The handbook contains more than 50 chapters by leaders from around the world and a broad range of sectors of academia and clinical practice spanning the ...

A landmark in the scientific literature, the Oxford Handbook of Neuroethics presents a pioneering review of a topic central to the biosciences. It breaks new ground in bringing together leading neuroscientists, philosophers, and lawyers to tackle some of the most significant ethical issues that face us now and will continue to do so.

The new field of neuroethics has recently emerged following unprecedented developments in the neurosciences. Neuroimaging and cognitive enhancement in particular are demanding ethical debate. For example, neuroscientists are able to measure, with increasing accuracy, intimate personal biases and thoughts as they occur in the brain. Smart drugs are now available that can effectively and safely enhance mental functioning in both healthy and clinical populations. This article describes the scientific principles behind these technologies, and urges the development of ethical principles based (...) on a clear understanding of them. Europe should take the United States’ lead in devoting resources specifically intended to examine neuroethical concerns within European healthcare and legal frameworks. (shrink)

Cognitive‐enhancing drugs are prescribed to patients with psychiatric disorders, such as attention deficit hyperactivity disorder (ADHD) and Alzheimer's disease, to treat cognitive deficits. This chapter discusses the use of pharmacological agents to improve the cognition of both those with cognitive impairments and of the general population, as well as some of the benefits, risks, and ethical issues associated with the use of cognitive‐enhancing drugs. The chapter also talks about a survey run by the journal Nature, which was prompted by a (...) commentary by the authors of this chapter, that asked readers for their views on the issues surrounding cognitive enhancement. It can be seen that the ethical issues surrounding the use of cognitive‐enhancing drugs are complex and require discussion among different groups. With the development of new drugs and methods of enhancing cognition, such as brain stimulation, the need for further research and discussion is likely to become more pressing. (shrink)

How do our brains make choices? How do factors such as Alzheimer's or depression impair decision-making? Presenting the latest research on 'hot' and 'cold' decision-making, Barbara Sahakian and Jamie Nicole LaBuzetta look at the therapeutic smart drugs now available, and raise concerns about their unregulated use to enhance mental performance.

Several previous studies have reported atypicality in resting-state functional connectivity in autism spectrum disorder, yet the relatively small effect sizes prevent us from using these characteristics for diagnostic purposes. Here, canonical correlation analysis and hierarchical clustering were used to partition the high-functioning ASD group into subgroups. A support vector machine model was trained through the 10-fold strategy to predict Autism Diagnostic Observation Schedule scores within the ASD discovery group, which was further validated in an independent sample. The neuroimage-based partition derived (...) two subgroups representing severe versus mild autistic patients. We identified FCs that show graded changes in strength from ASD-severe, through ASD-mild, to controls, while the same pattern cannot be observed in partitions based on ADOS score. We also identified FCs that are specific for ASD-mild, similar to a partition based on ADOS score. The current study provided multiple pieces of evidence with replication to show that resting-state functional magnetic resonance imaging FCs could serve as neural biomarkers in partitioning high-functioning autistic individuals based on their symptom severity and showing advantages over traditional partition based on ADOS score. Our results also indicate a compensatory role for a frontocortical network in patients with mild ASD, indicating potential targets for future clinical treatments. (shrink)

A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for (...) the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals. (shrink)

In June 2015, the Supreme Court of Canada struck down the Criminal Code's prohibition on assisted death. Just over a year later, the federal government crafted legislation to entrench medical assistance in dying (MAiD), the term used in Canada in place of physician‐assisted death. Notably, Canada became the first country to allow nurse practitioners to act as assessors and providers, a result of a strong lobby by the Canadian Nurses Association. However, a legislated approach to assisted death has proven challenging (...) in a number of areas. Although it facilitates a degree of accountability, precision and accessibility, it has also resulted in particular challenges negotiating the diverse perspectives of such a morally contentious act. One of these challenges is the tendency to conflate what is legal and what is moral in a modern liberal constitutionalism that places supreme value on autonomy and choice. Such a conflation tends to render invisible the legal and moral/ethical considerations necessary for nurses and nurse practitioners to remain ethical actors. In this paper, we introduce this conflation and then discuss the process of lawmaking in Canada, including the legalization of MAiD and the contributions of nursing to that legalization. We then engage in a hypothetical dialogue about the legal and moral/ethical implications of MAiD for nursing in Canada. We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses’ moral well‐being. (shrink)

The astonishing efficiency and accuracy of DNA replication has long suggested that refined rules enforce a single highly reproducible sequence of molecular events during the process. This view was solidified by early demonstrations that DNA unwinding and synthesis are coupled within a stable molecular factory, known as the replisome, which consists of conserved components that each play unique and complementary roles. However, recent single-molecule observations of replisome dynamics have begun to challenge this view, revealing that replication may not be defined (...) by a uniform sequence of events. Instead, multiple exchange pathways, pauses, and DNA loop types appear to dominate replisome function. These observations suggest we must rethink our fundamental assumptions and acknowledge that each replication cycle may involve sampling of alternative, sometimes parallel, pathways. Here, we review our current mechanistic understanding of DNA replication while highlighting findings that exemplify multi-pathway aspects of replisome function and considering the broader implications. Recent single-molecule studies have revealed that replisome function is dominated by stochastic sampling of multiple molecular pathways. In the context of these new findings, we re-examine the foundational assumptions and seminal experiments that have guided our understanding of replication mechanism and reconcile several long-debated coordination models. (shrink)

