Whenever health care reform is debated, the state of the medical professional liability system in the United States re-emerges as an issue of importance. What exactly is broken with the MPL system and what the implications are is a point of contention among different stakeholder groups. Recent data demonstrate that medical liability premiums have been improving in recent years and the majority of premiums remained flat in 2010. General agreement still exists, however, that medical professional liability insurance premiums have become (...) unaffordable for many physicians, and coverage has become less available, especially for certain medical specialties and in specific areas of the country.Multiple factors go into the determination of medical professional liability insurance premiums including return on investments, reinsurance costs, claims frequency, average amount paid out on malpractice claims, defense expenses, and administrative costs such as underwriting expense. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

The aim of our themed symposium is to explore the limits and possibilities of corporate reputation for enabling corporate accountability. We articulate three perspectives on corporate accountability. The communicative perspective equates accountability with disclosure and stakeholder engagement. The phenomenological perspective focuses on stakeholder expectations and reputation management. The consequential perspective focuses on effects/consequences. We then examine how corporate accountability is understood, how it relates to ideals, mission, and purpose, alternative pathways to corporate accountability, reputational consequences, and the role algorithms play (...) in relationships between corporate reputation and accountability. Using a multitude of organizational contexts, these papers advance our understanding of how corporate reputation can be used as a mechanism for creating greater corporate accountability, and for identifying alternative pathways when corporate reputation fails to do so. (shrink)

In this paper William Carroll argues that the alleged conflict between creation and science has its origin in a mistaken comprehension of the meaning of “creation”and the extent of explication that natural sciences can offer. Carroll explains that creation, a metaphysical and theological notion, affirms that everything which exists depends on one single cause which is God. But, on the other side, the object of study of natural sciences is the realm of changing things. Whereas creation speaks to (...) the cause of existence itself, evolutionary biology, cosmology and other natural sciences focus on phenomena subject to change.In contrast, creation should not be understood as the change from nothingness to something, but as a theological and metaphysical dependence in the order of being. This does not mean, however, that the theological and metaphysical approaches are incompatible with those of natural sciences. (shrink)

Next SectionBecause of the radically incarnational nature of the Christian understanding of ethics and bioethics, according to Kierkegaard, there has always been an infinite gulf between Christian bioethics and secular bioethics. However, the process of the secularization of the public square has made this gulf more apparent and salient for the current ethical debates in biomedicine and the culture more generally.

In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)

Many psychological scientists and behavioral neuroscientists affirm that “emotion” influences thinking, decision-making, actions, social relationships, well-being, and physical and mental health. Yet there is no consensus on a definition of the word “emotion,” and the present data suggest that it cannot be defined as a unitary concept. Theorists and researchers attribute quite different yet heuristic meanings to “emotion.” They show considerable agreement about emotion activation, functions, and regulation. The central goal of this article is to alert researchers, students, and other (...) consumers of “emotion” research to the multiple meanings or aspects that distinguished scientists attribute to ”emotion,” increase appreciation of its interesting and challenging complexity, and sharpen perspectives on “emotion” and the associated body of literature that is of critical significance to science and society. (shrink)

This article clarifies my current and seemingly ever-changing position on issues relating to emotions. The position derives from my differential emotions theory and it changes with new empirical findings and with insights from my own and others’ thinking and writing. The theory distinguishes between first-order emotions and emotion schemas. For example, it proposes that first-order negative emotions are attributable mainly to infants and young children in distress and to older individuals in emergency or highly challenging situations. Emotion schemas are defined (...) as emotion feelings interacting with cognition in motivating the decision making and actions of everyday life. (shrink)

This article suggests a way to circumvent some of the problems that follow from the lack of consensus on a definition of emotion (Izard, 2010; Kleinginna & Kleinginna, 1981) and emotion regulation (Cole, Martin, & Dennis, 2004) by adopting a conceptual framework based on discrete emotions theory and focusing on specific emotions. Discrete emotions theories assume that neural, affective, and cognitive processes differ across specific emotions and that each emotion has particular motivational and regulatory functions. Thus, efforts at regulation should (...) target the specific dysregulated emotions. The positive effects of emotion regulation are more likely to be optimized when they result from or lead to emotion utilization—the constructive use of the energy of emotion arousal. Effective processes for regulation differ for basic emotions and emotion schemas. This article identifies neural systems that facilitate emotion experiences and emotion regulation processes. It considers the implications of the developmental change from basic emotions to emotion schemas, and also briefly discusses the effects of interventions on changes in emotion knowledge, emotion regulation, and social and emotional competence. (shrink)

