As the structure of healthcare delivery undergoes a breathtaking transformation, many ethics committees are wondering how and if they will be affected. Although the impact has not yet been widely felt, hospital-based ethics committees cannot avoid the pressures and upheaval caused by the reorganization of healthcare. This article will briefly review some of the factors contributing to the transformation of medicine, and suggest a number of ways in which ethics committees can respond proactively.

Due to society's need to control health care costs and to the failure of legislated health care reform, managed care is expanding at a rapid rate and will soon be the predominate form of health care delivery. Plans by Congress to bring Medicare and Medicaid under managed care will further consolidate this trend. Barring some legislative fiat, managed care is here to stay.The term managed care describes a diverse set of organizational forms. Wide variations in approach, financing, physician involvement, and (...) philosophy exist among the different types of managed care organizations. While many articles on the ethics of managed care acknowledge this variety, most analyses focus on the for-profit entities, paying less attention to the ethical distinctions among the different forms of managed care. This paper discusses the key distinctions among MCO types, in particular the difference between for-profit and non-profit plans; the relationship of the physician to the MCO; the incentives used to control costs; the incentives that improve patient care; and the organizational features that nurture the principled practice of medicine. (shrink)

Due to society's need to control health care costs and to the failure of legislated health care reform, managed care is expanding at a rapid rate and will soon be the predominate form of health care delivery. Plans by Congress to bring Medicare and Medicaid under managed care will further consolidate this trend. Barring some legislative fiat, managed care is here to stay. The term managed care describes a diverse set of organizational forms. Wide variations in approach, financing, physician involvement, (...) and philosophy exist among the different types of managed care organizations. While many articles on the ethics of managed care acknowledge this variety, most analyses focus on the for-profit entities, paying less attention to the ethical distinctions among the different forms of managed care. This paper discusses the key distinctions among MCO types, in particular the difference between for-profit and non-profit plans; the relationship of the physician to the MCO; the incentives used to control costs; the incentives that improve patient care; and the organizational features that nurture the principled practice of medicine. (shrink)

Here, we compare birdsong and human musicality using insights from songbird neuroethology and evolution. For example, neural recordings during songbird duetting and other coordinated vocal behaviors could inform mechanistic hypotheses regarding human brain function during music-making. Furthermore, considering songbird evolution as a model system suggests that selection favoring certain culturally transmitted behaviors can indirectly select for associated underlying neural functions.

Oregon is the only state in the United States where a physician may legally prescribe a lethal dose of barbiturate for a patient intending suicide. The Oregon Death with Dignity Act was passed by voters in 1994 and came into effect after much legal wrangling in October of 1997. At the same time, a cabinetmaker named Pat Matheny was struggling with progressive weakness from amyotrophic lateral sclerosis, or ALS. I met with Pat and his family for a lengthy interview in (...) October 1998 in Coos Bay, Oregon, for a television news report on his decision to get a lethal prescription. Below is an extract from that interview. On the day this introduction was written, 10 March 1999, Pat took the prescribed lethal overdose of barbiturates and died at home. His illness was taking his voice, he could not move his hands or legs, and breathing was becoming very difficult. His mother told me he knew that was for him. (shrink)

This editorial introduces a revised set of publication requirements for papers, submitted to Homeopathy, that involve animal experimentation. Journals that publish studies involving animal experimentation have a major role to play in the maintenance of ethical standards because researchers are reliant upon them for publication of their findings. With an increasing global trend towards greater transparency and accountability in animal experimentation, many academic journals, such as the British Journal of Pharmacology, 1 and 2 are taking action to improve reporting standards. (...) In recognition of this need, members of Homeopathy's Editorial Board have been working together to examine the scientific rationale and the most relevant ethical guidelines for the use of animals in research. In addition, they have examined existing published studies in homeopathy research and current practice within the broad domain of medical research. Each of these aspects has informed the revised publication policy, whose overarching objectives are to maximise the ethical standards and scientific quality of animal research in homeopathy, and thereby ultimately to avoid any unnecessary suffering of animals used in such research. The following description details the background that was considered, the rationale for this development, and the steps that will be taken. (shrink)

Effective altruism is a growing humanitarian movement with a track record of success in evaluating the effectiveness of charitable spending across a wide range of projects. We suggest ways in which the foundations of this movement can be applied to the complex world of conservation.