This paper has two purposes: To report the findings of a study of ethnic differences in cognition in a rural West Sumatran area; and to demonstrate the importance of ethnicity—in at least some contexts—for tailoring agricultural research to farmers' needs. A cognitive mapping technique, called a Galileo, was used to measure people's views of soil and its relation to people among three Indonesian ethnic groups living in the same area. Findings from participant observation and from collaborative agricultural fieldwork with farmers (...) of all three ethnic groups are used to evaluate and interpret the Galileo results. (shrink)

Reasoning requires making inferences based on information gleaned from a set of relations. The relational complexity of a problem increases with the number of relations that must be considered simultaneously to make a correct inference. Previous work (Viskontas, Morrison, Holyoak, Hummel, & Knowlton, 2004) has shown that older adults have difficulty integrating multiple relations during analogical reasoning, especially when required to inhibit irrelevant information. We report two experiments that examined the ability to integrate multiple relations in younger, middle-aged, and older (...) adults performing two other reasoning tasks. These tasks systematically varied relational complexity, and required either inductive reasoning (a version of the Raven's Matrices Task) or transitive inference. Our results show that as people age they have increasing difficulty in solving problems that require them to integrate multiple relations. This difficulty may stem from a decrease in working memory capacity. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

We present a theoretical and an empirical challenge to Cushman's claim that rationalization is adaptive because it allows humans to extract more accurate beliefs from our non-rational motivations for behavior. Rationalization sometimes generates more adaptive decisions by making our beliefs about the world less accurate. We suggest that the most important adaptive advantage of rationalization is instead that it increases our predictability as potential partners in cooperative social interactions.

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast (...) clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

For a biological anthropologist interested in the prehistory of religion, J. Wentzel van Huyssteen's book is welcome and resonant. Van Huyssteen's central thesis is that humans' capacity for spirituality emerges from a transformation of cognition and emotions that takes place in the symbolic realm, within Homo sapiens and apart from biology. To his thesis I bring to bear three areas of response: the abundant cognitive and emotional capacities of living apes and extinct hominids; the role of symbolic ritual in the (...) evolutionary history of Homo sapiens; and the closely intertwined nature of biology and culture in the workings of evolutionary change. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

The notion of societal boundaries aims to enhance the debate on planetary boundaries. The focus is on capitalist societies as a heuristic for discussing the expansionary dynamics, power relations, and lock-ins of modern societies that impel highly unsustainable societal relations with nature. While formulating societal boundaries implies a controversial process – based on normative judgments, ethical concerns, and socio-political struggles – it has the potential to offer guidelines for a just, social-ecological transformation.

The planetary boundaries concept has profoundly changed the vocabulary and representation of global environmental issues. The article starts by highlighting the strengths and weaknesses of planetary boundaries from a social science perspective. It is argued that the growth imperative of capitalist economies, as well as other particular characteristics detailed below, are the main drivers of the ecological crisis and exacerbated trends already underway. Further, the planetary boundaries framework can support interpretations that do not solely emphasize technocratic operational approaches and costs, (...) but also assume that these alone can be the solution. (shrink)

Pharmacological substances used to improve cognition and brain function range from dietary supplements and caffeine to drugs targeted at altering particular neurochemical concentrations in the brain. This article considers current scientific research into pharmaceutical cognitive enhancement and likely future directions. Then it discusses the trends in the use of PCEs within patients groups for whom they were intended, as well as in those for whom they were not originally intended, including healthy adults and children. Finally, it provides an overview of (...) current and future ethical considerations and concludes that the use of PCE will likely continue both within patient and healthy individuals in the foreseeable future. Information regarding actual use, benefits, and harms in various populations is severely lacking. Therefore, more emphasis should be placed on obtaining the relevant empirical data, for example, by the long-term monitoring of effectiveness and side effects, and by accurate large-scale surveys to assess actual usage. (shrink)

Empirical studies show that though there is more room for improvement, much progress has been made toward gender equality since the second wave of feminism. Evidence also suggests that women’s advancements have been more dramatic in the public sphere of work and politics than in the private sphere of family life. We argue that this lopsided gender progress may be traced to uneven changes in gender attitudes. Using data from more than 27,000 respondents who participated in the General Social Survey (...) from 1977 through 2016, we show that gender attitudes have more than one underlying dimension and that these dimensions have changed at different rates over time. Using latent class analysis, we find that the distribution of respondents’ attitudes toward gender equality has changed over the past 40 years. There has been an increase in the number of egalitarians who support equality in public and private spheres, while the traditionals who historically opposed equality in both domains have been replaced by ambivalents who feel differently about gender equality in the public and private spheres. Meanwhile, successive birth cohorts are becoming more egalitarian, with Generation-Xers and Millennials being the most likely to hold strong egalitarian views. The feminist revolution has succeeded in promoting egalitarian views and decreasing the influence of gender traditionalism, but has yet to convince a substantial minority that gender equality should extend to both public and private spheres of social life. (shrink)