Over the past two decades ethics committees have proliferated in healthcare institutions across the country. Catalysts for this growth include the endorsement of ethics committees by the New Jersey Supreme Court in the Quinlan case, by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research in its report entitled Deciding to Forgo Life Sustaining Medical Treatment, by the U.S. Department of Health and Human Services in its 1985 “Baby Doe” regulations, by numerous other courts in (...) treatment decisionmaking opinions issued after Quinlan, and more recently by the Joint Commission on Accreditation of Healthcare Organizations. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

Purpose Recent research has found unrealistic optimism among patient-subjects in early-phase oncology trials. Our aim was to investigate the cognitive and motivational factors that evoke this bias in this context. We expected perceptions of control to be a strong correlate of unrealistic optimism. Methods A study of patient-subjects enrolled in early-phase oncology trials was conducted at two sites in the USA. Respondents completed questionnaires designed to assess unrealistic optimism and several risk attribute variables that have been found to evoke the (...) bias in other contexts. Results One hundred and seventy-one patient-subjects agreed to be interviewed for our study. Significant levels of perceived controllability were found with respect to all nine research-related questions. Perceptions of control were found to predict unrealistic optimism. Two other risk attribute variables, awareness of indicators and mental image, were correlated with unrealistic optimism. However, in multivariate regression analysis, awareness and mental image dropped out of the model and perceived controllability was the only factor independently associated with unrealistic optimism. Conclusion Patient-subjects reported that they can, at least partially, control the benefits they receive from participating in an early-phase oncology trial. This sense of control may underlie unrealistic optimism about benefiting personally from trial participation. Effective interventions to counteract unrealistic optimism may need to address the psychological factors that give rise to distorted risk/benefit processing. (shrink)

This paper presents a critical analysis of code-semiotics, which we see as the latest attempt to create paradigmatic foundation for solving the question of the emergence of life and consciousness. We view code semiotics as a an attempt to revise the empirical scientific Darwinian paradigm, and to go beyond the complex systems, emergence, self-organization, and informational paradigms, and also the selfish gene theory of Dawkins and the Peircean pragmaticist semiotic theory built on the simultaneous types of evolution. As such it (...) is a new and bold attempt to use semiotics to solve the problems created by the evolutionary paradigm’s commitment to produce a theory of how to connect the two sides of the Cartesian dualistic view of physical reality and consciousness in a consistent way. (shrink)

Resumen El presente artículo discute un estilo comunicativo típico de muchos hispanohablantes, que a menudo ha sido caracterizado en la literatura sobre pragmática y comunicación intercultural como de cercanía interpersonal y de confianza. El punto de partida teórico y metodológico es la teoría de la Metalengua Semántica Natural (NSM, por sus siglas en inglés), que propone el uso de un minivocabulario de conceptos básicos para explicar otros más complejos. En este caso, presentamos descripciones (que en la teoría se denominan guiones (...) culturales) de distintos aspectos de este estilo comunicativo de cercanía y de palabras claves culturales y rasgos gramaticales relacionados con este modo de comunicar al que, consciente o inconscientemente, adhieren muchos hispanohablantes. Nos basamos en trabajos ya realizados por otros autores dentro de la NSM y proponemos también nuevas descripciones. (shrink)

Family members can provide crucial support to individuals participating in clinical trials. In research on the “newest frontier” of Deep Brain Stimulation (DBS)—the use of DBS for psychiatric conditions—family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their (...) family members as interview participants. Using dyadic thematic analysis—an approach that takes both the individuals and the relationship as units of analyses—this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. (shrink)

In this article, we explore how deep brain stimulation (DBS) devices designed to “close the loop”—to automatically adjust stimulation levels based on computational algorithms—may risk taking the individual agent “out of the loop” of control in areas where (at least apparent) conscious control is a hallmark of our agency. This is of particular concern in the area of psychiatric disorders, where closed-loop DBS is attracting increasing attention as a therapy. Using a relational model of identity and agency, we consider whether (...) DBS designed for psychiatric regulation may require special attention to agency. To do this, we draw on philosophical work on relational identity and agency, connecting it with reports from people using first-generation DBS devices for depression and obsessive-compulsive disorder. We suggest a way to extend a notion of relational agency to encompass neural devices. (shrink)

What happens at the end of a clinical trial for an investigational neural implant? It may be surprising to learn how difficult it is to answer this question. While new trials are initiated with increasing regularity, relatively little consensus exists on how best to conduct them, and even less on how to ethically end them. The landscape of recent neural implant trials demonstrates wide variability of what happens to research participants after an neural implant trial ends. Some former research participants (...) continue to receive support for their devices (e.g., battery and component replacements, software updates, etc.). Others, when safe, have their neural implants removed through surgical explantation. Still others continue to live with a deactivated neural implant embedded in their body. In the United States, there are no uniform requirements to provide services, of any kind, after an neural implant study ends, and other nations are similarly facing this challenge. The existence of a post-trial gap in an expanding neural implant research ecosystem invites obvious questions: What is owed to neural implant research participants post-trial, and why has providing it been so difficult to accomplish in practice? To take a step forward on this difficult issue, we assembled one group of stakeholders – researchers funded for neuroethics grants by the National Institutes of Health – to explore possible starting points on one topic: ethical guidance for post-trial care of research participants in neural implant trials. Based on shared concerns discussed in the expert workshop the current paper is a call to action. It reports the key areas of convergence from the meeting and highlights important next steps towards developing much needed guidance. (shrink)

