Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the U.S., often with little or no (...) evidence of their effectiveness. (shrink)

This essay describes how longstanding conceptions of professionalism in American medical care came under attack in the decades since the enactment of Medicare in 1965 and how the reform strategy and core provisions of the 2010 Affordable Care Act illustrate the weakening of those ideas and the institutional practices embodying them.The opening identifies the dominant role of physicians in American medical care in the two decades after World War II. By the time Medicare was enacted in 1965, associations of American (...) physicians were almost completely in charge of medical education, specialist certification, and the enforcement of professional norms on their members. Who could be a doctor, what education and training would be required, and what collegial oversight was operative was first a professional matter and only secondly implicated the state through malpractice or major corporations via the employment of physicians. (shrink)

Many business and government institutions appear to have failed in meeting society’s expectations of them. Continuing scandals and failures, as well as an increasingly obvious lack of responsibility to customers, have caused communities to question the probity and operation of these organisations. Consequently, “social licence to operate” is becoming an increasingly common process and one which demands a change in management philosophy and behaviour in our institutions. Improving the quality of responsible management practice is a critical element in this new (...) management philosophy, and which demands an intense focus on including ethical considerations in the core management competence of decision-making. We draw on a combined 100-plus years of international consulting experience, “C“ and senior executive work experience, and academic research to present a practical framework for responsible management practice which, we believe, can also form the foundation for the required organisational cultural transformation required of many existing organisations. (shrink)

This article offers an historical-materialist account of the coup in Honduras on 28 June 2009, which ousted democratically elected President Manuel Zelaya. It draws on over two dozen interviews with members of theFrente Nacional de la Resistencia Popular[National Front of Popular Resistance, FNRP], and participation in numerous marches and assemblies over two periods of fieldwork – January 2010, and June–July 2011. The paper steps back in time to provide an historical cartography of the basic material structures of the Honduran economy (...) and its integration into the world market, as well as the geopolitical role it played as a launching pad for Ronald Reagan’s counter-insurgency campaigns against guerrilla forces elsewhere in the region during the 1980s. We show how the defeat of mass guerrilla insurgencies in Guatemala and El Salvador, as well as the triumph over the Sandinista government in Nicaragua by 1990, allowed for the neoliberal pacification of Central America as a whole, including Honduras. We further demonstrate how the centre-leftist Manuel Zelaya, elected to the Honduran presidency in 2006, modestly encroached upon neoliberal orthodoxy and forged geopolitical alliances with left and centre-left governments elsewhere in the region, laying the bases for his violent overthrow. Finally, the paper traces the origins, trajectory, and heterogeneity of the resistance that emerged almost immediately after the coup had been carried out. (shrink)

Many business and government institutions appear to have failed in meeting society’s expectations of them. Continuing scandals and failures, as well as an increasingly obvious lack of responsibility to customers, have caused communities to question the probity and operation of these organisations. Consequently, “social licence to operate” is becoming an increasingly common process and one which demands a change in management philosophy and behaviour in our institutions. Improving the quality of responsible management practice is a critical element in this new (...) management philosophy, and which demands an intense focus on including ethical considerations in the core management competence of decision-making. We draw on a combined 100-plus years of international consulting experience, “C“ and senior executive work experience, and academic research to present a practical framework for responsible management practice which, we believe, can also form the foundation for the required organisational cultural transformation required of many existing organisations. (shrink)

Biological kin share up to half of their genetic material, including predisposition to disease. Thus, variants of clinical significance identified in each individual’s genome can implicate an exponential number of relatives at potential risk. This has renewed the dilemma over family access to research participant’s genetic results, since prevailing US practices treat these as private, controlled by the individual. These individual-based ethics contrast with the family-based ethics – in which genetic information, privacy, and autonomy are considered to be familial – (...) endorsed in UK genomic medicine and by participants in a multi-method study of US research participants presented here. The dilemma reflects a conflict between US legal and ethical frameworks that privilege “the individual” and exclude “the family” versus actual human genetics that are simultaneously individual and familial. Can human genetics succeed in challenging bioethics’ hegemonic individualism to recognize and place the family at the center of the room where bioethics happens? (shrink)

