In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize (...) factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning. (shrink)

PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review (...) the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.ResultsPatient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).ConclusionFor simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. (shrink)

Repression has remained controversial for nearly a century on account of the lack of well-controlled evidence validating it. Here we argue that the conceptual and methodological tools now exist for a rigorous scientific examination of repression, and that a nascent cognitive neuroscience of repression is emerging. We review progress in this area and highlight important questions for this field to address.

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

The adage “an ounce of prevention is worth a pound of cure” is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards. The (...) purpose of this article is to: (1) describe the rationale for using ethics pocket cards, (2) provide examples of our cards, and (3) begin a dialogue about the potential uses of ethics pocket cards. In doing so, we hope to explore how such portable, economical devices can advance the goals of ethics consultation as well as the educational aims of ethics committees. (shrink)

Populations in many Midwest cities are declining. To maintain infrastructure with a shrinking tax base, city planners have sometimes proposed to right size such cities, sometimes shutting down or removing infrastructure. Such proposals have been met with fierce resistance among many residents, especially in communities with a history of top-down, racialized city planning. This raises the question: if population loss is a near certainty, is it possible to shrink justly? Much work on environmental injustice focuses on removing bad things from (...) an environment, but in shrinking cities, there is a high likelihood that good things will be removed. Is it at all possible to do this in a manner that promotes justice? In our view, the answer is perhaps. Academics and professional city planners ought not determine the fate of cities, but can develop detailed conceptions of a city’s future for residents to consider. To this end, we build on a theoretical framework—the notion of a “just city”– to sketch a few ideas about what a just shrinking city might look like, identifying both a wider array of hazards, and possible benefits, to reducing city services than is often noticed. (shrink)

Populations in many Midwest cities are declining. To maintain infrastructure with a shrinking tax base, city planners have sometimes proposed to right size such cities, sometimes shutting down or removing infrastructure. Such proposals have been met with fierce resistance among many residents, especially in communities with a history of top-down, racialized city planning. This raises the question: if population loss is a near certainty, is it possible to shrink justly? Much work on environmental injustice focuses on removing bad things from (...) an environment, but in shrinking cities, there is a high likelihood that good things will be removed. Is it at all possible to do this in a manner that promotes justice? In our view, the answer is perhaps. Academics and professional city planners ought not determine the fate of cities, but can develop detailed conceptions of a city’s future for residents to consider. To this end, we build on a theoretical framework—the notion of a “just city”– to sketch a few ideas about what a just shrinking city might look like, identifying both a wider array of hazards, and possible benefits, to reducing city services than is often noticed. (shrink)

In Walter Benjamin’s pivotal essay “Toward the Critique of Violence,” the state emerges as an originary site of violence, and the police figure as a key institution that makes possible both law-preserving and law-founding violence. I argue that Benjamin offers a unique and clarifying understanding of violence that can help make sense of twenty-first century calls for police and prison abolition. At the same time, Benjamin critiques several leftist attempts to combat state violence—such as the workplace strike (...) and leftist reformism—finding in them a reformulation of the very violence they seek to combat. I argue that many of these critiques could be equally levied at some manifestations of the contemporary abolitionist movement. This paper concludes by distilling some of Benjamin’s insights about the propensity to reflect the violence we attempt to contest into some lessons for contemporary activism and social movements. (shrink)

Throughout the U.S., state laws require professionals who work with children to report cases of suspected child abuse to child protection services. Both practically and conceptually, however, significant problems arise from a lack of clarity regarding the threshold that has been set for reporting. Specifically, there is no consensus as to what constitutes reasonable suspicion, and little direction for how mandated reporters should gauge their legal and professional responsibilities when they harbor suspicion. In this paper we outline the context of (...) the problem, discuss the nature and scope of its conceptual underpinnings, and offer recommendations for moving towards a concrete, practical solution. (shrink)

A father brings his six-year-old daughter and her older sister to their pediatrician to be evaluated for a history of cough, runny nose, and low-grade fever. In addition to signs of a cold, the girl's nasal bridge is quite swollen and bruised. When asked how her nose was injured, she shrugs, and her father's only conjecture is that she sleepwalks and might have bumped into something. The father sits impatiently and as questioning progresses becomes increasingly defensive, at one point angrily (...) declaring, “We don't beat our kids, if that's what you’re asking.” Further complicating the situation is information from nurses that this family is “on the brink” socially and financially, and that additional stress is likely “to blow this family apart.” A careful physical exam identifies no other injuries, and a thorough review reveals no evidence of prior suspicious injuries, frequent visits to the emergency room, or bleeding abnormalities. The evidence does not point to abuse as the most likely explanation for the injury, but it clearly is not ruled out. Should one report this family for suspected abuse? Is one required to report? (shrink)