Drawing on insights from social learning and social cognitive perspectives and research on the multilevel reality of leadership influences, we developed and tested a multilevel model that examines mechanisms and conditions through which ethical leadership deters work unit- and individual-level ostracism. Based on two field studies using multiple measurement points, we found that at the work unit level of analysis, relational climate partially mediates the negative relationship between ethical leadership and work unit-level ostracism whereas state mindfulness partially mediates the cross-level (...) influence of ethical leadership on individual-level ostracism. Contrary to our hypothesis, we found that the relationship between ethical leadership and relational climate was stronger when work units had a more mechanistic structure, and not when it had an organic work unit structure. Finally, we found that relational climate not only moderates the relationship between state mindfulness and individual-level ostracism, but also moderates the indirect influence of ethical leadership on individual-level ostracism through state mindfulness such that the indirect effect is stronger when relational climate is high as opposed to low. These findings highlight the individual- and work unit-level conditions and mechanisms through which ethical leadership relates to decreased ostracism at work, and thus extends theory and research on ethical leadership and ostracism. (shrink)

In the U.S. there has been considerable interest in connecting low-income households to alternative food networks like Community Supported Agriculture. To learn more about this possibility we conducted a statewide survey of CSA members in California. A total of 1149 members from 41 CSAs responded. Here we answer the research question: How do CSA members’ socioeconomic and demographic backgrounds, household conditions potentially interfering with membership, and CSA membership experiences vary between lower-income households and higher-income households? We divided members into LIHHs (...) and HIHHs. We present comparisons of LIHHs’ and HIHHs’ employment, race/ethnicity, household composition and education, use of food support, and enjoyment of food-related activities; conditions interfering with membership and major life events; and sources of information influencing decision to join, reasons for joining, ratings of importance of and satisfaction with various CSA attributes, gaps between importance of and satisfaction with various CSA attributes, valuing of the share and willingness to pay more, and impacts of membership. We find that LIHHs are committed CSA members, often more so than HIHHs, and that CSA members in California are disproportionately white, but that racial disproportionality decreases as incomes increase. We conclude by considering: the economic risks that LIHHs face in CSA membership, the intersection of economic risks with race/ethnicity and cultural coding in CSA; and the possibilities of increasing participation of LIHH in CSA. (shrink)

The manufacturing industry faces a trend in which employees’ work processes are being redesigned into simple, repetitive tasks that maximize performance and efficiency. This neo-Tayloristic business model reduces social interactions and stifles relationship building, leading to disgruntled employees and raising questions about leaders’ moral obligation as to the mechanisms they use to enhance employees’ performance at work. As an alternative to redesigning work processes, we contend that servant leaders can enhance employees’ overall performance by cultivating positive interpersonal dynamics at work (...) where social connectedness flourishes. Integrating insights from self-determination theory with servant leadership’s moral foundations, we investigate the degree to which servant leadership fosters two elements of a relationally supportive social context, interactional justice climate and coworker support, that facilitate its influence on followers’ intrinsic motivation and, subsequently, their voice and in-role performance. Temporally-separated data collected from a sample of 296 employees and their supervisors situated in 44 teams yielded results that support our hypotheses. Results underscore the importance of servant leadership cultivating a positive relational context to increase employees’ intrinsic motivation and improve their behaviors at work. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

Through careful interpretative essays on Greek poets, Shakespeare, and the Hebrew Bible, Athens, Arden, Jerusalem explores fundamental questions about God, human nature, and the political order. The collection of essays addresses topics ranging from friendship and marriage to sovereignty and tyranny, from piety and sin to comedy and contemplation.