Background: Genomic analysis may reveal both primary and secondary findings with direct relevance to the health of probands’ biological relatives. Researchers question their obligations to return findings not only to participants but also to family members. Given the social value of privacy protection, should researchers offer a proband’s results to family members, including after the proband’s death? Methods: Preferences were elicited using interviews and a survey. Respondents included probands from two pancreatic cancer research resources, plus biological and nonbiological family members. (...) Hypothetical scenarios based on actual research findings from the two cancer research resources were presented; participants were asked return of results preferences and justifications. Interview transcripts were coded and analyzed; survey data were analyzed descriptively. Results: Fifty-one individuals (17 probands, 21 biological relatives, 13 spouses/partners) were interviewed. Subsequently, a mailed survey was returned by 464 probands, 1,040 biological family members, and 399 spouses/partners. This analysis highlights the interviews, augmented by survey findings. Probands and family members attribute great predictive power and lifesaving potential to genomic information. A majority hold that a proband’s genomic results relevant to family members’ health ought to be offered. While informants endorse each individual’s choice whether to learn results, most express a strong moral responsibility to know and to share, particularly with the younger generation. Most have few concerns about sharing genetic information within the family; rather, their concerns focus on the health consequences of not sharing. Conclusions: Although additional studies in diverse populations are needed, policies governing return of genomic results should consider how families understand genomic data, how they value confidentiality within the family, and whether they endorse an ethics of sharing. A focus on respect for individual privacy—without attention to how the broad social and cultural context shapes preferences within families—cannot be the sole foundation of policy. (shrink)

In this undergraduate textbook Lewis R. Gordon offers the first comprehensive treatment of Africana philosophy, beginning with the emergence of an Africana consciousness in the Afro-Arabic world of the Middle Ages. He argues that much of modern thought emerged out of early conflicts between Islam and Christianity that culminated in the expulsion of the Moors from the Iberian Peninsula, and from the subsequent expansion of racism, enslavement, and colonialism which in their turn stimulated reflections on reason, liberation, and the (...) meaning of being human. His book takes the student reader on a journey from Africa through Europe, North and South America, the Caribbean, and back to Africa, as he explores the challenges posed to our understanding of knowledge and freedom today, and the response to them which can be found within Africana philosophy. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor (...) evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)