Within the field of medical ethics there is a startling amount of diversity regarding which issues and relationships are deemed relevant for ethical inquiry and analysis, what strategies are appropriate for examining and resolving ethical conflict, what should be the goals for medical ethics, even who should participate in that project. What I will try to make clear in this paper is that how we go about this process of doing medical ethics, of examining, reflecting, decisionmaking, and behaving, makes a (...) practical difference, and not just a philosophical one, in terms of the understandings we will reach about ethical matters. Without attempting to resolve any of the conflicts within or between different conceptions of doing ethics, I will try to articulate the differences in orientation, and particularly the tone and educational emphasis, that attend four major contemporary approaches to ethical inquiry and analysis: deductivism, principlism, modern casuistry, and feminist/relationist ethics. Keywords: casuistry, deductivism, ethics, feminism, principlism, relationism CiteULike Connotea Del.icio.us What's this? (shrink)

In the United States, the implementation of a successful system of mandated reporting of suspected child abuse continues to be plagued by the absence of a clear standard for when one must report. All 50 states of the U.S. have laws requiring certain individuals to report suspected child abuse. However, at present, there are variable thresholds for mandated reporting and no clear consensus on how existing thresholds should be interpreted. Because “child abuse” is often present as a possible etiology for (...) injuries and non-infectious conditions that beset children, it is problematic to suggest that “the mere possibility of child abuse” qualifies as cause to report. In an effort to move toward a more effective system of mandated reporting of child maltreatment, this paper discusses how the absence of a clear threshold affects mandated reporters, examines the relevant legal and conceptual issues, and suggests future directions for policy, practice, and research. (shrink)

Disorders of volition are often accompanied by, and may even be caused by, disruptions in the phenomenology of agency. Yet the phenomenology of agency is at present little explored. In this paper we attempt to describe the experience of normal agency, in order to uncover its representational content.

Despite their ethical intentions, ethically minded consumers rarely purchase ethical products (Auger and Devinney: 2007, Journal of Business Ethics76, 361–383). This intentions–behaviour gap is important to researchers and industry, yet poorly understood (Belk et al.: 2005, Consumption, Markets and Culture8(3), 275–289). In order to push the understanding of ethical consumption forward, we draw on what is known about the intention–behaviour gap from the social psychology and consumer behaviour literatures and apply these insights to ethical consumerism. We bring together three separate (...) insights – implementation intentions (Gollwitzer: 1999, American Psychologist54(7), 493–503), actual behavioural control (ABC) (Ajzen and Madden: 1986, Journal of Experimental Social Psychology22, 453–474; Sheeran et al.: 2003, Journal of Social Psychology, 42, 393–410) and situational context (SC) (Belk: 1975, Journal of Consumer Research2, 157–164) – to construct an integrated, holistic conceptual model of the intention–behaviour gap of ethically minded consumers. This holistic conceptual model addresses significant limitations within the ethical consumerism literature, and moves the understanding of ethical consumer behaviour forward. Further, the operationalisation of this model offers insight and strategic direction for marketing managers attempting to bridge the intention–behaviour gap of the ethically minded consumer. (shrink)

Prenatal genetic testing is becoming available for an increasingly broad set of diseases, and it is only a matter of time before parents can choose to test for hundreds, if not thousands, of genetic conditions in their fetuses. Should access to certain kinds of fetal genetic information be limited, and if so, on what basis? We evaluate a range of considerations including reproductive autonomy, parental rights, disability rights, and the rights and interests of the fetus as a potential future child. (...) We conclude that parents should be able to access information that could be useful during pregnancy, but that testing for non-medical information should be limited. Next, we argue that the government lacks a compelling state interest in regulating prenatal genetic testing and propose that regulation should occur through medical professional organizations. Finally, we present a framework for determining what testing physicians should recommend, offer neutrally, or not offer at all. (shrink)

While we often talk about time using spatial terms, experimental investigation of space-time associations has focused primarily on the space in front of the participant. This has had two consequences: the disregard of the space behind the participant and the creation of potential task demands produced by spatialized manual button-presses. We introduce and test a new paradigm that uses auditory stimuli and vocal responses to address these issues. Participants made temporal judgments about deictic or sequential relationships presented auditorily along a (...) body-centered sagittal or transversal axis. Results involving the transversal axis replicated previous work while sagittal axis results were surprising. Deictic judgments did not use the sagittal axis but sequential judgments did, in a previously undocumented way. Participants associated earlier judgments with the space in front of them and later judgments with the space behind them. These findings, using a new approach, p.. (shrink)

