This book offers an in-depth analysis of the cognitive and ethical role of emotion, particularly empathy, in medical practice. The author explains how doctors can use empathy in diagnosing and treating patients without jeopardizing their objectivity or projecting their own values on to patients.

Unrealistic therapeutic beliefs are very common—the majority of patient-subjects enrol in phase 1 trials seeking and expecting significant medical benefit, even though the likelihood of such benefit has historically proven very low. The high prevalence of therapeutic misestimation and unrealistic optimism in particular has stimulated debate about whether unrealistic therapeutic beliefs in early-phase clinical trials preclude adequate informed consent. We seek here to help resolve this controversy by showing that a crucial determination of when such therapeutic beliefs are ethically problematic (...) turns on whether they are causally linked and instrumental to the motivation to participate in the trial. Thus, in practice, it is ethically incumbent on researchers to determine which understanding and beliefs lead to the participant’s primary motivation for enrolling, not to simply assess understanding, beliefs and motivations independently. We further contend that assessing patient-subjects’ appreciation as a component of informed consent—it is already an established component of decision-making capacity assessments—can help elucidate the link between understanding-beliefs and motivation; appreciation refers to an individual’s understanding of the personal significance of both the medical facts and the experience of trial participation. Therefore, we recommend that: in addition to the usual question, ‘Why do you want to participate in this trial?’, all potential participants should be asked the question: ‘What are you giving up by participating in this trial?’ and researchers should consider the settings in which it may be possible and practical to obtain ‘two-point consent’. (shrink)

What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal parameter (...) adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored. (shrink)

There is an important gap in philosophical, clinical and bioethical conceptions of decision-making capacity. These fields recognize that when traumatic life circumstances occur, people not only feel afraid and demoralized, but may develop catastrophic thinking and other beliefs that can lead to poor judgment. Yet there has been no articulation of the ways in which such beliefs may actually derail decision-making capacity. In particular, certain emotionally grounded beliefs are systematically unresponsive to evidence, and this can block the ability to deliberate (...) about alternatives. People who meet medico-legal criteria for decision-making capacity can react to health and personal crises with such capacity-derailing reactions. One aspect of this is that a person who is otherwise cognitively intact may be unable to appreciate her own future quality of life while in this complex state of mind. This raises troubling ethical challenges. We cannot rely on the current standard assessment of cognition to determine decisional rights in medical and other settings. We need to understand better how emotionally grounded beliefs interfere with decision-making capacity, in order to identify when caregivers have an obligation to intervene. (shrink)

Volume 20, Issue 8, August 2020, Page 1-4.

Principles are static; narratives move. They show us how people change; they depict character development and moral growth (or decline). They do this by pulling us inside lived time, where we empathize with a character's dilemmas about, and responsibility for, his or her future. This feature of narratives fits well with ethics, for ethics begins with practical questions about what to do or how to be (or even whether to be). Such questions require that one view the future as something (...) one has some freedom to shape. Narrative and principle‐based ethics support each other, and both are necessary, but in this essay I will focus on one side and consider how narrative dynamism enlivens a static bioethical principle, opening up new possibilities for moral action. (shrink)

In response to the article by Baum-Baicker and Sisti, I will consider the kind of wisdom involved in therapeutic listening; the role of life wisdom; and the challenge of imparting clinical wisdom to young health professionals’ education.

Metaphors used to describe new technologies mediate public understanding of the innovations. Analyzing the linguistic, rhetorical, and affective aspects of these metaphors opens the range of issues available for bioethical scrutiny and increases public accountability. This article shows how such a multidisciplinary approach can be useful by looking at a set of texts about one issue, the use of a newly developed technique for genetic modification, CRISPRcas9.

the recent announcement of the claimed births of CRISPR-edited babies has prompted both widespread condemnation and calls by leading scientists for a moratorium on any further germline genome editing for reproductive purposes. Concurrently, national and international bodies are calling for the development of robust guidelines and requirements that will identify permissible conditions under which such GGE efforts may proceed. As detailed recommendations to navigate this unique terrain are under development, we suggest an approach that begins with identifying serious concerns about (...) social exclusion and social justice that arise... (shrink)

In response to increasing use of practice guidelines in medicine, physicians have focused their attention on how these guidelines can restrict their medical practices. However, guidelines not only restrict physician discretion, but they also limit the treatment options available to patients. As a result, treatments which patients consider beneficial may not be recommended; for example, some hysterectomies for abnormal uterine bleeding, and cataract surgery in patients with dementia. When guidelines are used to determine which medical treatments a health care organization (...) or insurer will cover, these recommendations become restrictions. Thus far, guidelines have been developed without adequate attention to the impact that their restrictive use has on diverse patient values.Two significant tensions in current medical ethics relate to the inclusion of patient values in practice guidelines. First, a tension exists between the traditional paternalistic model of care, in which the physician judges unilaterally which treatments will benefit the patient, and the more recent autonomy model, in which the physician elicits the individual patient's health values to determine which treatments will be beneficial. (shrink)

