BackgroundUse of routinely collected patient data for research and service planning is an explicit policy of the UK National Health Service and UK government. Much clinical information is recorded in free-text letters, reports and notes. These text data are generally lost to research, due to the increased privacy risk compared with structured data. We conducted a citizens’ jury which asked members of the public whether their medical free-text data should be shared for research for public benefit, to inform an ethical (...) policy.MethodsEighteen citizens took part over 3 days. Jurors heard a range of expert presentations as well as arguments for and against sharing free text, and then questioned presenters and deliberated together. They answered a questionnaire on whether and how free text should be shared for research, gave reasons for and against sharing and suggestions for alleviating their concerns.ResultsJurors were in favour of sharing medical data and agreed this would benefit health research, but were more cautious about sharing free-text than structured data. They preferred processing of free text where a computer extracted information at scale. Their concerns were lack of transparency in uses of data, and privacy risks. They suggested keeping patients informed about uses of their data, and giving clear pathways to opt out of data sharing.ConclusionsInformed citizens suggested a transparent culture of research for the public benefit, and continuous improvement of technology to protect patient privacy, to mitigate their concerns regarding privacy risks of using patient text data. (shrink)

Advance directives are critically important for capable individuals who wish to avoid the burdens of life-prolonging interventions in the advanced stages of dementia. However, this paper will argue that advance directives should have less application to questions about feeding patients during the clinical course of dementia than often has been presumed. The argument will be framed within the debate between Ronald Dworkin and Rebecca Dresser regarding the moral authority of precedent autonomy to determine an individual’s future end-of-life care plan. We (...) will use a brief analysis of the positions taken in two important papers that come out of the Dworkin/Dresser debate and a hypothetical patient, John, who will be followed from diagnosis of dementia to death, to show how advance directives should apply to key points in the progression of his disease, particularly in relation to food and nutrition. (shrink)

This is my translation of Gadamer's 1990 lecture "The Diversity of Languages and Understanding of the World." "In his lecture, Gadamer presents his views of language and world in a distinctively hermeneutical key. For example, he emphasizes language as that which 'belongs to conversation.' That is, language as conversation helps to bring about understanding and involves the play of dialogical exchange. 'Language is not proposition and judgment; rather, it is what it is, only when it is question and answer.' Language (...) involves another; it is on-the-way [unterwegs] to another. In fact, when addressing his question—what does world mean—Gadamer clarifies that humans and world are intimately connected; the world is that in which we are 'in the midst' and 'understanding is understanding oneself in the world.' But we are also in-the-world with others, and understanding ourselves in the world, means to understand ourselves with others. Gadamer goes so far as to say that our self-understanding as achieved in relation to others, as well as our understanding of others, should be taken in a moral and political sense. That is, the other is not there as merely a means to our ends or to exploit. Rather, 'the other indicates a principal limit to our self-love and self-centeredness. This is a general moral problem. It is also a political problem.' He goes on to emphasize the difficult task of achieving genuine solidarity with those from different cultures. Such a task requires language as conversation, the back-and-forth of dialogical exchange in which we come to understand the other and the other comes to understand us. Again and again, Gadamer underscores the task that each of has in light of our pluralistic world “to learn to bridge and reconcile the distances and differences between us and that means that we respect, look after, care for the other, and give one other a new hearing.” In contrast with the story of the Tower of Babel in which the people sought a pseudo-unity or 'oneness' driven by a will to dominate, Gadamer embraces both cultural and linguistic diversity and warns against reducing these multiple horizons 'by any special contrivance of unity [Einheitsmechanik].' He encourages us to seek out the open spaces that arise in our interactions with one another, to resist the levelling of language that information technology tends toward, and to 'cultivate language in its most distinctive possibilities.' In our present age of disinformation warfare, which threatens democracies worldwide and is a direct challenge to truth and the possibility of a meaningful dialogue with others, we would do well to linger with Gadamer’s hermeneutical and ethical insights and contemplate how we might bring these insights to bear on the global and political crises that we face today—Russia’s war of aggression against Ukraine, our climate catastrophe, and ever new forms of technical sophistry and disinformation that seek to erode our trust in truth, reality, and language itself.". (shrink)

The burdens of mental illnesses and substance use disorders do not lie merely with the individuals who suffer from these conditions but affect, and are affected by, their families, communities, cities and countries. The ethical and political challenges that arise in the treatment of mental illnesses and substance abuse disorders are, therefore, challenges that affect both individuals and communities.