Business Ethics, the Environment & Responsibility, EarlyView.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.1 (2003) 1-21 [Access article in PDF] Did Habermas Cede Nature to the Positivists? Gordon R. Mitchell Jürgen Habermas's "colonization of the lifeworld" thesis (1987, 332-73) posits that many of society's pathologies are due to the tendency of institutions to convert social issues that ought to be sorted out by a debating citizenry into technical problems ripe for resolution by expert bureaucracies, thus pre-empting important (...) public discussion. Habermas has attempted to lay bare the pernicious effects of this colonization process in his analysis of public opinion polling, welfare policy, education, German reunification, immigration, and other social issues (see Habermas 1997, 1994, and 1970; Holub 1992). In each of these contexts, Habermas has publicly challenged the encroachment of scientistic modes of decision-making into spheres where joint communicative action by deliberating citizens would yield more appropriate and legitimate judgments. This critical impulse is also evident in Habermas's methodological reflections on the proper role of academic scholarship, where he has argued vigorously against attempts to graft "objectivating" methods of natural scientific inquiry onto research projects in the social sciences (1971, 304-17).From all of this, one might gather that Habermas's commitment to rolling back the influence of technical forms of reasoning is connected to some intrinsic quarrel he has with the natural sciences. Yet such a sweeping generalization is hard to sustain in light of the fact that Habermas does not oppose technical reasoning per se; he recognizes that the daunting complexity of social life in late capitalism requiresthat certain "steering" tasks be delegated to systems that utilize largely instrumental logics to co-ordinate action. Likewise, he acknowledges that the disciplines of the natural sciences necessarily play important supporting roles in such steering projects.One normative presupposition of Habermas's colonization thesis is that there exists some proper boundary demarcating where the sphere of technical reasoning ends and the realm of communicative rationality begins. [End Page 1] On one side of this boundary, Habermas has provided many details on what he sees as the essential qualities of a properly functioning "public sphere," where "new social movements" continuously reweave the threads of communicative fabric holding society together (1996, 359-87), and where "historico-hermeneutic" academic study reflects on public life, sluicing insight back into the capillaries of democratic deliberations (1987, 374-403).What lies on the other side of the boundary is murkier. The proper role of natural scientific investigation has received relatively scant attention in Habermas's critical theory of society, and this has led to some confusion regarding his account of the natural sciences, as well as debate over whether this account has political purchase. One would think that sympathetic commentators, such as Helen Longino (who bases much of her own coherence theory of scientific truth on Habermas), would have reassuring things to say on this point. Yet her lukewarm assessment that, "in trying to clear a space for an autonomous social and critical theory, [Habermas] has ceded nature to the positivists" (1990, 202), raises questions about the flexibility and scope of Habermas's theory of communicative action as a basis for critique of scientific practice.One way to test Habermas's account of the natural sciences on this count is to put his views in conversation with science studies commentators who share a similar commitment to the idea that dialogue and argumentation are constitutive elements of scientific practice. Such an approach recasts the "ceding to positivism" question into a moment of controversy over the role of dialogue, not only as an essential motor driving the scientific enterprise, but also as a vehicle for democratic decision-making on issues related to the purpose and direction of scientific inquiry in society.Part one of this essay locates discursive norms embedded pragmatically in the notion of scientific objectivity. By bringing a modified version of Habermas's theory of communicative action into conversation with other approaches to science studies that foreground intersubjective dialogue as the key motor driving the scientific enterprise, I develop a foundation for robust criticism of systematically distorted scientific communication. Specific strategies of... (shrink)

Despite a large and multifaceted effort to understand the vast landscape of phenotypic data, their current form inhibits productive data analysis. The lack of a community-wide, consensus-based, human- and machine-interpretable language for describing phenotypes and their genomic and environmental contexts is perhaps the most pressing scientific bottleneck to integration across many key fields in biology, including genomics, systems biology, development, medicine, evolution, ecology, and systematics. Here we survey the current phenomics landscape, including data resources and handling, and the progress that (...) has been made to accurately capture relevant data descriptions for phenotypes. We present an example of the kind of integration across domains that computable phenotypes would enable, and we call upon the broader biology community, publishers, and relevant funding agencies to support efforts to surmount today's data barriers and facilitate analytical reproducibility. (shrink)

CRISPR‐Cas technology accelerates development of fast, accurate, and portable diagnostic tools, typified by recent applications in COVID‐19 diagnosis. Parasitic helminths cause devastating diseases afflicting 1.5 billion people globally, representing a significant public health and economic burden, especially in developing countries. Currently available diagnostic tests for worm infection are neither sufficiently sensitive nor field‐friendly for use in low‐endemic or resource‐poor settings, leading to underestimation of true prevalence rates. Mass drug administration programs are unsustainable long‐term, and diagnostic tools – required to be (...) rapid, specific, sensitive, cost‐effective, and user‐friendly without specialized equipment and expertise – are urgently needed for rapid mapping of helminthic diseases and monitoring control programs. We describe the key features of the CRISPR‐Cas12/13 system and emphasise its potential for the development of effective tools for the diagnosis of parasitic and other neglected tropical diseases (NTDs), a key recommendation of the NTDs 2021–2030 roadmap released by the World Health Organization. (shrink)