Abstract“Psychological essentialism” refers to our tendency to view the natural world as emerging from the result of deep, hidden, and internal forces called “essences.” People tend to believe that genes underlie a person’s identity. People encounter information about genetics on a regular basis, as through media such as a New York Times piece “Infidelity Lurks in Your Genes” or a 23andMe commercial showing people acquiring new ethnic identities as the result of their genotyping. How do people make sense of new (...) scientific findings that are inherently complex if they don’t have years of specialized training and education at their disposal? Given the substantial overlap between a lay understanding of genetics and lay intuitions about essences, we argue that, when most people are thinking about genes, they are not really thinking about genes in the complex ways that good scientists are. Combating people’s essentialist biases can be a formidable challenge. Although we have identified some promising results of trying to reduce people’s genetic essentialist tendencies, there is still much to learn about how these essentialist biases can be countered. It is important to help people understand genetic information so they are able make well‐informed decisions about their lives. (shrink)

According to the character condition, a person is morally responsible for an action A only if a character trait of hers non-accidentally motivates her performing A. But that condition is untenable according to the out of character objection because people can be morally responsible for acting out of character. We reassess this common objection. Of the seven accounts of acting out of character that we outline, only one is even a prima facie counterexample to the character condition. And it is (...) not obvious that people act out of character in that sense. We argue that whether the out of character objection succeeds ultimately depends on the unnoticed methodological commitment that cases that may not resemble human life provide good data for theorizing about moral responsibility. But even if such cases provide good data, the forcefulness of the objection is at least deflated given that its persuasive power is supposed to come from clear real-life cases. (shrink)

There is a difference between the private and social cost of preserving the past. While it may be privately rational to forget the past, the social cost is significant: we fail to see that Classical political economy is a polemic against racism. The past is a rich source of surprises and debates, and resources on the Web are uniquely suited to teaching such wide-ranging debates. Our ASecret History of the Dismal Science on the web, provides a rich series of windows (...) on the literary and analytical texts, and the artwork, that figured in the debates. Students who read Smith juxtaposed with Whitman, who read the Carlyle-Mill exchange, and who see these images, understand the debate the way a student who reads only the Wealth of Nations, Ricardo's Principles, or John Stuart Mill cannot. (shrink)

This chapter focuses on the role of temporal scarcity and language in reform. These are linked because language lies at the foundation of Smith’s account of a society in which the scarcity of time prevents us from being friends with more than a small number of people. When friendship-linked benevolence fails, we persuade and exchange. The scarcity of one’s life is, we argue, foundational for Smith. He brings this consideration to bear at the centre of his thoughts on reforming the (...) state when he argues that we have time to develop affection for our systems of thought but not for the people described by these systems. Smith’s account, in which habitual sympathy motivates, allows him to describe an affection for systems built in language. Affection gives motivational power to a system but it also presents a great danger. We may care about a system far more than the people described in the system. The central challenge for Smith is that of combining the motivational power of system without succumbing to the temptation to use a system to justify breaking our fellow humans. The exceptions he allows to his own system of natural liberal offer evidence that he did not exempt his own system of reform from the constraint of individual happiness. (shrink)

Essays consider Drucilla Cornell’s contributions to philosophy, political theory, and legal studies.

Stanovich & West (S&W) appear to overlook the adaptivity of variation. Behavioral variability, both between and within individuals, is an absolute necessity for phylogenetic and ontological adaptation. As with all heritable characteristics, inter-individual behavioral variation is the foundation for natural selection. Similarly, intra-individual variation allows a broad exploration of potential solutions. Variation increases the likelihood that more optimal behaviors are available for selection. Four examples of the adaptivity of variation are discussed: (a) Genetic variation as it pertains to behavior and (...) natural selection; (b) behavioral and cognitive aspects of mate selection which may facilitate genetic diversity; (c) variation as a strategy for optimizing learning through greater exploration; and (d) behavioral variation coupled with communication as a means to propagate individually discovered behavioral success. (shrink)

Catastrophic climate change overshadows the present and the future. Wrenching economic transformations have devastated workers and hollowed out communities. However, those fighting for jobs and those fighting for the planet have often been at odds. Does the world face two separate crises, environmental and economic? The promise of the Green New Deal is to tackle the threat of climate change through the empowerment of working people and the strengthening of democracy. In this view, the crisis of nature and the crisis (...) of work must be addressed together-or they will not be addressed at all. This book brings together leading experts to explore the possibilities of the Green New Deal, emphasizing the future of work. Together, they examine transformations that are already underway and put forth bold new proposals that can provide jobs while reducing carbon consumption-building a world that is sustainable both economically and ecologically. Contributors also debate urgent questions: What is the value of a federal jobs program, or even a jobs guarantee? How do we alleviate the miseries and precarity of work? In key economic sectors, including energy, transportation, housing, agriculture, and care work, what kind of work is needed today? How does the New Deal provide guidance in addressing these questions, and how can a Green New Deal revive democracy? Above all, this book shows, the Green New Deal offers hope for a better tomorrow-but only if it accounts for work's past transformations and shapes its future. (shrink)

_Essays consider Drucilla Cornell’s contributions to philosophy, political theory, and legal studies._.