Sterelny’s Thought in a Hostile World ([ 2003 ]) presents a complex, systematically structured theory of the evolution of cognition centered on a concept of decoupled representation. Taking Godfrey-Smith’s ([ 1996 ]) analysis of the evolution of behavioral flexibility as a framework, the theory describes increasingly complex grades of representation beginning with simple detection and culminating with decoupled representation, said to be belief-like, and it characterizes selection forces that drive evolutionary transformations in these forms of representation. Sterelny’s ultimate explanatory target (...) is the evolution of human agency. This paper develops a detailed analysis of the main cognitive aspects. It is argued that some of the major claims are not correct: decoupled representation as defined doesn’t capture belief-like representation, and, properly understood, decoupled representation turns out to be ubiquitous among multicellular animals. However, some of the key ideas are right, or along the right lines, and suggestions are made for modifying and expanding the conceptual framework. (shrink)

This co-edited volume compares Chinese and Western experiences of engineering, technology, and development. In doing so, it builds a bridge between the East and West and advances a dialogue in the philosophy of engineering. Divided into three parts, the book starts with studies on epistemological and ontological issues, with a special focus on engineering design, creativity, management, feasibility, and sustainability. Part II considers relationships between the history and philosophy of engineering, and includes a general argument for the necessity of dialogue (...) between history and philosophy. It continues with a general introduction to traditional Chinese attitudes toward engineering and technology, and philosophical case studies of the Chinese steel industry, railroads, and cybernetics in the Soviet Union. Part III focuses on engineering, ethics, and society, with chapters on engineering education and practice in China and the West. The book’s analyses of the interactions of science, engineering, ethics, politics, and policy in different societal contexts are of special interest. The volume as a whole marks a new stage in the emergence of the philosophy of engineering as a new regionalization of philosophy. This carefully edited interdisciplinary volume grew out of an international conference on the philosophy of engineering hosted by the University of the Chinese Academy of Sciences in Beijing. It includes 30 contributions by leading philosophers, social scientists, and engineers from Australia, China, Europe, and the United States. (shrink)

In the words of Catharine MacKinnon, "a woman is not yet a name for a way of being human." In other words, women are still excluded, as authors and agents, from identifying what it is to be human and what therefore violates the dignity and integrity of humans. Recognition, Responsibility, and Rights is written in response to that failure. This collection of essays by prominent feminist thinkers advances the positive feminist project of remapping the moral landscape by developing theory that (...) acknowledges the diversity of women. (shrink)

Internalists about reasons following Bernard Williams claim that an agent’s normative reasons for action are constrained in some interesting way by her desires or motivations. In this paper, I offer a new argument for such a position—although one that resonates, I believe, with certain key elements of Williams’ original view. I initially draw on P.F. Strawson’s famous distinction between the interpersonal and the objective stances that we can take to other people, from the second-person point of view. I suggest that (...) we should accept Strawson’s contention that the activity of reasoning with someone about what she ought to do naturally belongs to the interpersonal mode of interaction. I also suggest that reasons for an agent to perform some action are considerations which would be apt to be cited in favor of that action, within an idealized version of this advisory social practice. I then go on to argue that one would take leave of the interpersonal stance towards someone—thus crossing the line, so to speak—in suggesting that she do something one knows she wouldn’t want to do, even following an exhaustive attempt to hash it out with her. An internalist necessity constraint on reasons is defended on this basis. (shrink)

A philosopher examines the complicated phenomenon of gaslighting “Gaslighting” is suddenly in everyone’s vocabulary. It’s written about, talked about, tweeted about, even sung about (in “Gaslighting” by The Chicks). It’s become shorthand for being manipulated by someone who insists that up is down, hot is cold, dark is light—someone who isn’t just lying about such things, but trying to drive you crazy. The term has its origins in a 1944 film in which a husband does exactly that to his wife, (...) his crazy-making efforts symbolized by the rise and fall of the gaslights in their home. In this timely and provocative book, Kate Abramson examines gaslighting from a philosophical perspective, investigating it as a distinctive moral phenomenon. Gaslighting, Abramson writes, is best understood as a form of interpersonal interaction, a particular way of fundamentally undermining someone. The gaslighter, Abramson argues, aims to make his target experience herself as incapable of reasoning, perceiving, or reacting in ways that would allow her to form appropriate beliefs, perceptions, or emotions in the first place. He seeks not only to induce in her this unmoored sense of herself but also to make it a reality. Using examples and analysis, Abramson gives an account of gaslighting and its immorality, and argues that such a discussion can help us understand other aspects of social life—from racism and sexism to the structure of interpersonal trust. (shrink)

