Abstractabstract:This article provides an in-depth ethical analysis of living donor uterus transplantation, incorporating clinical, psychological, and qualitative study data into the discussion. Although the concept of living organ donors as patients in their own right has not always been present in the field of transplantation, this conceptualization informs the framework for living donor ethics that we apply to living uterus donation. This framework takes root in the principles of research ethics, which include respect for persons, beneficence, and justice. It incorporates (...) an analysis based on eight potential vulnerabilities of living donors: capacitational, juridic, deferential, social, medical, situational, allocational, and infrastructural. Finally, it recognizes that special relationships—such as that of the living donor advocate with the potential donor—require special responsibilities, including identifying vulnerabilities and engaging donors in a shared decision-making process. Directed and non-directed uterus donors require separate ethical analyses because their different relationships with recipients will influence the types of vulnerabilities, they are subject to as well as the potential benefits they may gain from donation. (shrink)

In their manuscript, Nielsen Busch and Mjaaland (2023) argue that controlled donation after circulatory death (cDCD) is compatible with the dead donor rule (DDR) by describing the DDR and the incor...

Ethical problems are common in clinical medicine, so medical volunteers who practice clinical medicine in developing countries should expect to encounter them just as they would in their practice in the developed world. However, as this article argues, medical volunteers in developing countries should not expect to encounter the same ethical problems as those that dominate Western biomedicine or to address ethical problems in the same way as they do in their practice in developed countries. For example, poor health and (...) advanced disease increase the risks and decrease the potential benefits of some interventions. Consequently, when medical volunteers intervene too readily, without considering the nutritional and general health status of patients, the results can be devastating. Medical volunteers cannot assume that the outcomes of interventions in developing countries will be comparable to the outcomes of the same interventions in developed countries. Rather, they must realistically consider the complex medical conditions of patients when determining whether or not to intervene. Similarly, medical volunteers may face the question of whether to provide a pharmaceutical or perform an intervention that is below the acceptable standard of care versus the alternative of doing nothing. This article critically explores the contextual features of medical volunteer work in developing countries that differentiate it from medical practice in developed countries, arguing that this context contributes to the creation of unique ethical problems and affects the way in which these problems should be analyzed and resolved. (shrink)

A woman with congenital absence of a uterus applied for participation in a clinical trial for uterus transplantation. She was married to a woman who had the potential to carry a child without the need for aggressive medical intervention. Thus, the question arose regarding whether the infertile partner should be considered for uterus transplantation. In this article we discuss the ethical issues with uterus transplantation for a member of a same-sex couple, whose partner could carry a pregnancy. We review the (...) medical criteria for uterus transplantation, discuss the additional options for parenthood in same-sex couples, examine how to determine if this meets the criteria of just distribution of uterus grafts, and ultimately argue that the value of gestation is at the level of the individual rather than the couple. (shrink)

In their article, Bruno and Arora (2018) conclude that if deceased donor uterus transplantation has equivalent outcomes and the supply of deceased donors is sufficient, then living uterus donation...

A man of twenty‐two is admitted to an intensive care unit (ICU)after intentionally overdosing on Tylenol. The nurse asks the intensivist on call if someone from the local organ procurement organization should be called in to speak to the family, given a worsening clinical picture and the likelihood that the patient will progress to brain death. The patient's condition is such that multiple organs, including his heart and lungs, could be donated. The intensivist instructs the nurse not to call, as (...) he wishes to have an end‐of‐life discussion with the parents. He believes that the parents should know that death is imminent and that further interventions will not save their son. He argues that introducing the OPO at this point will cause the family more distress. He wants the parents to be able to give their son a peaceful death without additional stressors. What are the broader implications of not calling the OPO at this juncture? Does the nurse involved have an ethical obligation to override the intensivist's instructions by calling the OPO? Should the fact that multiple healthy organs could be harvested from this patient's body have any bearing on the decision to call the OPO? (shrink)

Volume 19, Issue 11, November 2019, Page 25-26.