Revisions of the King James Version of 1611 continued into the 20th and 21st centuries as literal or word-for-word translations. This development corresponds with a new age in Bible translation that started in the second half of the 20th century, which involves at least six changes in the philosophy of Bible translation. Firstly, Bible translation is characterised by interconfessional cooperation. Secondly, the plain meaning intended in the incipient texts is made accessible to readers. Thirdly, new critical editions of the Hebrew (...) and Greek incipient texts on the basis of new discoveries of texts are utilised. Fourthly, there is the tendency to remove archaic language to make versions intelligible. Fifthly, there is a tendency to use gendered and inclusive language. Sixthly, the move is from print communication, which can be typified as typographic interpretive culture, to electronic or media communication, which can be typified as digital-media interpretive culture, where sound and visuality become prominent as a contextual supplement to words. In the analysis it will be determined which of these aspects are reflected in the Revised Standard Version and its revisions as part of the linear emergence of the Tyndale–King James Version tradition. However, unlike the King James Version, the Revised Standard Version and its revisions failed to achieve widespread approval from satisfied readers, thus opening the door to alternative revisions.Contribution: Instead of viewing the Revised Standard Version and its revisions as new and independent from the Tyndale–King James Version tradition, it is demonstrated that they are a linear continuation of the emergence of the pre-20th century translation complex within this tradition without replicating the success of the King James Version. (shrink)

BackgroundTranscranial magnetic stimulation (TMS) is an FDA approved treatment for major depression, migraine, obsessive compulsive disorder, and smoking addiction. TMS has gained popular media support, but media coverage and commercial reporting of TMS services may be contributing to the landscape of ethical issues.MethodsWe explore the differences between the academic and print media literature portrayals of TMS to evaluate their ethical impact for the public. We performed a comprehensive literature review using PubMed and NexisUni databases to evaluate the literature available on (...) TMS from 2014 to 2019. Our sample consisted of 1632 academic articles and 468 print media articles for a total of 2100 articles. We then coded each article for seven specific top-level codes: (1) type of source, (2) year of publication, (3) purpose of TMS application, (4) age of subjects, (5) population, (6) overall tone, and (7) specification of TMS parameters. We also made some additional notes of the TMS parameters where specified and the breakdown of mental health applications.ResultsOur results indicated several discrepancies between the academic and the print media reporting about TMS technology, particularly with regards to tone and specificity. Namely, the academic sample was largely neutral and specific about the parameters under which TMS was being applied, while the print media sample was heavily optimistic and presented the application of TMS with far less specificity. There was some convergence between the two samples, such as the focus of both on therapy as the predominant TMS application.ConclusionsWe call upon the academic community to increase scrutiny of TMS services in order to ensure that people’s knowledge of health technologies is not unduly influenced by sensational claims and a general lack of adequate information. (shrink)

The long-running discourse on respect for human dignity and autonomy in the physician-patient relationship pertaining to persons with dementia (PwDs) is explored deeply in this paper through the use of a real-life case, to highlight the complex interplay between autonomy and best interest when it comes to a PwD's experiential and critical interests. Many scenarios and perspectives are described and applies to the case. However, there are a few perspectives, which are touched upon that could do with further scrutiny. Firstly, (...) it has been argued that rigid adherence to the advance directives of PwDs means that PwDs will be the only people who are not allowed to ever change their minds. This withdrawal of a fundamental freedom hardly accords with respect for human dignity, or for any residual autonomy that these individuals may still enjoy. Secondly, viewing this case through the lens of care ethics, and incorporating the recently proposed conceptual framework of anthropological vulnerability, may reveal valuable insights regarding care provision and caring physician-patient relationships. These perspectives would analyse the role of relational ontology, particularly in relation to significant others, significant communities, and caregivers. (shrink)