The American conservative movement is a force of anti-reflexivity insofar as it attacks two key elements of reflexive modernization: the environmental movement and environmental impact science. Learning from its mistakes in overtly attacking environmental regulations in the early 1980s, this counter-movement has subsequently exercised a more subtle form of power characterized by non-decision-making. We examine the conservative movement’s efforts to undermine climate science and policy in the USA over the last two decades by using this second dimension of power. The (...) conservative movement has employed four non-decision-making techniques to challenge the legitimacy of climate science and prevent progress in policy-making. We argue that reflexive modernization scholars should focus more attention on similar forces of anti-reflexivity that continue to shape the overall direction of our social, political and economic order, and the life chances of many citizens. Indeed, better understanding of the forces and effectiveness of anti-reflexivity may very well be crucial for societal resilience and adaptation, especially in the face of global environmental problems like climate change. (shrink)

Many emotion researchers would probably agree that at least some aspects of discrete emotions are evolutionarily conserved (e.g., the sensation/feeling component cannot be learned). Such agreement probably extends to the notion that aspects of emotions emerge in ontogeny as a function of developmental, learning, and cultural processes. Determining when and under what circumstances they emerge seems largely a matter for empirical research, though theories differ in their predictions and in the way they describe the relevant emotional-, cognitive-, and neuro-developmental processes.

Overgeneral autobiographical memory (OGM) is strongly associated with depression in adults and appears to reflect a stable cognitive bias. However, it is not known whether this bias exists in children or what factors contribute to its development. We examined the roles of age, dysphoria, and a new variable, emotion‐focusing (EF), on the production of specific autobiographical memory (AM) in children, using the standard Autobiographical Memory Test (AMT; CitationWilliams & Broadbent, 1986). Results show that older children are more specific than younger (...) children, irrespective of cue valence. Dysphoria was linked to less specific retrieval of positive memories in children. A three‐way interaction between age, valence, and dysphoria was also found, such that older dysphoric children demonstrated a difficulty in retrieving specific negative memories. In addition, emotion‐focusing was associated with specific AM recall, especially to negative cues. Results are discussed with reference to the development of depressogenic biases. (shrink)

I am very appreciative of those who wrote comments on my article. They raised some interesting and some quite challenging questions. Their responses seem quite in synchrony with my focus and intent—to reveal some problems that we need to address in advancing emotion science. The authors of the commentaries reflected some of the same sort of differences among themselves as I found among the emotion scientists whom I surveyed in search of a definition of emotion. Like the emotion scientists who (...) responded to my survey, most of the authors of the commentaries were generally in agreement on the significance of research in the emotion domain but not in agreement on the meaning of the term emotion. I briefly discuss the noteworthy question (raised in one of the commentaries) as to whether and when discrete emotion concepts might someday share the same fate as the general term emotion and disappear from emotion science. (shrink)

Stem cell science, using both embryonic and a variety of tissue-specific stem cells, is advancing rapidly and offers promise to improve medical care in the future. Yet, with the notable exception of hematopoietic stem cell transplantation, a long-established approach to treating certain cancers of the blood system, this promise is long term and most stem cell research focuses on basic scientific questions or the collection of pre-clinical data. Although some clinical trials are underway, most are focused on safety, and novel (...) effective therapy is likely a long way off. Despite the preliminary nature of most stem cell research, however, numerous clinics around the world offer stem cell “therapies” to patients today outside the context of a clinical trial. Although the number of patients who have received these stem cell-based interventions is unknown, anecdotal reports suggest a substantial population of patients is willing to try them, despite unresolved questions about their safety and efficacy. (shrink)

Mazur & Booth present an intriguing model of the relationship between circulating testosterone levels and dominance behaviour in man, but their review of studies on testosterone–behaviour relationships in man is selective. Much of the evidence they cite is correlational in nature. Placebo-controlled manipulations of testosterone levels are required to test their hypothesis that dominance levels are testosterone-dependent in man. The changes in testosterone level that follow behavioural experience may be a consequence of stress. Testosterone levels in man are determined by (...) a wide variety of factors, and a multivariate approach is required. (shrink)

Throughout the Old Testament, the stories, laws, and songs not only teach a way of life that requires individuals to be moral, but they demonstrate how. In biblical studies, character ethics has been one of the fastest-growing areas of interest. Whereas ethics usually studies rules of behavior, character ethics focuses on how people are formed to be moral agents in the world. This book presents the most up-to-date academic work in Old Testament character ethics, covering topics throughout the Torah, the (...) Prophets, and the Writings, in addition to the use of the Bible in the modern world. In addition to Carroll and Lapsley, contributors are Denise M. Ackermann, Cheryl B. Anderson, Samuel E. Balentine, William P. Brown, Walter Brueggemann, Thomas B. Dozeman, Bob Ekblad, Jose Rafael Escobar R., Theodore Hiebert, Kathleen O'Connor, Dennis T. Olson, J. David Pleins, Luis R. Rivera Rodriguez, J. J. M. Roberts, and Daniel L. Smith-Christopher. (shrink)