Surgeons are in a unique position, serving as gatekeepers to the operating room. They determine if operations are possible, are indicated, and have a reasonable risk–to–benefit profile. When an operation is indicated and the patient is amenable to it, the conversation between surgeon and patient is usually straightforward. On the other hand, when a patient’s co–morbidities substantially increase the risk of operative intervention, surgeons often question the utility of offering their services. These situations become immensely more difficult when patients have (...) the expectation of being offered surgical treatment. This case describes the clinical encounter between an endocrine surgeon and an 83–year–old woman who has been incidentally found to have adrenal metastasis from melanoma. The patient wants an operation that the surgeon is reluctant to offer because of her frailty and high operative risk. The case focuses on the ethical dilemma that arises when a patient wants an operation that a surgeon does not want to perform. I was the resident in the endocrine surgery clinic the day that Ms. M came in. Given my background in bioethics, the attending physician told me about the patient’s history beforehand and asked for advice on how to approach the clinical encounter. I then accompanied him into her room to talk with her and her husband. (shrink)

This paper proposes a new definition of vocation that honors the concept’s ancient roots, is consistent with how the term is used in modern contexts, and also expands the concept for greater versatility. We discuss the centrality of service in the concept of vocation locating it as part of the bridge between a student’s core values and their embodiment in community life. The commitment to one’s profession begins before independent status as a practitioner of that profession. It begins in training (...) during which service-learning is a laudable and increasingly popular way to connect to the charitable aspects of professionalism. We further discuss how the concept of vocation is especially appropriate in the context of citizenship. Citizenship is a way of belonging to a community. It is a relationship that requires giving and taking. Service-learning is an ideal way to practice good citizenship on a local scale, and prepare future professionals for understanding their communities and commitments morebroadly. We discuss how these concepts are being emphasized in the medical informatics master’s degree program at Saint Louis University through the incorporation of a service-learning module. We describe the module, discussing how it can be applied to curricula at other institutions and modified for inclusion in other types of courses. (shrink)

This paper proposes a new definition of vocation that honors the concept’s ancient roots, is consistent with how the term is used in modern contexts, and also expands the concept for greater versatility. We discuss the centrality of service in the concept of vocation locating it as part of the bridge between a student’s core values and their embodiment in community life. The commitment to one’s profession begins before independent status as a practitioner of that profession. It begins in training (...) during which service-learning is a laudable and increasingly popular way to connect to the charitable aspects of professionalism. We further discuss how the concept of vocation is especially appropriate in the context of citizenship. Citizenship is a way of belonging to a community. It is a relationship that requires giving and taking. Service-learning is an ideal way to practice good citizenship on a local scale, and prepare future professionals for understanding their communities and commitments morebroadly. We discuss how these concepts are being emphasized in the medical informatics master’s degree program at Saint Louis University through the incorporation of a service-learning module. We describe the module, discussing how it can be applied to curricula at other institutions and modified for inclusion in other types of courses. (shrink)

Background: Ethical frameworks for organ donation following circulatory death (DCD) were established >20 years ago. However, considerable variation exists among these, indicating consensus has not been reached on all issues. Additionally, advances such as cardiac DCD transplants and normothermic regional perfusion (NRP) may have reignited old debates.Methods: We reviewed the English-language literature addressing ethical issues in DCD from 1993 to 2022, examining changes in frequency with which ethical principles and their sub-themes identified within each, were addressed.Results: Non-maleficence was the most (...) frequently addressed principle (192 of 199 articles), as well as the most varied, with 9 subthemes (versus 2-4 within each of the other bioethical principles).Conclusions: There were several changes in the terminology used to refer to DCD over time, and substantial interest in cardiac DCD and NRP in recent publications, arising in 11 and 19 of the 30 publications from 2018 to 2022. (shrink)

This paper presents the Rational Action, Noisy Choice for Habituation (RANCH) model. The model was evaluated with adult looking time collected from a paradigm analogous to the infant habituation paradigm. And the model captured key patterns of looking time documented in developmental research: habituation and dishabituation.

Jerry L. Walls, the author of books on hell and heaven, completes his tour of the afterlife with a philosophical and theological exploration and defense of purgatory, the traditional teaching that most Christians require a period of postmortem cleansing and purging of their sinful dispositions and imperfections before they will be fully made ready for heaven. He examines Protestant objections to the doctrine and shows that the doctrine of purgatory has been construed in different ways, some of which are fully (...) compatible with Protestant theology. In particular, while purgatory has often been understood as matter of punishment in order to make satisfaction for sins that have not been fully remitted, it can also be seen as the completion of the sanctification process, an account of the doctrine that is fully consistent with the Protestant doctrine of justification by faith. Purgatory assumes not only continuity of personal identity but also gradual moral and spiritual growth between death and resurrection. Different theories of personal identity are examined and assessed in light of these assumptions. Walls also shows that the traditional doctrine of purgatory is not understood as a second chance for salvation, but goes on to argue that it should be modified to allow for postmortem repentance. He concludes with an examination of C.S. Lewis's writings on purgatory, and suggests that Lewis can be a model for evangelicals and other Protestants to engage the doctrine of purgatory in a way that is true to their theology. (shrink)

