Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Comprehensive work on philosophy of religion and religions in India.

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

In recent years a burgeoning bicycle culture has reanimated the city of Detroit. The following essay analyzes this reanimation through the themes of embodiment, mobility, spatiality, and the intersubjective creation of place, using the techniques of phenomenology. The description that emerges is an evolving social ontology with implications for cities like Detroit. In such cities any plan for re-urbanization must re-conceptualize both transportation schemas and public space on terrain once dominated by the automobile. The provisional phenomenological description on offer here (...) should be thought of as just one tool in this project, as Detroit and cities like it negotiate the reconstitution of their communities. (shrink)

AbstractOrganizations receive multiple benefits when their members act ethically. Of interest in this study is if the actors receive benefits as well, especially as individuals look to work to fulfill psychological and social needs in addition to economic ones. Specifically, we highlight a series of ongoing ethical practices embodied in professional moral courage and their relationship to actor’s work meaningfulness and life well-being. Drawing on self-determination theory and affective events theory, we explore how exercising professional moral courage in one’s work (...) leads to positive work and life outcomes. Data from 106 administrative staff of non-profit organizations demonstrates the positive benefits of adopting ethical practices at work. Specifically, professional moral courage is found to be significantly related to both work meaningfulness and individual eudaimonic life well-being. Our findings note positive benefits for individuals who incorporate professional moral courage into their daily lives and provide support for organizations seeking to encourage it from their employees; benefits for organizations and employees go beyond just the gains from ethical behavior into other positive psychological processes. Implications for future work that considers both the psychological and normative approaches to meaningful work are discussed. (shrink)

A poetry anthology in which fourteen American poets of varied ethnic backgrounds explore their own origins and the process of assimilation that has helped shape this country.

"By combining recent advances in the physical sciences with some of the novel ideas, techniques, and data of modern biology, this book attempts to achieve a new and different kind of evolutionary synthesis. I found it to be challenging, fascinating, infuriating, and provocative, but certainly not dull."--James H, Brown, University of New Mexico "This book is unquestionably mandatory reading not only for every living biologist but for generations of biologists to come."--Jack P. Hailman, Animal Behaviour , review of the first (...) edition "An important contribution to modern evolutionary thinking. It fortifies the place of Evolutionary Theory among the other well-established natural laws."--R.Gessink, TAXON. (shrink)

In recent years, the changing landscape for the conduct and assessment of research and of researchers has increased scrutiny of the reward systems of science. In this context, correcting the research record, including retractions, has gained attention and space in the publication system. One question is the possible influence of retractions on the careers of scientists. It might be assessed, for example, through citation patterns or productivity rates for authors who have had one or more retractions. This is an emerging (...) issue today, with growing discussions in the research community about impact. We have explored the influence of retractions on grant review criteria. Here, we present results of a qualitative study exploring the views of a group of six representatives of funding agencies from different countries and of a follow-up survey of 224 reviewers in the US. These reviewers have served on panels for the National Science Foundation, the National Institutes of Health, and/or a few other agencies. We collected their perceptions about the influence of self-correction of the literature and of retractions on grant decisions. Our results suggest that correcting the research record, for honest error or misconduct, is perceived as an important mechanism to strengthen the reliability of science, among most respondents. However, retractions and self-correcting the literature at large are not factors influencing grant review, and dealing with retractions in reviewing grants is an open question for funders. (shrink)

The computational approach to psychiatric disorders, including delusions, promises explanation and treatment. Here, we argue that an information processing approach might be misleading to understand psychopathology and requires further refinement. We explore the claim of computational psychiatry being a bridge between phenomenology and physiology while focussing on the ontological commitments and corresponding methodology computational psychiatry is based on. Interconnecting ontological claims and methodological practices, the paper illustrates the structure of theory-building and testing in computational psychiatry.First, we will explain the ontological (...) commitments computational psychiatry is grounded in, theBayesian Brain hypothesis(BBH) of unconscious inference, paired with normative deontic approaches applied to gauge psychopathology. We then turn to the steps taken in empirical paradigms, from definitions, which are used as starting points, to the operationalisation and isolation of cognitive processes and hypothesis testing based on algorithmic models, to consecutive interpretations regarding the aetiology of psychiatric disorders. We outline how experimental paradigms in computational psychiatry are specifically designed to confirm aberrations in assumed inferential processes, which are thought of as being the underlyingcore invariant features.We will illustrate a gap between the ontological commitments of computational psychiatry and the operationalisation and testing of the cognition assumed to be relevant for psychopathology. This conceptual gap is of utmost importance when designing computational paradigms and may impede a crisp understanding of the approach. Lastly, in evaluating the conceptual gap, it becomes apparent that the information processing formalism used in computational psychiatry is still grounded in rational cognitive psychology. (shrink)

Business Ethics: A European Review, EarlyView.

Children in foster care are considered a “vulnerable population” in clinical care and research, with good reason. These children face multiple medical, psychological, and social risks that obligate the child welfare and healthcare systems to protect them from further harms. An unintended consequence of the “vulnerable population” designation for children in foster care is that it may impose barriers on tracking and studying their health that creates gaps in knowledge that are key to their receipt of medical care and good (...) outcomes. These gaps in knowledge have implications for justice, beneficence, and maleficence and serve to undermine “protection” of this population. Here we review the challenges of research regarding children in foster care, particularly medically complex children, and offer specific recommendations to include children in foster care in medical research. (shrink)

In the best Menippean tradition theDe Consolatione Philosophiaeof Boethius is peppered with quotations from different authors, most notably from the works of Homer. The quotations are generally spoken by Philosophy, and are used to articulate the narrative, e.g. at 1. 4 we find a line fromIliad1. 363 whose application to the f present situation is immediately comprehensible, and would have been appreciated by the average reader. Another similar quotation is that ofIliad12. 176: ⋯ργαλ⋯oν δ⋯ με ταȗτα Өε⋯ν ὣς π⋯ντ' ⋯γoρε⋯ειν (...) at 4. 6. 53. Such uses are very simiar to what one, finds in theApocolocyntosisof Seneca, albeit there used for comic effect. There are also snippets of popular wisdom in the form of an old proverb – though it is one with Menippean associations – and a Pythagorean maxim. (shrink)

Approximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child’s medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child’s biological parents should play in making serious medical decisions. Here we highlight some of (...) the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician. (shrink)

Memory should make more available things that are more likely to be needed. Across multiple environmental domains, it has been shown that such a system would match qualitatively the memory effects involving repetition, delay, and spacing (Schooler & Anderson, 2017). To obtain data of sufficient size to study how detailed patterns of past appearance predict probability of being needed again, we examined the patterns with which words appear in large two data sets: tweets from popular sources and comments on popular (...) subreddits. The two data sets show remarkably similar statistics, which are also consistent with earlier, smaller studies of environmental statistics. None of a candidate set of mathematical models of memory do well at predicting the observed patterns in these environments. A new model of human memory based on the environmental model proposed by Anderson and Milson (1989) did better at predicting the environmental data and a wide range of behavioral studies that measure memory availability by probability of recall and speed of retrieval. A critical variable in this model was range, the span of time over which an item occurs, which was discovered in mining the environmental data. These results suggest that theories of memory can be guided by mining of the statistical structure of the environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved). (shrink)

The consensus recommendations by Salter and colleagues (2023) regarding pediatric decision-making intentionally omitted adolescents due to the additional complexity their evolving autonomy presented. Using two case studies, one focused on truth-telling and disclosure and one focused on treatment refusal, this article examines medical decision-making with and for adolescents in the context of the six consensus recommendations. It concludes that the consensus recommendations could reasonably apply to older children.