Background Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling, which involves a healthcare professional using a social networking site or publicly available search engine to find patient information online. The study’s aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. Method The authors surveyed final year medical students at the (...) Otago Medical School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students’ attitudes towards PTG, and reasons why they might engage in PTG. Results Fifty-four students completed the survey, which showed that PTG was uncommon. Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue. SNS usage was high ; participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. Conclusions The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information. (shrink)

Carpendale & Lewis's (C&L's) interesting and insightful article did not integrate several potentially useful notions from emotion theory and research into their explanatory framework. I propose that emotions are indigenous elements of mind and that children's understanding of them is fundamental to their understanding of the mental life of self and others, understandings critical to the development of social and emotional competence.

Lewis makes a strong case for the interdependence and integration of emotion and cognitive processes. Yet, these processes exhibit considerable independence in early life, as well as in certain psychopathological conditions, suggesting that the capacity for their integration emerges as a function of development. In some circumstances, the concept of highly interactive emotion and cognitive systems seems a viable alternative hypothesis to the idea of systems integration.

I agree with Williams that evolutionary theory provides the best account of the pain expression. We may disagree as to whether pain has an emotional dimension or includes discrete basic emotions as integral components. I interpret basic emotion expressions that occur contemporaneously with pain expression as representing separate but highly interactive systems, each with distinct adaptive functions.

Block's target article makes a significant contribution toward sorting the neural bases of phenomenal consciousness from the neural systems that underlie cognitive access to it. However, data from developmental science suggest that cognitive access may be only one of several ways to access phenomenology. These data may also have implications for the visual-cognitive phenomena that Block uses to support his case.

Vigil's socio-relational framework of sex differences in emotion-expressive behavior has a number of interesting aspects, especially the principal concepts of reciprocity potential and perceived attractiveness and trustworthiness. These are attractive and potentially heuristic ideas. However, some of his arguments and claims are not well grounded in research on early development. Three- to five-year-old children did not show the sex differences in emotion-expressive behavior discussed in the target article. Our data suggest that Vigil may have underestimated the roles of epigenetic and (...) cultural factors in shaping emotion-expressive behavior. (shrink)

Despite advances in medical knowledge regarding pain management, pain continues to be significantly undertreated in the United States. There are many drug and nondrug treatments, but the use of controlled substances, particularly the opioid analgesics, is universally accepted for the treatment of pain from cancer. Although opioid analgesics are safe and effective in treating chronic pain, there is continued research and discussion about patient selection and long-term effects. A number of barriers in the health care and drug regulatory systems account (...) for the gap between what is known about pain management and what is practiced. Among the barriers are physicians’ fears of being disciplined by state regulatory boards for inappropriate prescribing.State medical boards are in a unique position not only to address physicians’ concerns about being investigated, but also to encourage pain management. Prior to 1989, a few state medical boards had policies relating to controlled substances or pain. Subsequently, state medical boards began adopting policies regarding the prescribing of opioids for the treatment of pain; many of these specifically addressed physicians’ fear of regulatory scrutiny. (shrink)

The life perspectives of persons with disabilities have been neglected in many countries and particularly in lower- and middle-income countries that have fewer resources to adequately address the societal needs of these persons. Bioethics purports normative standards for the way in which we treat with others, and the virtue of care should be at the heart of everyday life. Human rights are norms that aspire to protect all persons everywhere. Within this milieu, persons with disabilities who make up a significant (...) portion of all societies worldwide meet many social barriers that inhibit their quality of life and leave them greatly disadvantaged in comparison to able-bodied persons. This article focuses on the notion of quality of life, the presumed perspectives of biomedicine and bioethics on disability, the neglect of the lived experience of persons with disabilities, and the discrimination underlying the struggle for equal rights and opportunities for persons with disability. It argues for equal access to social and beneficial medical interventions for persons with disabilities; that persons with disabilities should be seen as different but equal; that their contributions to societal deliberations would enhance the richness of thought, views, narratives and perspectives; and that society should stop using the term disability and use instead the less value-laden term anomaly. Finally, it recommends educational campaigns to change negative attitudes towards persons with predicaments or anomalies, the respecting of human diversity, collaboration between upper-income and lower- and middle-income countries to develop strategies that seek to change negative attitudes towards persons with anomalies, and the inclusion worldwide of all these matters as a part of a bioethics agenda that advocates for respecting the human rights of persons with anomalies. (shrink)

Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given disease (...) can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. (shrink)

In the Caribbean as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.

Counter storytelling, used in critical race theory and narrative ethics, is a tool used to contradict and expose the oppression in a dominant narrative, by focusing attention on the stories of the...