In response to increasing use of practice guidelines in medicine, physicians have focused their attention on how these guidelines can restrict their medical practices. However, guidelines not only restrict physician discretion, but they also limit the treatment options available to patients. As a result, treatments which patients consider beneficial may not be recommended; for example, some hysterectomies for abnormal uterine bleeding, and cataract surgery in patients with dementia. When guidelines are used to determine which medical treatments a health care organization (...) or insurer will cover, these recommendations become restrictions. Thus far, guidelines have been developed without adequate attention to the impact that their restrictive use has on diverse patient values.Two significant tensions in current medical ethics relate to the inclusion of patient values in practice guidelines. First, a tension exists between the traditional paternalistic model of care, in which the physician judges unilaterally which treatments will benefit the patient, and the more recent autonomy model, in which the physician elicits the individual patient's health values to determine which treatments will be beneficial. (shrink)

Walter and Ross rightfully argue that healthcare providers need to employ a less authoritarian, more empowering approach if they want to support patients’ behavioral changes. They show how motivational interviewing (MI), informed by self-determination theory, engages patients and thus may inspire enduring changes. They ground these interventions in an important, new model of relational autonomy, emphasizing the patient’s self-respect and self-cohesion as well as self-determination, and they show how patient–provider interactions influence these three aspects of autonomy. It may be surprising (...) then, that in the first part of this essay, I argue that it is problematic for them to ground their empowerment model in the .. (shrink)

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide (...) care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians. (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models (...) of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

Research partnerships between institutions in the Global North and institutions in the Global South have many potential benefits, including sharing of knowledge and resources. However, such partnerships are traditionally exploitative to varying degrees. In order to promote equity in South‐North research partnerships, it is necessary to learn from the experiences of researchers collaborating internationally. This study analyzed transcripts from eleven semi‐structured qualitative interviews with researchers working at Clínica de Familia La Romana, an institution in the Dominican Republic with decades of (...) experience with research and research partnerships with institutions from the Global North. The findings of this study suggest that respect for resources invested in research, as well as for the researchers and institutions themselves, are vital components to a successful global health research partnership. These findings have implications for individual research partnerships, as well as the policies of journals and institutions providing funding that affect these partnerships. (shrink)

Empathy is an extensively studied construct, but operationalization of effective empathy is routinely debated in popular culture, theory, and empirical research. This article offers a process-focused approach emphasizing the relational functions of empathy in interpersonal contexts. We argue that this perspective offers advantages over more traditional conceptualizations that focus on primarily intrapsychic features. Our aim is to enrich current conceptualizations and empirical approaches to the study of empathy by drawing on psychological, philosophical, medical, linguistic, and anthropological perspectives. In doing so, (...) we highlight the various functions of empathy in social interaction, underscore some underemphasized components in empirical studies of empathy, and make recommendations for future research on this important area in the study of emotion. (shrink)

Base of the pyramid ventures seek to create “mutual value” for themselves and poor communities, but often use business models unadapted for the BoP context, and have been less successful than hoped. Sustainable business models’ multi-stakeholder lens offers a promising alternative path to mutual value, but BoP-based SBM studies are scarce. This single case study explores whether and how SBM characteristics manifest in the business model and value outcomes of Habi, a Manila footwear company successfully creating mutual value with BoP (...) suppliers. We find SBM characteristics underpin Habi’s dual-structure business model and success in four ways: viewing profits as a tool for community development resulted in designing both product and business model around community strengths; understanding communities as systems helped Habi address the complexities of poverty; balancing short-term business needs with a long-term, slow-growth approach led to their choice of investors; and implementing community value capture mechanisms ensured enduring community benefit. (shrink)

Research clearly shows that increasing the number of women in leadership positions yields financial benefits for the organization. Despite this, there has been limited upward movement in the percentage of women in senior leadership positions. Few studies have examined the linkage between masculine culture and the implications for men. Using a mixed methods approach with two studies, this research focused on four aspects of masculine contest cultural norms and how they impact male identity and perceptions of career advancement. Study 1 (...) used a qualitative interview study of 10 male executives and found that masculine contest culture norms were evident but were being perpetuated and reinforced by organizational culture instead of individual masculine identities. In addition, Study 1 demonstrated a shift in masculine contest culture norms reducing the emphasis on the strong male archetype. Study 2 examines the relationship between masculine contest culture attributes impacting perceived opportunities for career development and promotion. We evaluated these relationships through a large‐scale survey study and found that at higher levels of masculine contest culture norms, men's perceptions of procedural justice for career development and promotion were lower compared with women. Broadly, the findings suggest that masculine archetypes of leadership negatively affect men and women. (shrink)

