues in Plato's metaphysics and epistemology, issues concerning the nature and extent of knowledge, and its relation to perception, sensibles, and forms; and issues concerning the nature of forms, such as whether they are universals or particulars, separate or immanent, and whether they are causes. A specially written (...) introduction draws together the themes of the volume, which will reward the attention of anyone interested in Plato or in ancient metaphysics and epistemology. (shrink)

Selections seeks to provide an accurate and readable translation that will allow the reader to follow Aristotle's use of crucial technical terms and to grasp the details of his argument. Unlike anthologies that combine translations by many hands, this volume includes a fully integrated set of translations by a two-person team. The glossary--the most detailed in any edition--explains Aristotle's vocabulary and indicates the correspondences between Greek and English words. Brief notes supply alternative translations and elucidate difficult passages.

I distinguish between two senses in which feminists have argued that the knower is social: 1. situated or socially positioned and 2. interdependent. I argue that these two aspects of the knower work in cooperation with each other in a way that can produce willful hermeneutical ignorance, a type of epistemic injustice absent from Miranda Fricker's Epistemic Injustice. Analyzing the limitations of Fricker's analysis of the trial of Tom Robinson in Harper Lee's To Kill a Mockingbird with attention to the (...) way in which situatedness and interdependence work in tandem, I develop an understanding of willful hermeneutical ignorance, which occurs when dominantly situated knowers refuse to acknowledge epistemic tools developed from the experienced world of those situated marginally. Such refusals allow dominantly situated knowers to misunderstand, misinterpret, and/or ignore whole parts of the world. (shrink)

The literature on epistemic injustice has been helpful for highlighting some of the epistemic harms that have long troubled those working in area studies that concern oppressed populations. Nonetheless, a good deal of this literature is oriented toward those in a position to perpetrate injustices, rather than those who historically have been harmed by them. This orientation, I argue, is ill-suited to the work of epistemic decolonization. In this essay, I call and hold attention to the epistemic interests of those (...) who are epistemically marginalized on account of relations of dominance and oppression. To do so, I draw on Kristie Dotson’s work, which uses a systems approach focused on epistemic agency. I develop Dotson’s insights further to argue that epistemic inclusions may be just as pernicious as epistemic exclusions Specifically, I highlight some of the ways in which epistemic agents can be included in epistemic systems in a manner that is epistemically exploitative—extracting epistemic labor coercively or in ways that are distinctly non-reciprocal. I then turn to María Lugones’ distinction between horizontal and vertical practices to discuss avenues of resisting both exclusions and inclusions that thwart the epistemic agency of marginalized knowers. (shrink)

This Commentary offers a critique of an eco-relational approach in robot ethics, highlighting the importance of articulating an ecologically-sensitive ethical orientation that incorporates the entire more-than-human world, including technological entities like forms of artificial intelligence. While the eco-relational approach enhances our understanding of the complex way in which morally significant properties operate on a phenomenological level, it is not without its flaws. In particular, this perspective focuses on ethical concepts when it needs to be rooted in ethical systems, misrepresents the (...) extant literature on relational approaches to moral status, and is insufficiently ecological in a way that would bring machines into the moral universe by way of their location in and importance to the larger environment. At a time when the legal status of robots is being decided before moral questions are settled, it remains important to get the contours of relevant debates right so that the robot ethics discourse brings us closer to developing practical solutions for ethical dilemmas emerging in our increasingly technological age. (shrink)

Among those included in the lists of being sent out in 1922 as part of the “Philosophers’ Steamboat,” there was Sergei Nikolayevich (Father Sergius) Bulgakov (1871–1944). Prior to his deportation, Bulgakov, after many years of struggle, reunited his philosophical and theological journeys. This is reflected in his dialogues and essays, in particular, in At the Feast of the Gods and At the Walls of Chersonesus, and Tragedy of Philosophy. In exile, Bulgakov continued to reflect on the tragedy of a thinker (...) facing a spiritual catastrophe, the tragedy of Russia torn by wars and revolutions, and his personal tragedies. Having regained his firm foundation and a way to overcome his uprootedness, Bulgakov makes an outstanding contribution to preserving Russian culture. This paper focuses on Bulgakov as a person, and his philosophy of religion is considered from the vantage point of how it reflects his personal struggles and humanistic worldview. The Philosophers’ Steamboat, an act of ideological repressions that followed the turbulent years of the Bolshevik Revolution and the Civil War, bears a lesson for today when Russia is at war again, and many prominent cultural figures sever ties with their country. Sergei Bulgakov’s fate and work set an example of living and creating through tragedy. (shrink)