This discourse analytic study integrates theories of stance and membership categorization to investigate one online discussion thread initiated by a woman who asks for diet and health advice on behalf of her boyfriend, an interactive move we term ‘asking for another’. Posters to the thread, in relatively explicit ways, construe the original poster as a ‘nag’ and ‘mother-figure’ and her boyfriend as a ‘victim of nagging’ and ‘childish’. Our analysis illuminates how two features of the asking-for-another post evoke these identities: (...) extreme case formulations, created via adjectives and adverbs, lead others to view the woman as inappropriately involved and controlling and her boyfriend as immature, and details about the boyfriend’s diet, provided via nouns and adjectives, index cultural ideologies of food and identity. This study illuminates the ambiguity and polysemy of the move of asking for another, contributing to research on identity construction and health-related advice-seeking online. (shrink)

This is a translation of Hans-Georg Gadamer’s 1988 essay, “Musik und Zeit: Ein philosophisches Postscriptum.” The essay, although brief, is noteworthy in that it contains Gadamer’s philosophical reflections on music—reflections which are largely absent in his masterwork, Truth and Method. In the essay, one finds several important Gadamerian hermeneutical themes such as the notion of art as performance or enactment (Vollzug), the linguisticality of understanding, the importance of lingering with an artwork or text, and how our absorption in the work (...) gives rise to a particular experience of time. (shrink)

A decade on after it first published to international acclaim, the seminal Handbook of Organization Studies has been updated to capture exciting new developments in the field. Providing a retrospective and prospective overview of organization studies, this Handbook continues to challenge and inspire readers with its synthesis of knowledge and literature. As ever, contributions have been selected to reflect the diversity of the field. New chapters cover areas such as organizational change, knowledge management and organizational networks.

When it’s time for a game change, you need a guide to the new rules. Helping Students Make Sense of the World Using Next Generation Science and Engineering Practices provides a play-by-play understanding of the practices strand of A Framework for K–12 Science Education (Framework) and the Next Generation Science Standards (NGSS). Written in clear, nontechnical language, this book provides a wealth of real-world examples to show you what’s different about practice-centered teaching and learning at all grade levels. The book (...) addresses three important questions: 1. How will engaging students in science and engineering practices help improve science education? 2. What do the eight practices look like in the classroom? 3. How can educators engage students in practices to bring the NGSS to life? Helping Students Make Sense of the World Using Next Generation Science and Engineering Practices was developed for K–12 science teachers, curriculum developers, teacher educators, and administrators. Many of its authors contributed to the Framework’s initial vision and tested their ideas in actual science classrooms. If you want a fresh game plan to help students work together to generate and revise knowledge—not just receive and repeat information—this book is for you. (shrink)

In ‘On McDowell's identity conception of truth’ , we suggested that McDowell's Identity Theory, according to which a proposition is true if and only if it is identical with a fact, is only fully understood when we realize that there are two identity claims involved. The first is that, when one thinks truly, the content of a whole thought is identical with a Tractarian Tatsachen – a complex fact constituted by simple Sachverhalte – and the second is that these simple (...) Sachverhalte are in turn identical with simple Fregean senses. 1As an example, we suggested that the complex content/proposition/Fregean sense is identical with the Tractarian Tatsachen constituted by the two Sachverhalte: the object's being a tiger and the object's being undernourished, both of which can be seen, as the second identity with simple Fregean senses requires, to present an object in a certain way – as being, in turn, a tiger and undernourished.In his response to our article, Julian Dodd raises three internal criticisms concerning the coherence of the view as a whole, as well as the interpretative criticism that, regardless of the internal coherence of the view, it is not McDowell's. We think that Dodd fails to appreciate the view we have developed in our article, so much so that he believes that his own proffered view of McDowell, articulated in the final section of his response, is an alternative to our own position when in fact it is simply a restatement of that position. Because this point is so fundamental, we begin below by spelling out exactly where Dodd's understanding of our view goes wrong and so why his interpretative criticism misses its target before addressing the internal criticisms concerning the coherence of the view as a …. (shrink)