Realist synthesis is often offered as a useful strategy to understand intervention complexity. Its unique selling point is its basis in a critical realist philosophy of science. However, we argue t...

Charges of inconsistency are frequently made against opponents of abortion for failing to ‘live out’ their beliefs. One such popular charge is that opponents of abortion are inconsistent for failing to ‘adopt the babies they don’t want aborted’—in this chapter, I will focus on a slightly broader version of this charge. I will understand adoption* broadly to include adopting and/or fostering children, as well as concretely supporting the systems involved in facilitating adoption and foster care through financial means, volunteering, and/or (...) advocacy. I will argue that opponents of abortion do not have special obligations to adopt* for the reasons often presumed, and thus are not inconsistent for failing to do so. However, I will go on to argue that they nevertheless have compelling reasons to do so—to decrease future abortions and oppose abortion with integrity. (shrink)

`This book contributes to the growing debates about social theory and its role through a discussion of the ways in which gender and race contributed to the exclusion of important thinkers from the sociological canon' - John Hughes, Lancaster University Who makes up the `canon' of sociology - and who doesn't? And does sociology need a canon in the first place? Beyond Social Theory offers an innovative and passionate contribution to current debates on the history and development of sociology and (...) the exclusion of theorists - who are female, black, or both - from the mainstream of social theorizing. With compelling biographical sketches bringing the dynamics behind the `canon' to life, Kate Reed focuses sharp analysis on the exclusion of theorists on race and gender from important debates on inequality. An important contribution to the debate on non-exclusionary theory, this book critically examines existing accounts of the history of the discipline, situating the development of social theory within a wider social and political context. (shrink)