This article explores the development of a novel biomedical research organism, and its potential to remake the species and spaces of translational medicine. The humanized mouse is a complex experimental object in which mice, rendered immunodeficient through genetic alteration, are engrafted with human stem cells in the hope of reconstituting a human immune system for biomedical research and drug testing. These chimeric organisms have yet to garner the same commentary from social scientists as other human–animal hybrid forms. Yet, they are (...) rapidly being positioned as central to translational medicine in immunological research and pharmaceutical development. This article explores the complex relations between species and spaces they seek to enact. Humanizing mice simultaneously moves these animal forms towards the intimate geographies of corporeal equivalence with humans and the expansive geographies of translational research. These multiple trajectories are achieved by the way humanized mice function as both uncertain ‘epistemic things’ and as expansive ‘collaborative things’, articulating mouse genetics with other research, notably stem cell science. In the context of post-genomics, their indeterminacy is critical to their collaborative value; their expansive potential follows as much from their biological openness as from specific expectations. Yet, these new research organisms have both accumulative and disruptive capacities, for there are patterns of interference between these trajectories, remaking boundaries between experimental practices and clinical contexts. (shrink)

This paper is a counter to the view that names are always predicates with the same extension as a metalinguistic predicate with the form “is a thing called “N”” (the Predicate View). The Predicate View is in opposition to the Referential View of names. In this paper, I undermine one argument for the Predicate View. The Predicate View’s adherents take examples of uses of names that have the surface appearance of a predicate and generalise from these to treat uses of (...) names that do not have the surface appearance of a predicate. They show that the Predicate View can provide a unified account of these two uses and assume that the Referential account cannot. I propose an alternative view of names, the Polysemy View. This view allows one to resist the pressure to generalise from the cases with the surface appearance of predicates to all uses of names while nevertheless providing connections between the uses. On the Polysemy View names are not, in their core use, metalinguistic predicates. Names are predominantly referring expressions but they also freelance as metalinguistic predicates on occasion. They have a double life. This double life is possible because of the pragmatic and conventional connections between the two aspects of that life. My main aim in this paper is to show that the Predicate View is not the only view that can give a good account of apparently predicative uses of names. In addition, I offer some inconclusive reasons to prefer the Polysemy View over the Predicate View. My paper assumes a background framework that the Predicate and Referentialist Views share and I do not attempt to justify that framework. I ignore many other views of names (notably descriptivist views and relevance theoretic views) in order to focus on the debate between these two opponents. (shrink)

This book responds to the Bush Administration position on the “war on terror.” It examines preemption within the context of “just war”; justification for the United States-led invasion of Iraq, with some authors charging that its tactics serve to increase terror; global terrorism; and concepts such as reconciliation, Islamic identity, nationalism, and intervention.

The IMF, World Bank, and former colonial powers have put pressure on African countries to adopt multiparty democracy. Because of this pressure, many formerly one‐party states as well as some military dictatorships have embraced Western and Parliamentarian democratic forms. But does this mean that democracy has succeeded in Africa? Ernest Wamba‐dia‐Wamba of the University of Dar‐es‐Saalam and CODESRIA argues that embracing Western paradigms in an unthinking fashion will not bring real democracy, i.e. people's liberation. He advances criticisms of party politics (...) and statism, and suggests that African palaver and people's movements are a surer site of political action. In his criticisms of representative government he parallels the thoughts and criticism of Hannah Arendt. Arendt advocated a council system that shares many of the attributes of African palaver communities. By consulting the criticisms of Arendt and Wamba‐dia‐Wamba, we can see that an easy optimism about the multiparty system is unfounded. (shrink)

This paper uses the figure of the inbred laboratory mouse to reflect upon the management and mobilization of biological difference in the contemporary biosciences. Working through the concept of shifting experimental systems, the paper seeks to connect practices concerned with standardization and control in contemporary research with the emergent and stochastic qualities of biological life. Specifically, it reviews the importance of historical narratives of standardization in experimental systems based around model organisms, before identifying a tension in contemporary accounts of the (...) reproduction and differentiation of inbred mouse strains within them. Firstly, narratives of new strain development, foregrounding personal biography and chance discovery, attest to the contingency and situatedness of apparently universal biotechnological production. Secondly, discoveries of unexpected animal litters challenge efforts to standardize mouse phenotypes and control the reproduction of murine strains over space. The co-existence of these two narratives draws attention to the importance of and interplay between both chance and control, determination and emergence, and the making and moving of experimental life in biomedical research. The reception or denial of such biological excess reflects the distribution of agencies and the emerging spatialities of the global infrastructures of biotechnological development, with implications for future relations between animal lives and human becomings in experimental practices. (shrink)