Positive public perceptions of academic quality and professional ethics are critical to the long-term legitimacy of American colleges and universities. Faculty codes of conduct are one mechanism whereby the professoriate can define acceptable practice, exercise social control, and maintain public confidence in higher education, yet the drivers of their adoption are not well understood. Building upon previous research into such organizational behavior by institutional type, this study examined the prevalence and content of publicly posted faculty codes of conduct within an (...) organizational field of institutions that share a common religious identity but differ in their institutional types and employment structures. Faculty handbooks from American member institutions of the Council for Christian Colleges & Universities, an international association of faith-based institutions, were gathered and analyzed. Although only 27% of CCCU member institutions in the U.S. publicly posted faculty codes of conduct, the average number of tenets present in each code was higher than suggested by previous research. Study findings also revealed that membership category, institutional type, and employment structures influence the content of faculty codes of conduct, indicating that isomorphic pressures operate within this particular organizational field. The piece concludes by commending publicly posted codes of conduct as an affirmation of the personal responsibility, fairness, and care exercised by ethical professionals in the academy. (shrink)

We use discourse analysis to examine a group supervision meeting in which graduate students who are training to become school counselors discuss counseling experiences that they had at local high schools. Focusing on metadiscourse, or talk about talk, we integrate Ochs’ concepts of epistemic stance and affective stance and Tannen’s discussion of linguistic strategies as ambiguous and polysemous in terms of power and solidarity in order to demonstrate how counselors-in-training construct their identities as what Woodside et al. call ‘boundary-dwellers’ in (...) their professional community of practice. Examination of metadiscourse regarding address terms and the speech act of asking questions – and in particular highlighting how participants use negatively valenced affect words, the verb feel, and what Tannen calls ‘constructed dialogue’ – reveals their stances of uncertainty and discomfort, their transitional professional identities as entailing an uneasy navigation of relationships, and their recognition of the pivotal role of language in the process. (shrink)

Traditionally, hospital emergency readiness plans primarily addressed natural disasters, but because of preparations for year 2000, the arrival of terrorism in the United States, and the potential for mass casualties, hospitals were prompted to bring together new partners and create new emergency readiness plans. These new plans, however, give rise to a number of important issues hospitals must consider. First, hospitals must consider legal liability that might arise during an emergency. For example, what liability might arise when decision are made (...) regarding the provision of individual treatment versus mass triage? Second, hospitals must be cognizant of relevant privacy rules, such as the Health Insurance Portability and Accountability Act, as they apply to public health emergencies activities. Third, hospitals must be aware of the Emergency Medical Treatment and Active Labor Act which requires Medicarefunded hospitals to screen patients for emergency medical conditions and prohibits their transfer until they are stabilized. (shrink)

The ecofeminist cosmologies of Indian scientist Vandana Shiva and Catholic theologian Ivone Gebara are examined. At the centre of each author’s discourse is their feminist epistemology that occasion a new way of knowing, incorporating each thinker’s social locations as nexus for authority. For Shiva, the feminine principle of Prakriti, or the awareness of nature as a living, interdependent force, is realized through the inclusion of women as sources of expertise and knowledge. Gebara rejects classical theology and philosophy as androcentric, anthropocentric, (...) and hierarchical. Instead Gebara envisions a revised epistemology of inclusivity with emphasis on multiplicity and unity initiated by an ecofeminist Trinitarian cosmology. Taken together Shiva and Gebara provide an epistemology that privileges the paradox of unity through diversity and difference as a solution to society’s current ecological crises. (shrink)