This work provides a reflective assessment of recent developments, social relevance and future of environmental political theory, concluding that although the alleged pacification of environmentalism is more than skin deep, it is not yet quite deep enough. This book will appeal to students and researchers of social science and philosophers with an interest in environmental issues.

Black Panther presents an African cultural tapestry. The wide breadth of the African elements fit Black Panther well within Afrofuturism, a genre defined by its use and placement of people of African descent in the past, present, and future of society. Beyond these cultural elements, Black Panther 's Afrofuturism employs water imagery and spinal cord injury as potent symbols of disconnection and reconnection. Black Panther draws from a long tradition of Afrofuturist literature that is influenced by a desire to remedy (...) the injuries of the past and reconnect people of African descent with the continent from which they've been severed. Black Panther 's Afrofuturism reimagines antebellum slavery society's flight fantasy as a powerful science fiction, T'Challa's Royal Talon Flyer. The narratives of T'Challa, Shuri, and Wakanda have been continuously remolded and expanded upon since the 1960s by artists who have been inspired by other Afrofuturist works. (shrink)

We show that recurrence conditions do not yield invariant Borel probability measures in the descriptive set-theoretic milieu, in the strong sense that if a Borel action of a locally compact Polish group on a standard Borel space satisfies such a condition but does not have an orbit supporting an invariant Borel probability measure, then there is an invariant Borel set on which the action satisfies the condition but does not have an invariant Borel probability measure.

Abstractabstract:Being a parent is hard, particularly parenting adolescents, who need to be given choices and allowed the space to learn how to make choices for themselves, even when those choices result in negative consequences. This essay explores how Steven Sondheim and James Lapine's 1987 musical Into the Woods provides relatable stories of the challenges of being a parent, the challenges of parenting adolescents, and just how messy parents and families can be despite everyone trying their best. The stories of Little (...) Red Riding Hood, Rapunzel, Jack, and Cinderella show us various stages, trajectories, and occasional tragedies of adolescents' emerging autonomy, while the Baker's and the Witch's struggles becoming and being parents encapsulate how disorderly and untidy parenting often is. Pediatricians and clinical bioethicists, who are often in a position to scrutinize the choices of parents and teens, should remember that parents and adolescents are almost always motivated by good intentions and doing the best that they can. Perhaps the best we can do is accompany them on their journey "into the woods.". (shrink)

The Tuskegee Syphilis Experiment (TSE) has shaped African Americans’ views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton’s attempt to restore African Americans’ trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude by (...) noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies. (shrink)

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

The recent upsurge in “brain-training and perceptual-cognitive-training", proposing to improve isolated processes such as brain function, visual perception and decision-making, has created significant interest in elite sports practitioners, seeking to create an ‘edge’ for athletes. The claims of these related 'performance-enhancing industries' can be considered together as part of a process training approach proposing enhanced cognitive and perceptual skills and brain capacity, to support performance in everyday life activities, including sport. For example, the 'process-training industry' promotes the idea that playing (...) games not only makes you a better player, but also smarter, more alert, and a faster learner. In this position paper we critically evaluate the effectiveness of both types of process-training programmes in generalizing transfer to sport performance. These issues are addressed in three stages. First, we evaluate empirical evidence in support of perceptual-cognitive process training, and its application to enhancing sport performance. Second, we critically review putative modularised mechanisms underpinning this kind of training, addressing limitations and subsequent problems. Specifically, we consider merits of this highly specific form of training, which focuses on training of isolated processes such as cognitive processes (attention, memory, thinking) and visual perception processes, separately from performance behaviors and actions. We conclude that these approaches may, at best, may provide some 'general transfer' of underlying processes to specific sport environments, but lack 'specificity of transfer' to contextualize actual performance behaviors. A major weakness of process training methods is their focus on enhancing performance in body “modules” (e.g., eye, brain, memory, anticipatory sub-systems). What is lacking is evidence on how these isolated components are modified and subsequently interact with other process “modules”, which are considered to underlie sport performance. Finally, we propose how an ecological dynamics approach, aligned with an embodied framework of cognition undermines the rationale that modularised processes can enhance performance in competitive sport. An ecological dynamics perspective proposes that the body is a complex adaptive system, interacting with performance environments in a functionally integrated manner, emphasising that the inter-relation between motor processes, cognitive and perceptual functions and the constraints of a sport task is best understood at the performer-environment scale of analysis. (shrink)