This book provides a systematic analysis of the ethical implications of traditional and complementary medicine, focusing on pragmatic solutions. The author uses a bioethical methodology called the “Ethical Matrix,” to consider the impact of T&CM use for animals and the environment as well as for humans. A systematic search of the literature reveals that most published ethical concerns are related to the safety of T&CM use for humans. However, application of the Ethical Matrix demonstrates that the ethical implications for T&CM (...) use are much broader. In this book, the author analyses the most serious implications, including adverse events related to homeopathy, the use of animals in T&CM products, and the impact of herbal medicine on the environment. Comparisons with the ethical implications of conventional biomedicine help readers to contextualise debate, and highlight aspects that may be unique to T&CM. Globally, many high-level health policy makers promote T&CM as an accessible and affordable healthcare option. However, their use is considered by some to be a waste of resources, unscientific, and unethical. Offering a frank analysis of this largely ignored field of healthcare ethics, this book is both timely and essential. It helps patients, policy makers, practitioners, researchers, and students gain the knowledge they need to make more informed decisions. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Search of FaithKate RowlandSometimes I’m jealous of my patients’ faith. As a former happily religious person I miss the benefits I used to get from an active faith. I know that some of my patients must struggle with their faith, and I know the struggle probably affects their well–being. For those who simply believe or those who simply don’t believe, it’s easy. And for those who do believe, (...) there can be so much serenity and so much reward.As a doctor, I spend a lot of time reading science, weighing evidence, and making recommendations. Religion has been a respite from this. Faith, for me, has never been a series of decisions based on the best available evidence. I could analyze it as much as I wanted, peel its layers apart, question it, but in the end, it was just faith, not a hypothesis. It has always been something that I believe (or don’t), and practicing my faith had always been a relatively pleasant decision of figuring out what kind of community I want to share in.My faith life has been in shambles for the past several years. I feel distant from and unwelcome in the church where I was raised, and I haven’t found anywhere else to land. I cannot decide how to raise my own small children. I want them to have grounding in God, but I can’t decide how much I believe in God anymore, and I am fixated on the idea that I don’t want to be hypocritical or lie to [End Page 210] them. I don’t want them to see me worshipping in a way that is not really authentic to me.My husband is agnostic—literally—on the issue. He is open to introducing a loving, kind, forgiving God, but unsure about a God incarnate. We both worry about the identity with a particular religion usurping the actual relationship with God: I am [religion], therefore I believe [this], therefore my God does [this] or is [this].And so all of these fears and doubts have led us to live with no religion, and no outward faith. Our children attend a parochial nursery school run by a religion other than one where we were raised, and they have an apparently happy but neutral opinion of religion and God. They understand ceremonies. At age four, they have a more active faith life than I do, since they attend weekly services at school. But then, they have fewer choices than I do. They do what the teachers tell them. They would do what I told them to do, if I could ever decide what I believed in.I spend so many hours a week with my patients that they have become my main source of demonstration of active, living faith. I know that they share mostly good parts with me. I see so much of the good because I mostly see patients who get to choose how to practice their own religions; they don’t feel oppressed by religious or culturo–religious demands or expectations. It’s interesting that I see the positive sides of their faith, not the struggle, because I otherwise see a lot of the struggling parts of their lives. I see the flinty, edgy woman, the patient who has spent more time in the hospital in the past month than I have, the woman who is sick of her low platelet count that keeps her from living a normal life. And every day she has some message of faith: she tells our medical team what Bible passage is keeping her strong, she tells us how God watches over her when we tell her that her counts are better, she tells us to have a blessed day. Sometimes she curses at the hospital or her condition or at her medications, sometimes at us. So far her faith is unshaken.I take care of a woman who has burning mouth syndrome, a chronic condition that causes her lips, her tongue, and her palate to feel as though they are on fire. Eating makes it worse, drinking makes it worse, breathing makes it worse... (shrink)

This study is the first to address the ways in which male perpetrators of intimate partner violence talk about memory in their reports of their IPV and how these are used to manage their accountability for the violence. Drawing on and developing the discursive psychological literature on talk about memory, which highlights how such talk is used to perform practical actions within interactions, a discourse analysis is conducted on interviews with six male perpetrators of recent, multiple incidents of IPV who (...) were undergoing treatment. The analysis identified the varying ways in which memory was used: first, claims of forgetting were used to avoid answering difficult and potentially incriminating questions; second, claims of clear memories were used to position partners as problematic and responsible for violence; and third, claims about simultaneously remembering and forgetting were found. The implications of these strategies for managing identity and accountability are discussed. (shrink)

The moral questions raised by synthetic media are considered in the context of posthumous documentary biography. Two possibilities are explored: firstly, that synthesis of the voice in biographical documentary deceives in a distinctive way and secondly, that it is possible for synthetic media to harm the subject of posthumous documentary.

What role, if any, does formal logic play in characterizing epistemically rational belief? Traditionally, belief is seen in a binary way - either one believes a proposition, or one doesn't. Given this picture, it is attractive to impose certain deductive constraints on rational belief: that one's beliefs be logically consistent, and that one believe the logical consequences of one's beliefs. A less popular picture sees belief as a graded phenomenon.

In this article, we analyse one of the most famous recent thought‐experiments in philosophy, namely Donald Davidson's Swampman. Engaging recent commentators on Davidson's Swampman as well as analysing the spatio‐temporal conditions of the thought‐experiment, we will show how the ‘experiment’ inevitably fails. For it doesn't take seriously some of its own defining characteristics: crucially, Swampman's creation of a sudden in a place distinct from Davidson's. Instead of denigrating philosophical thought‐experiments per se, our analysis points towards considering thought‐experiments in a different (...) sense: imaginary scenarios helpfully self‐deconstructing rather than constituting substantive philosophical resources. (shrink)