When the fuzzy indeterminacy of quantum mechanics overthrew the orderly world of Isaac Newton, Albert Einstein and Erwin Schrödinger were at the forefront of the revolution. Neither man was ever satisfied with the standard interpretation of quantum mechanics, however, and both rebelled against what they considered the most preposterous aspect of quantum mechanics: its randomness. Einstein famously quipped that God does not play dice with the universe, and Schrödinger constructed his famous fable of a cat that was neither alive nor (...) dead not to explain quantum mechanics but to highlight the apparent absurdity of a theory gone wrong. But these two giants did more than just criticize: they fought back, seeking a Theory of Everything that would make the universe seem sensible again. In Einstein’s Dice and Schrödinger’s Cat, physicist Paul Halpern tells the little-known story of how Einstein and Schrödinger searched, first as collaborators and then as competitors, for a theory that transcended quantum weirdness. This story of their quest—which ultimately failed—provides readers with new insights into the history of physics and the lives and work of two scientists whose obsessions drove its progress. Today, much of modern physics remains focused on the search for a Theory of Everything. As Halpern explains, the recent discovery of the Higgs Boson makes the Standard Model—the closest thing we have to a unified theory— nearly complete. And while Einstein and Schrödinger failed in their attempt to explain everything in the cosmos through pure geometry, the development of string theory has, in its own quantum way, brought this idea back into vogue. As in so many things, even when they were wrong, Einstein and Schrödinger couldn’t help but get a great deal right. (shrink)

Why read Leibniz today? Can we still learn from him and not just about him? This book argues that Leibniz offers a powerful, productive model for transdisciplinary thinking that can push back against the narrowness of the humanities today. Richard Halpern recasts Leibniz as a great writer as well as a great philosopher, demonstrating that his philosophical project cannot be fully understood without taking its literary elements into account. He shows Leibniz to be a prescient thinker about art and (...) beauty whose insights into the relationship between aesthetic experience and thought remain invaluable. Leibnizing asks readers to follow the dynamic movement of Leibniz’s writing instead of attempting to grasp a static philosophical system and to pay careful attention to the rhetorical and stylistic registers of Leibniz’s work as well as its conceptual and logical dimensions. For philosophers, this book offers a novel approach to reading and interpreting Leibniz. For literary and other theorists, it showcases the relevance of Leibniz’s thought to areas from aesthetics to politics and from metaphysics to computer science. Written in a lucid and even witty style, Leibnizing provides readers with an accessible entryway into Leibniz’s sometimes forbidding but ultimately rewarding philosophical vision. (shrink)

In thinking about which works of Jewish thought can and should be an essential part of every Jewish library, I conceived of the volume you hold in your hand. Each chapter in this book features a scholar of Jewish studies revisiting a particularly foundational and salient work of maḥshevet Yisrael (Jewish thought), from medieval to modern, and discussing its themes, its historical context, the circumstances and background of its author (the "person of the book"), and, most importantly, its contemporary relevance."--Preface, (...) pages ix-x. (shrink)

This monograph aims to mathematically codify the notion of "moral systems" and define a sensible distance between them. It consists of three parts, aimed at an audience with varying interests and mathematical backgrounds. The first part steers philosophical, formally defining moral systems and several related concepts. The second part studies black box algorithms, including questions of inference and metric construction. The third part explores the technical construction of metrics amongst conditional probability distributions.

An Ecological Pedagogy of Joy is an interweaving that explores the conduct of pedagogy in these ecologically sorrowful times. Drawing upon our collective experiences as teachers and students, as well as First Nations ancestries and knowledge, ecological images and ideas, and threads of thought from interpretive traditions, our book not only speaks about these matters, but is organized to provide readers with pathways, alternating voices, deep philosophical ventures, and personal and practice examples. This book is a valuable resource for any (...) practicing teacher or education student (graduate or undergraduate) who is interested in exploring emerging ventures into relations, aliveness, and love as keys to the well-being of schools. It also provides examples of how interpretive work can be done in a rigorous and scholarly manner, and carefully threads into this First Nations ideas and practices that enhance and elaborate the pathways we have taken. (shrink)

What do the airplane, the escalator, the vacuum cleaner, and the Polaroid camera have in common? It took many, many attempts to perfect these inventions. But the people who invented them persevered and did not give up on their ideas. With TIME For Kids content, this nonfiction book will engage students in reading about inventions as they build their comprehension, vocabulary, and literacy skills. The Reader's Guide and culminating activity direct students back to the text as they develop their higher-order (...) thinking skills. Check It Out! provides resources for additional reading and learning. With text features such as a glossary, index, and table of contents, this book aligns with national and state standards and will keep students engaged in reading. (shrink)