Amid increasing demands from students and the public, universities have recently reinvigorated their efforts to increase the number of faculty from underrepresented populations. Although a myriad of piecemeal programs targeting individual recruitment and development have been piloted at several institutions, overall growth in faculty diversity remains almost negligible and highly localized. To bring about genuine change, we hypothesize a consortia approach that links individuals to hiring opportunities within a state university system might be more effective. Here we present a case (...) study describing the progress of the NSF-funded Alliances for Graduate Education and the Professoriate PROMISE Academy Alliance, a consortium within the University System of Maryland collaborating to develop, implement, self-study, evaluate, and disseminate a unique postdoc-to-faculty conversion model in the biomedical sciences. The initiative centers on diversifying faculty across five institutions in the USM, including teaching-focused institutions, comprehensive universities, research institutions, and professional schools. Components of this approach include enhanced recruiting and hiring practices to attract outstanding postdoctoral scholars from underrepresented backgrounds, multi-institutional networking and professional development, and facilitated processes to transition postdocs into tenure-track positions at their postdoctoral institution or another institution in the state system. This model is distinct from more deficit-based approaches because it goes beyond focusing on building the individual’s skills to enter the professoriate. This program restructures the traditionally short-term nature of postdoctoral employment and incorporates a pathway to a tenure-track professorship at the same institution or within the same statewide system where the postdoc is trained. This multi-institutional model leverages collaboration and distinct institutional strengths to create cross-institutional support, advocacy, and policy. Importantly, it uses a decentralized financial structure that makes this approach distinctly replicable. Recognizing the immediate need for more collaborative approaches to diversify faculty and a lack of literature about such approaches, this case study describes the development of, and potential benefits of, a state university system, as well as the qualitative lessons learned from self-study, internal evaluation, external evaluation, and NSF site visits. The AGEP PROMISE Academy can serve as a model for replication at other university systems hoping to diversify their faculty. (shrink)

Business Ethics: A European Review, EarlyView.

This commentary speaks to the relationship between Depue & Marrone-Strupinsky's (D&M-S's) concept of trait affiliation and affiliative memory and the formation of human community, especially among peer groups. The target article suggests a model for how and why dynamic communities form in a number of disparate contexts and under a number of circumstances.

The relationship between corporate executives and shareholders has riveted the attention of business ethicists since the inception of the field. Most ethicists agree that corporate executives owe their investors the duties of loyalty, candor, and care. These fiduciary duties undergird the promises made to shareholders at the time of incorporation, placing on executives moral obligations to engage in fair dealing and to avoid conflicts of interest.We concur that executives owe all of their existing shareholders both promise-keeping and fiduciary duties and (...) argue that some corporateexecutives violate these responsibilities by attempting to withhold information from or limit information to some shareholders while courting others. We analyze the ethical implications of six techniques and tools that executives use to attract certain types of shareholders while deterring others. We conclude with recommended structural and behavioral changes to these current managerial and investor practices. (shrink)

Mass incarceration has become a flashpoint in a number of recent political and public policy debates. Consensus about how to balance the just punishment of offenders with the humanitarian goal of providing inmates with genuine opportunities for reconciliation, rehabilitation, and reintegration into society is lacking. Unfortunately, a dualistic “us-versus-them” narrative surrounding these issues has become entrenched, occluding fruitful dialogue and obscuring our ability to see the detrimental effects that our nation’s punitive turn has created. In this essay, we affirm the (...) insights of Wacquant, Clear, and other sociologists and introduce a theological narrative of solidarity and vulnerability that undermines the “us-versus-them” dichotomy and opens up a path for cultivating a “we” community. (shrink)

Extending and expanding Geiger and Feller’s analysis of increasing dispersion in R&D expenditures during the 1980s, the paper analyzes publication and citation counts as well as R&D expenditures for 194 top producers using Web of Science data. We find high and stable levels of inequality in the 1990s and 2000s, combined with robust growth both in the system and on individual campuses, considerable opportunities for short-range mobility and very limited opportunities for long-range mobility. Initial investments in research, private control, and (...) the capacity of wealthy institutions to attract productive faculty are associated with high levels of scientific output. New entrants to the system and those that leave the system are both clustered near the bottom of the hierarchy. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