The eminent scholar Lewis R. Gordon offers a probing meditation on freedom, justice, and decolonization. What is there to be understood and done when it is evident that the search for justice, which dominates social and political philosophy of the North, is an insufficient approach for the achievements of dignity, freedom, liberation, and revolution? Gordon takes the reader on a journey as he interrogates a trail from colonized philosophy to re-imagining liberation and revolution to critical challenges raised by (...) Afropessimism, theodicy, and looming catastrophe. He offers not forecast and foreclosure but instead an urgent call for dignifying and urgent acts of political commitment. Such movements take the form of examining what philosophy means in Africana philosophy, liberation in decolonial thought, the unshackling of political philosophy from the liberal moral theory setting the stage for the decolonization of justice and normative life, unleashing the obstacles to cultivating emancipatory politics, challenging reductionist forms of thought that proffer harm and suffering as conditions of political appearance and the valorization of nonhuman being. He asserts instead emancipatory considerations for occluded forms of life and the irreplaceability of existence in the face of catastrophe and ruin, and he concludes, through a discussion with the Circassian philosopher and decolonial theorist, Madina Tlostanova, with the project of shifting the geography of reason. (shrink)

Lewis Gordon presents the first detailed existential phenomenological investigation of antiblack racism as a form of Sartrean bad faith. Bad faith, the attitude in which human beings attempt to evade freedom and responsibility, is treated as a constant possibility of human existence. Antiblack racism, the attitude and practice that involve the construction of black people as fundamentally inferior and subhuman, is examined as an effort to evade the responsibilities of a human and humane world. Gordon argues that the (...) concept of bad faith militates against any human science that is built upon a theory of human nature and as such offers an analysis of antiblack racism that stands as a challenge to our ordinary assumptions of what it means to be human. (shrink)

BackgroundKinarm Standard Tests is a suite of upper limb tasks to assess sensory, motor, and cognitive functions, which produces granular performance data that reflect spatial and temporal aspects of behavior. We have previously used principal component analysis to reduce the dimensionality of multivariate data using the Kinarm End-Point Lab. Here, we performed PCA using data from the Kinarm Exoskeleton Lab, and determined agreement of PCA results across EP and EXO platforms in healthy participants. We additionally examined whether further dimensionality reduction (...) was possible by using PCA across behavioral tasks.MethodsHealthy participants were assessed using the Kinarm EXO and EP. Four behavioral tasks were performed that quantified arm sensory and motor function, including position sense [Arm Position Matching ] and three motor tasks [Visually Guided Reaching, Object Hit, and Object Hit and Avoid ]. The number of components to include per task was determined from scree plots and parallel analysis, and rotation type was decided on a per-task basis. To assess agreement, we compared principal components across platforms using distance correlation. We additionally considered inter-task interactions in EXO data by performing PCA across all six behavioral assessments.ResultsBy applying PCA on a per task basis to data collected using the EXO, the number of behavioral parameters were substantially reduced by 58–75% while accounting for 76–87% of the variance. These results compared well to the EP analysis, and we found good-to-excellent agreement values between PCs from the EXO and those from the EP. Finally, we were able to reduce the dimensionality of the EXO data across tasks down to 16 components out of a total of 76 behavioral parameters, which represents a reduction of 79% while accounting for 73% of the total variance.ConclusionPCA of Kinarm robotic assessment appears to capture similar relationships between kinematic features in healthy individuals and is agnostic to the robotic platform used for collection. Further work is needed to investigate the use of PCA-based data reduction for the characterization of neurological deficits in clinical populations. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Individual differences in the mere willingness to think analytically has been shown to predict religious disbelief. Recently, however, it has been argued that analytic thinkers are not actually less religious; rather, the putative association may be a result of religiosity typically being measured after analytic thinking (an order effect). In light of this possibility, we report four studies in which a negative correlation between religious belief and performance on analytic thinking measures is found when religious belief is measured in a (...) separate session. We also performed a meta-analysis on all previously published studies on the topic along with our four new studies (N = 15,078, k = 31), focusing specifically on the association between performance on the Cognitive Reflection Test (the most widely used individual difference measure of analytic thinking) and religious belief. This meta-analysis revealed an overall negative correlation (r) of -.18, 95% CI [-.21, -.16]. Although this correlation is modest, self-identified atheists (N = 133) scored 18.7% higher than religiously affiliated individuals (N = 597) on a composite measure of analytic thinking administered across our four new studies (d = .72). Our results indicate that the association between analytic thinking and religious disbelief is not caused by a simple order effect. There is good evidence that atheists and agnostics are more reflective than religious believers. (shrink)