The article examines the role of ethnic favoritism in maldistribution of national resources in Kenya and discusses two broad proposals for attacking such corruption. Evidence drawn from research in Kenya disproves the view of Chabal and Daloz, who argue that Africans prefer to distribute goods according to ethnic ties, and shows that frustration with the lack of alternatives to such a system, rather than enthusiasm for it, drives cooperation with corrupt maldistribution. One solution to the problem is to decentralize government (...) so that resources are retained locally. A second solution is to attack the culture of appropriation and push for a fair evaluation of needs and the equitable distribution of national resources to where they are needed most. Drawing on the ideas of Hannah Arendt, the article proposes a modified federalism where government is small enough to enlist the help and support of locals but powerful enough to provide funds to impoverished sectors of the country. (shrink)

This editorial critically engages with the understanding of openness by attending to how notions of presence and absence come bundled together as part of efforts to make open. This is particularly evident in contemporary discourse around data production, dissemination, and use. We highlight how the preoccupations with making data present can be usefully analyzed and understood by tracing the related concerns around what is missing, unavailable, or invisible, which unvaryingly but often implicitly accompany debates about data and openness.

This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be permitted (...) access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

Representing a new generation of theorists reaffirming the radical dimensions of art, Gail Day launches a bold critique of late twentieth-century art theory and its often reductive analysis of cultural objects. Exploring core debates in discourses on art, from the New Left to theories of "critical postmodernism" and beyond, Day counters the belief that recent tendencies in art fail to be adequately critical. She also challenges the political inertia that results from these conclusions. Day organizes her defense around critics (...) who have engaged substantively with emancipatory thought and social process: T. J. Clark, Manfredo Tafuri, Fredric Jameson, Benjamin H. D. Buchloh, and Hal Foster, among others. She maps the tension between radical dialectics and left nihilism and assesses the interpretation and internalization of negation in art theory. Chapters confront the claim that exchange and equivalence have subsumed the use value of cultural objects—and with it critical distance— and interrogate the proposition of completed nihilism and the metropolis put forward in the politics of Italian operaismo. Day covers the debates on symbol and allegory waged within the context of 1980s art and their relation to the writings of Walter Benjamin and Paul de Man. She also examines common conceptions of mediation, totality, negation, and the politics of anticipation. A necessary unsettling of received wisdoms, _Dialectical Passions_ recasts emancipatory reflection in aesthetics, art, and architecture. (shrink)

This book opens the door to the effects of intellectual, educational, and economic colonization of young children throughout the world. Using a postcolonial lens on current educational practices, the authors hope to lift those practices out of reproducing traditional power structures and push our thinking beyond the adult/child dichotomy into new possibilities for the lives that are created with children.

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

A co-founder of the Catholic Worker Movement, its newspaper, and hospitality houses, the writer Dorothy Day promoted public peace nationally and internationally as a journalist, an organizer of public protests, and a builder of associational communities. Drawing upon Hannah Arendt’s conceptions of the role of speech and action in creating the public realm, this paper focuses on several of Day’s most controversial public positions: her leadership of non-cooperation against Civil Defense drills intended to prepare New York City residents to survive (...) a nuclear war; her urging of Catholics to find common cause with the Cuban revolutionary government; and her support for interracial farming communities in the Southern United States. As Arendt asserts about Rahel Varnhagen’s salon in Berlin, by being public meeting spaces hosted in private houses, Catholic Worker communities fostered egalitarian rather than “agonal” politics. Like Gandhi’s newspapers and ashrams as well as “Occupy” communities such as Zuccotti Park, Day’s newspaper was a center for incubating and implementing social reform. The Catholic Worker provided a place where writers could question the official rhetoric of such conflicts as World War II and the Cold War, put forward different interpretations of unfolding events, and chart possible alternatives to establishment agendas. (shrink)

ABSTRACT This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be (...) permitted access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

Existing metasemantic projects presuppose that word- (or sentence-) types are part of the non-semantic base. We propose a new strategy: an endogenous account of word types, that is, one where word types are fixed as part of the metasemantics. On this view, it is the conventions of truthfulness and trust that ground not only the meaning of the words (meaning by convention) but also what the word type is of each particular token utterance (words by convention). The same treatment extends (...) to identifying the populations through which the conventions prevail. We consider whether this proposal leads to new underdetermination challenges for metasemantics, and make a case that it does not. (shrink)