What is introspective know ledge of one’s own intentional states like? This paper aims to make plausible the view that certain cases of self-knowledge, namely the cogito-type ones, are enough like perception to count as cases of quasi-observation. To this end it considers the highly influential arguments developed by Sydney Shoemaker in his recent Royce Lectures. These present the most formidable challenge to the view that certain cases of self-knowledge are quasi-observational and so deserve detailed examination. Shoemaker’s arguments are directed (...) against two models of ordinary perception, the “object perception model” and the “broad perceptual model”. I argue that the core theses that Shoemaker associated with them are either dubious in their own right or applicable to certain cases of self-knowledge. Overall the aim is to show that there is such a variety of patterns in each case that simple analogies or disanalogies are unhelpful. (shrink)

In this interview, Cynthia Hammond sits down with Marc Lafrance in order to discuss the 30-year sketching practice that led to her exhibition, Drawings for a Thicker Skin, in 2012. In this practice, Hammond made small, quick drawings of the clothes she would need for trips or key professional events. As she explains, the drawings were not just essential to knowing what to pack; they were essential to being able to pack. While she never conceived of the practice as (...) art, when invited to exhibit the drawings she found a way to relate this idiosyncratic and private practice to a larger set of ontological concerns. Clothing as a second skin is the key idea here, as Hammond and Lafrance explore what it means to navigate identity, idealized self-image, professional ‘passing’ and the skin ego. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 225-226 [Access article in PDF] Travelers in the Land of Sickness Eric J. Cassell THE PROBLEM OF knowing another person and the world in which that person lives, particularly someone with major mental illness, is addressed in this interesting and rich essay. The number of different metaphors and concepts Potter employs to describe the task of crossing into and then understanding the (...) thoughts, emotions, symptoms, constraints, context, and perspectives of another testifies to the difficulties involved.Yet, as I read the essay, it was not clear what the clinician world traveler, moral tourist, empathizer (and other categories) is supposed to do on the journey to another person. Why do we reach out to the sick person? What is it that we want to know or do that makes this trip necessary? Potter is primarily concerned with mental illness—the examples she cites are patients with schizophrenia—while my experience has in the main been with persons with physical illness, but for the moment, the differences are less important than the central lesson. The illness that the patient presents—the experience of the symptoms, the impairments, disability, and disruptions of the emotional and social existence that happen because of the disease result from an amalgam of the disease process with the specific nature of the sick person. There is no disease in pure form; there is no disease in abstract for clinicians. There is only this sick person. She correctly quotes me, because of all this, as pointing out the importance of integrating knowledge of this particular patient with the abstract knowledge of disease to understand the illness as it is expressed in this person. All to form a basis for the treatment of the patient and especially to help relieve suffering because suffering is always personal, particular, and individual. (It is important in thinking about this topic to remember that most serious diseases, psychiatric and otherwise, are chronic and take place over significant lived time. The acute schizophrenic symptoms or the acute infectious diseases, as dramatic as they are, distract attention from the importance of the place of the sick person.)In physical disease, our long (and continuing) history of separating human beings from nature and the body, and the importance medicine places on objectivity and the objective, have made the inevitable personalization of the disease and symptoms virtually invisible. After ages of explaining psychiatric diseases as the alienation of the person, and a long psychoanalytic period of finding their origins in the person, in the last 30 years these diseases have become increasingly objectified. The place of the person has been diminished as psychiatry has entered the DSM, neurotransmitter, and effective psychotropic drug era. For both physical and mental disease, however, and whatever the current ideology, the nature of person is crucial in determining the onset, diagnosis, course, treatment, and outcome of each illness. It is in order to have an impact on these crucial aspects of sickness that clinicians must come to know their patients to the degree possible. [End Page 225]But there is something more. Nancy Potter quotes a woman with schizophrenia as saying, "All that was my former self has crumbled and fallen together and a creature has emerged of whom I know nothing. She is a stranger to me... She is not real—she is not I... She is I—and because I still have myself on my hands, even if I am a maniac, I must deal with me somehow." (Potter, 2003, p. 215)Must she deal with this crazy self alone? Is that not what her doctors and caregivers are for? But how can they take care of her, protect her, keep what is left intact, and sustain her until she is (hopefully) better without knowing who she is? She makes clear in those few phrases that inside her there is a person with a past, a family, a world, a culture, a role(s) in life, relationships, a body, dreams for the future, things she does, and all the other things that make up a person. It is in... (shrink)