Naturalistic ethics is the reigning paradigm among contemporary ethicists; in God and Cosmos, Baggett and Walls argue that this approach is seriously flawed. This book canvasses a broad array of secular and naturalistic ethical theories in an effort to test their adequacy in accounting for moral duties, intrinsic human value, prospects for radical moral transformation, and the rationality of morality. In each case, the authors argue, although various secular accounts provide real insights and indeed share common ground with theistic ethics, (...) the resources of classical theism and orthodox Christianity provide the better explanation of the moral realities under consideration. Among such realities is the fundamental insight behind the problem of evil, namely, that the world is not as it should be. Baggett and Walls argue that God and the world, taken together, exhibit superior explanatory scope and power for morality classically construed, without the need to water down the categories of morality, the import of human value, the prescriptive strength of moral obligations, or the deliverances of the logic, language, and phenomenology of moral experience. This book thus provides a cogent moral argument for God's existence, one that is abductive, teleological, and cumulative. (shrink)

Paul Ricoeur's understanding of the relations of faith, love, and hope suggests a unique approach to theological ethics, one that holds fresh promise for bringing together considerations of the good (teleology) and the right (deontology) around the notion of an "economy of the gift." The economy of the gift articulates Ricoeur's distinctively dialectical understanding of the relation of the human and the divine, and the resulting dialectical moral relation of the self and the other. Despite our fallen condition, Ricoeur suggests, (...) we are called by the divine to embrace the radical possibility of the reconciliation of human goods under the requirement of accountability to human diversity and otherness. (shrink)

Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims’s medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical (...) source material and concludes that the charges that have been made against Sims are largely without merit. Sims’s modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, the evidence suggests that Sims’s original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time. (shrink)

INTRODUCTION Linguists who work within the tradition of transformational generative grammar tend to regard semantics as an intractable, perhaps ultimately ...

In this study I defend an account of 'dispositional coercion' and coercive offers which hinges primarily on the intentions of both the coercer and the victim. In doing so I argue against various baseline accounts of coercion. ;Baseline accounts center on the victim's estimation of a proposal's effect, the determination of coercive threats and offers primarily hinging on the victim's beliefs and preferences. I believe that it is the intended action of the individual making the proposal that provides the core (...) consideration for defining coercive threats and offers. ;The following is my set of jointly necessary and sufficient conditions for 'dispositional coercion' wherein X coerces Y to do A: X threatens Y, that is, X intentionally attempts to create the belief in Y that X will be responsible for harm coming to Y should Y fail to do A. X's motive for attempting to create this belief is his desire to bring about a state of affairs in which Y's recognition of this possible harm to himself influences Y to do A. X successfully creates the belief in Y that Y may be harmed if he fails to do A, that is, X is successful in causing Y to recognize that harm may come to him should he fail to do A. Y intends to do A, and Y's motive for intending to do A is Y's desire to avoid harm to himself. Y does A. ;I also argue that X makes Y a coercive offer if and only if: ; X either intentionally attempts to create the following beliefs in Y, or for cases in which X believes that Y already holds beliefs and , attempts to create belief in Y: X is able to prevent some harm from coming to Y. Y needs X's assistance in preventing this harm. X will not assist Y in preventing this harm if Y does not do A. ; X's motive for attempting to create beliefs - in Y, or for cases in which Y already holds beliefs and , to attempt to create belief in Y is his desire to bring about a state of affairs in which Y's recognition of this possible harm to himself influences Y to do A. (shrink)

While popular cultural representations portray the “new father” of the past two decades as more involved, more nurturing, and capable of coparenting, many argue that actual fathering conduct has not kept pace. Others, however, question the extent to which the culture of fatherhood does indeed support involved fathering and, if so, what this involvement entails. This study aims to contribute to the exploration of the culture of fatherhood through an analysis of a yearlong Canadian newspaper series dedicated to family issues. (...) Findings suggest that through representations of parental guilt, parental responsibility, work—family balance issues, and hegemonic masculinity, mothers continue to be positioned as primary parents. Support for father involvement, to the extent that it exists, occurs within the framework of fathers as part-time, secondary parents whose relationship with children remains less important than mothers'. (shrink)