In his 1981 article "What is 'business ethics'"? Peter Drucker maintains that the then current business ethics literature is a form of casuistry, and it provides an illegitimate argument for business apologists, while it also unjustly bashes business. I agree with W. Michael Hoffman's and Jennifer Mills Moore's criticisms of Drucker's article. However, by limiting themselves to this article, rather than considering Drucker's management works, they have missed an opportunity to benefit from his acknowledged practical wisdom. In this paper, I (...) seize the opportunity to show that Drucker takes business ethics seriously, and I develop his position on business morality. His view of business management responsibility and the related notion of a just organization is seen to be essentially Platonic. (shrink)

This paper traces a relatively linear sequence of early research approaches to the formal verification of concurrent programs. It does so forwards and then backwards in time. After briefly outlining the context, the key insights from three distinct approaches from the 1970s are identified (Ashcroft/Manna, Ashcroft (solo) and Owicki). The main technical material in the paper focuses on a specific program taken from the last published of the three pieces of research (Susan Owicki’s): her own verification of her _Findpos_ example (...) is outlined followed by attempts at verifying the same example using the earlier approaches. Reconsidering the prior approaches on the basis of Owicki’s useful example illuminates similarities and differences between the proposals. Along the way, observations about interactions between researchers (and some “blind spots”) are noted. (shrink)

This article explores the connection between the Heng Xian and the Changes of Zhou tradition, especially the “Tuan” and “Attached Verbalizations” commentaries. Two important Heng Xian terms—heng 恆 and fu 復—are also Changes of Zhou hexagrams and possible connections are explored. Second, the Heng Xian account of the creation of names is compared with the “Attached Verbalizations” account of the creation of the Changes of Zhou system. Third, the roles played by knowing and desire in both Heng Xian and the (...) Changes of Zhou tradition are explored, with particular focus on potential points of similarity. Finally, insights gained through these comparisons are used to interpret the Heng Xian advice on initiating action. (shrink)

For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship from (...) the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings. (shrink)

For the general public, there is an intuitive appeal to an animal's living in the wild rather than in captivity. Rarely is it an appeal informed by careful scientific or ethical analysis, however. This paper discusses how animal release projects ought to be conducted, guided by the question, "what are the duties of humans toward animals that are to be released?" It studies the ethical responsibilities of caretakers, practical elements of a responsible release, and proper selection of candidate animals for (...) release, and what marine science tells us about how best these requirements might be achieved. (shrink)

Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physicianpatient relationship, but little data have been collected and (...) analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

First published in 1985, the _Handbook for Achieving Gender Equity Through Education_ quickly established itself as the essential reference work concerning gender equity in education. This new, expanded edition provides a 20-year retrospective of the field, one that has the great advantage of documenting U.S. national data on the gains and losses in the efforts to advance gender equality through policies such as Title IX, the landmark federal law prohibiting sex discrimination in education, equity programs and research. Key features include:_ (...) Expertise_ – Like its predecessor, over 200 expert authors and reviewers provide accurate, consensus, research-based information on the nature of gender equity challenges and what is needed to meet them at all levels of education._ Content Area Focus_ – The analysis of gender equity within specific curriculum areas has been expanded from 6 to 10 chapters including mathematics, science, and engineering._ Global/Diversity Focus_ – Global gender equity is addressed in a separate chapter as well as in numerous other chapters. The expanded section on gender equity strategies for diverse populations contains seven chapters on African Americans, Latina/os, Asian and Pacific Island Americans, American Indians, gifted students, students with disabilities, and lesbian, gay, bisexual, and transgender students. _ Action Oriented_ – All chapters contain practical recommendations for making education activities and outcomes more gender equitable. A final chapter consolidates individual chapter recommendations for educators, policymakers, and researchers to achieve gender equity in and through education._ New Material_ – Expanded from 25 to 31 chapters, this new edition includes: *more emphasis on male gender equity and on sexuality issues; *special within population gender equity challenges ; *coeducation and single sex education; *increased use of rigorous research strategies such as meta-analysis showing more sex similarities and fewer sex differences and of evaluations of implementation programs; *technology and gender equity is now treated in three chapters; *women’s and gender studies; *communication skills relating to English, bilingual, and foreign language learning; and *history and implementation of Title IX and other federal and state policies. Since there is so much misleading information about gender equity and education, this _Handbook_ will be essential for anyone who wants accurate, research-based information on controversial gender equity issues—journalists, policy makers, teachers, Title IX coordinators, equity trainers, women’s and gender study faculty, students, and parents. (shrink)

This article (reprinted in Philosophy Now's 'The Ultimate Guide to Metaphysics' in 2018) introduces J.M.E. McTaggart's famous arguments for the 'unreality' of time, and their implications.