The contention that cognitive psychology and radical behaviorism yield equivalent accounts of decision making and problem solving is examined by contrasting a framework of cognitive interpretation, Dennett's intentional stance, with a corresponding interpretive stance derived from contextualism. The insistence of radical behaviorists that private events such as thoughts and feelings belong in a science of human behavior is indicted in view of their failure to provide a credible interpretation of complex human behavior. Dennett's interpretation of intentional systems is an exemplar (...) of the interpretive stance radical behaviorism requires; a corresponding interpretive position can be based initially on a radical behaviorist view of human behavior and its determinants. This "contextual stance" is ontologically and methodologically distinct from the intentional stance over the range of explanations for which scientific psychology, cognitive or behaviorist, is responsible. (shrink)

Epictetus was born a slave. His master, Epaphroditus, allowed him to attend the lectures of the Stoic philosopher Musonius Rufus and later gave him his freedom. From numerous references in his Discourses it is clear that Epictetus valued freedom as a precious possession. He would have been on the side of the many people living now who, while not actually enslaved, are denied true freedom by the harsh circumstances of their lives. Epictetus's teachings about freedom and human dignity have echoed (...) through the millennia-in the writings of Spinoza, Thomas Paine and Martin Luther King, Jr., to name a few. He was much concerned with human behavior. His advice to not worry about what is not in our control is pointedly relevant to our busy modern society-which is often fraught with anxiety. Some people might argue that what Epictetus taught is not serious philosophy, more like self-help. But the range of topics addressed by the essays in this book clearly indicates that the teachings of Epictetus provide strong incentive to present day philosophical thinking. "Epictetus: His Continuing Influence and Contemporary Relevance" is the title of a conference on Epictetus held at Rochester Institute of Technology in April 2012, when many of the ideas in these essays were first presented. (shrink)

The emergence of a conception of the marketing firm (Foxall, 1999a) conceived within behavioral psychology and based on a corresponding model of consumer choice, (Foxall, 1990/2004) permits an assessment of the levels of behavioral and organizational analysis amenable to neuroscientific examination. This paper explores the ways in which the bilateral contingencies that link the marketing firm with its consumerate allow appropriate levels of organizational neuroscientific analysis to be specified. Having described the concept of the marketing firm and the model of (...) consumer behavior on which it is based, the paper analyzes bilateral contingencies at the levels of (i) market exchange, (ii) emotional reward, and (iii) neuroeconomics. Market exchange emerges as a level of analysis that lends itself predominantly to the explanation of firm—consumerate interactions in terms of the super-personal level of reinforcing and punishing contingencies: the marketing firm can be treated as a contextual or operant system in its own right. However, the emotional reward and neuroeconomic levels of analysis should be confined to the personal level of analysis represented by individual managers on the one hand and individual consumers on the other. This also entails a level of abstraction but it is one that can be satisfactorily handled in terms of the concept of bilateral contingency. (shrink)

This article distinguishes thought on phenomenology and psychoanalysis versus doing phenomenology and psychoanalysis and argues that while Fanon was primarily concerned with the latter, his thought also offers contributions to the former. They include methodological critique and an interrogation into the human sciences that includes a psychoanalytical decolonial critical reflection on science linked to open possibilities of human conditions.