In 1866, the young John Venn published The Logic of Chance, motivated largely by the desire to correct what he saw as deep fallacies in the reasoning of historical determinists such as Henry Buckle and in the optimistic heralding of a true social science by Adolphe Quetelet. Venn accepted the inevitable determinism implied by the physical sciences, but denied that the stable social statistics cited by Buckle and Quetelet implied a similar determinism in human actions. Venn maintained that probability statements (...) were intelligible solely as projections of the ultimate frequency of an outcome in an unlimited series of trials and therefore led to no inferences about free will. An issue here was Venn's claim that although the aggregate probability may be stable, the individual events were completely irregular and, in fact, displayed randomness. Venn's concept of randomness was really apparent, or pseudo-, randomness, which could be totally determined. Ironically, Venn's frequentist position was very useful to the growing field of statistics, which could develop correlations and predictive models empirically without having to address implications for personal freedom or fatalism. (shrink)

Jerry L. Walls argues that the doctrine of heaven is ripe for serious reconsideration. He contends not only that the orthodox view of heaven can be defended from objections commonly raised against it, but also that heaven is a powerful resource for addressing persistent philosophical problems, not the least of which concern the ground of morality and the meaning of life. Walls shows how heaven is integrally related to central Christian doctrines, particularly those related to salvation, and tackles the difficult (...) problem of why faith in Christ is necessary to save us from our sins. In addition, heaven is shown to illumine thorny problems of personal identity and to be an essential component of a satisfactory theodicy. Walls goes on to examine data from near-death experiences from the standpoint of some important recent work in epistemology and argues that they offer positive evidence for heaven. He concludes that we profoundly need to recover the hope of heaven in order to recover our very humanity. (shrink)

Having visited Ireland regularly during the 1930s, Ludwig Wittgenstein resigned his Cambridge philosophy professorship in 1947 and moved there, living in a fishing village on the Atlantic coast and hotels in Dublin and the Wicklow Mountains. Although Wittgenstein spent some time out of the country, Ireland was effectively his base for three very productive years during which he worked on what would become one of his key books, the posthumously published Philosophical Investigations. Wittgenstein in Ireland represents the first sustained account (...) of Wittgenstein's time in Ireland, placing it in its historical context. Wall pays a good deal of attention to the representation of the Irish landscape in which the Austrian philosopher found himself able to work; a large part of his writings were produced in the bleak landscapes of Ireland and Norway. (shrink)

John Venn is known as one of the clearest expounders of the interpretation of probability as the frequency of a particular outcome in a potentially unlimited series of possible events. This view he held to be incompatible with the alternate interpretation of probability as a measure of the degree of belief that would rationally be held about a certain outcome based upon the reliability of testimony and other prior information. This paper explores the reasons why Venn may have been so (...) opposed to the degree-of-belief interpretation and suggests that it may have been a way for him to resolve a conflict in his own mind between his ideas of proper scientific methods of inference and the religious beliefs that he held as a young man. (shrink)

Since at least the 1970s in Canada, there have been calls for health system reforms based on innovative roles and expanded scopes of practice for nurses. Professional regulatory organizations, through legislation, define the standards and parameters of professional nursing practice. Nursing regulators emphasize public protection over the advancement of nursing; regulatory processes and decisions tend to be conservative and risk‐averse. This study explored the impact that regulatory processes have on innovation in nursing roles. Nurses in a range of unique practice (...) situations were interviewed, including nurses in non‐traditional roles and/or settings, those with cross‐jurisdictional career histories, and those working in interdisciplinary practices and educational settings. For these nurses, nursing practice was viewed through a traditional clinical lens, which did not fit for them. They experienced hassle, delay, and inconsistencies in regulatory practices. They felt mistreated and fearful of the regulator and lamented the ways in which ambitious, creative, capable nurses were stymied in attempting new applications for nursing knowledge. Nursing is constraining its own mandate to contribute to health care through stringent licensing processes. Healthcare reform provides an opportunity for nursing regulators to rethink their processes and provide the latitude for nurse‐driven change. (shrink)