In a critical discussion, interlocutors can strategically maneuver by shading their expressed degree of standpoint commitment for rhetorical effect. When is such strategic shading reasonable, and when does it cross the line and risk fallacious derailment of the discussion? Analysis of President George W. Bush’s 2002–2003 prewar commentary on Iraq provides an occasion to explore this question and revisit Douglas Ehninger’s distinction between argumentation as coercive correction and argumentation as a person-risking enterprise. Points of overlap between Ehninger’s account and pragma-dialectical (...) argumentation theory suggest avenues for harmonization of rhetorical and dialectical perspectives on argumentation. Out of this conceptual convergence comes theoretical resources for understanding strategic maneuvering, by accounting for ways that discussants exploit gaps between their externalized and actual discussion attitude. As such higher-order strategic maneuvering played a major role in the 2003 Iraq prewar discourse failure, perspicacious understanding of this particular argumentative maneuver carries practical, as well as theoretical import. (shrink)

This article explores five ways in which philosophy could be colonized: (1) racial and ethnic origins, (2) coloniality of its norms, (3) market commodification, (4) disciplinary decadence, (5) solipsism—and what the author calls a teleological suspension of philosophy as consideration among other practices of thought.

What does it mean for philosophy to be ‘colonised’ and what are some of the challenges involved in ‘decolonising’ it in philosophical and political terms? After distinguishing between philosophy and its practice as a professional enterprise, I explore six ways in which philosophy, at least as understood in its Euromodern form, could be interpreted as colonised: (1) Eurocentrism and its asserted racial and ethnic origins/misrepresentations of philosophy's history, (2) coloniality of its norms, (3) market commodification of the discipline, (4) disciplinary (...) decadence, (5) solipsism, and (6) appeals to redemptive narratives of colonial practice. The remainder of the article examines conditions for decolonising philosophy, which include unlocking its potential as a liberatory practice, identifying its humanistic dimensions, rethinking metaphysical assumptions, and embracing political responsibility wrought from the production of knowledge. (shrink)

This book addresses issues of philosophy and religion from a non Western as well as a Western perspective.

This paper’s purpose is to provide a foundation for viewing critical thinking as both a maximal and typical performance construct. While maximal performance measures the best a person can do, typical performance measures what the person is most likely to do. An overview of maximal performance, including its history and limitations, will be given. The role of maximal and typical performance in cognitive development will be demonstrated through an exploration of the relationships between behavior, the environment, personality, crystallized intelligence, and (...) fluid intelligence. Furthermore, these topics will be related to the development and use of critical thinking skills. Discussion will conclude with directions for future research. (shrink)

While many "benchtop-to-bedside" research pathways have been developed in "Type I" translational medicine, vehicles to facilitate "Type II" and "Type III" translation that convert scientific data into clinical and community interventions designed to improve the health of human populations remain elusive. Further, while a high percentage of physicians endorse the principle of citizen leadership, many have difficulty practicing it. This discrepancy has been attributed, in part, to lack of training and preparation for public advocacy, time limitation, and institutional resistance. As (...) translational medicine and physician-citizenship implicate social, political, economic and cultural factors, both enterprises require "integrative" research strategies that blend insights from multiple fields of study, as well as rhetorical acumen in adapting messages to reach multiple audiences. This article considers how argumentation theory's epistemological flexibility, audience attentiveness, and heuristic qualities, combined with concepts from classical rhetoric, such as rhetorical invention, the synecdoche, and ethos, yield tools to facilitate translational medicine and enable physician-citizenship. (shrink)

Since its founding in 1943, Medievalia et Humanistica has won worldwide recognition as the first scholarly publication in America to devote itself entirely to medieval and Renaissance studies. Since 1970, a new series, sponsored by the Modern Language Association of America and edited by an international board of distinguished scholars and critics, has published interdisciplinary articles. In yearly hardbound volumes, the new series publishes significant scholarship, criticism, and reviews treating all facets of medieval and Renaissance culture: history, art, literature, music, (...) science, law, economics, and philosophy. (shrink)