Doing research with young children can be challenging for many reasons, but this book provides clear guidance on how to engage in appropriate methods. Focusing on researching through play, careful consideration is given to: · the founding principles of playful research · understanding young children's perspectives · prioritising the rights of the child and the voice of the child · examples of innovative research methods Real life examples and research projects are presented, to enable common challenges to be anticipated and (...) to showcase successful creative approaches, and to inspire new paths in research. (shrink)

Are liberalism and perfectionism compatible? In this study Steven Wall presents and defends a perfectionist account of political morality that takes issue with many currently fashionable liberal ideas but retains the strong liberal commitment to the ideal of personal autonomy. He begins by critically discussing the most influential version of anti-perfectionist liberalism, examining the main arguments that have been offered in its defence. He then clarifies the ideal of personal autonomy, presents an account of its value and shows that (...) a strong commitment to personal autonomy is fully compatible with an endorsement of perfectionist political action designed to promote valuable pursuits and discourage base ones. (shrink)

The Plant Ontology (PO; http://www.plantontology.org/) is a publicly-available, collaborative effort to develop and maintain a controlled, structured vocabulary (“ontology”) of terms to describe plant anatomy, morphology and the stages of plant development. The goals of the PO are to link (annotate) gene expression and phenotype data to plant structures and stages of plant development, using the data model adopted by the Gene Ontology. From its original design covering only rice, maize and Arabidopsis, the scope of the PO has been expanded (...) to include all green plants. The PO was the first multi-species anatomy ontology developed for the annotation of genes and phenotypes. Also, to our knowledge, it was one of the first biological ontologies that provides translations (via synonyms) in non-English languages such as Japanese and Spanish. There are about 2.2 million annotations linking PO terms to over 110,000 unique data objects representing genes or gene models, proteins, RNAs, germplasm and Quantitative Traits Loci (QTLs) from 22 plant species. In this paper, we focus on the plant anatomical entity branch of the PO, describing the organizing principles, resources available to users, and examples of how the PO is integrated into other plant genomics databases and web portals. We also provide two examples of comparative analyses, demonstrating how the ontology structure and PO-annotated data can be used to discover the patterns of expression of the LEAFY (LFY) and terpene synthase (TPS) gene homologs. (shrink)

This paper articulates and defends a novel hybrid account of well-being. We will call our view a Robust Hybrid. We call it robust because it grants a broad and not subservient role to both objective and subjective values. In this paper we assume, we think plausibly but without argument, that there is a significant objective component to well-being. Here we clarify what it takes for an account of well-being to have a subjective component. Roughly, we argue, it must allow that (...) favoring attitudes that are not warranted by the lights of objective values can ground benefits. Given this understanding, we show that there is an important and unrecognized expansion in the resources available to fully objectivist views: namely that such views can help themselves to the value of warranted love of objective goods. Such a move by the objectivist can help them respond to concerns that, on their view, a person’s well-being can be too alien to them. We next argue that, nonetheless, such objectivist views are still unconvincing due to their lack of a subjective component. This motivates a move from fully objective accounts to hybrid accounts. We show that many prominent hybrid theories in the literature are inadequate because they implausibly minimize the subjective component. This motivates a move to a robust hybrid view that has an expanded subjectivist component. We conclude with some remarks about the interrelation between the subjective and objective components in the hybrid account that we favor and a role for resonance in a theory of well-being other than serving as a hard constraint on any benefit. (shrink)

Many writers claim that democratic government rests on a principled commitment to the ideal of political equality. The ideal of political equality holds that political institutions ought to be arranged so that they distribute political standing equally to all citizens. I reject this common view. I argue that the ideal of political equality, under its most plausible characterizations, lacks independent justificatory force. By casting doubt on the ideal of political equality, I provide indirect support for the claim that democratic government (...) is only instrumentally justified. (shrink)

Emotion regulation is one of the major foci of study in the fields of emotion and emotional development. This article proposes that to properly study emotion regulation, one must consider not only an intrapersonal view of emotion, but a relational one as well. Defining properties of intrapersonal and relational approaches are spelled out, and implications drawn for how emotion regulation is conceptualized, how studies are designed, how findings are interpreted, and how generalizations are drawn. Most research to date has been (...) conducted from an intrapersonal perspective, and the shortcomings of this approach for understanding emotion regulation are highlighted. The article emphasizes major conceptual and methodological steps required for a fuller description of the process of emotion regulation. (shrink)