In this case study, I address the procedural ethics of conversation analysis (CA) and the collection of naturally occurring mundane interactions. I draw from the challenges that emerged from the institutional ethics review of the HIV, health and interaction study (the H2I Study), a CA project that sought to identify the practices through which normative assumptions of HIV and other health conditions are produced in conversations. Consistent with CA’s preference for naturally occurring interactions, the H2I Study collected and analysed everyday (...) telephone calls involving people living with HIV. This article offers practical strategies CA researchers might use to navigate two ethical concerns raised about the collection of naturally occurring mundane interactions. The first questions the merits of collecting naturally occurring mundane interactions. For those unfamiliar with CA, the specific advantages of analysing naturally occurring mundane interactions may not be self-evident. This places an evidentiary burden on CA researchers to warrant the collection of this type of data. To address this concern, I suggest demonstrating in ethics applications the analytic value of CA using publicly available interactions. The second concern questions the use of verbal consent necessary for the collection of naturally occurring mundane interactions. Like most CA research, the H2I Study required flexible informed consent protocols appropriate for spontaneous and unpredictable interactions. Drawing from within and outside the CA literature, I offer three rationales for the use of verbal consent. This article is written as a practical resource for conversation analysts seeking approval from their research ethics board (REB) and for REBs who might be unfamiliar with CA research. This article contributes to a small but growing body of literature that documents not only the kinds of challenges CA researchers encounter from institutional ethics review, but the specific procedural ethics they may employ to secure ethics approval. (shrink)

The Heythrop Journal, Volume 63, Issue 3, Page 333-348, May 2022.

Despite a century of progress in medical knowledge, many diagnostic odysseys end in disappointment, especially when the child has a developmental disorder. In cases of autism and intellectual disability, relatively few children receive a specific diagnosis, and virtually none of those diagnoses lead to a specific medical treatment. Whole‐genome or ‐exome sequencing offers a quantum leap in the diagnostic odyssey, in that we will always learn something from sequencing—sometimes much more than families bargained for, as discussed elsewhere in this special (...) report. The trick is whether the knowledge gained will help the child and family. A family‐centered approach gives families permission to choose but does not lay all of the responsibility on them. The goal is to pursue the degree of medical diagnostic evaluation that matches the family's values. (shrink)

It has been proposed that inferring personal authorship for an event gives rise to intentional binding, a perceptual illusion in which one’s action and inferred effect seem closer in time than they otherwise would . Using a novel, naturalistic paradigm, we conducted two experiments to test this hypothesis and examine the relationship between binding and self-reported authorship. In both experiments, an important authorship indicator – consistency between one’s action and a subsequent event – was manipulated, and its effects on binding (...) and self-reported authorship were measured. Results showed that action-event consistency enhanced both binding and self-reported authorship, supporting the hypothesis that binding arises from an inference of authorship. At the same time, evidence for a dissociation emerged, with consistency having a more robust effect on self-reports than on binding. Taken together, these results suggest that binding and self-reports reveal different aspects of the sense of authorship. (shrink)

The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of (...) humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day. (shrink)

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured (...) by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions. (shrink)

Technology tends toward perpetual innovation. Technology, enabled by both political and economic structures, propels society forward in a kind of technological evolution. The moment a novel piece of technology is in place, immediately innovations are attempted in a process of unending betterment. Bernard Stiegler suggests that, contra Heidegger, it is not being-toward-death that shapes human perception of time, life, death, and meaning. Rather, it is technological innovation that shapes human perception of time, life, death, and meaning. In fact, for Stiegler, (...) human evolution has always been part of technological evolution. While one can quibble with the notion of human-technology co-evolution, there is something to be said for the way in which human perception of time, of ageing, and of death seems to be judged against the horizon of perpetual evolution of technological innovation. In this technological imaginary, of which modern medicine is constituent, ageing and death seemingly may be infinitely deferred, and it is this innovating deferral that shapes the contemporary social imaginary around ageing and death in modern medicine. Yet, the reality of living and dying always manifests itself differently than the scripts given to us by the technological imaginary with its myth of endless innovation. In fact, I shall argue that, where the Church created an ars moriendi, the technological imaginary gives us an ars ad mortem when it becomes clear that ageing and death cannot be infinitely deferred. And further, I shall argue that the Church must revivify its ars vivendi—that is to say, its liturgies, its arts, its technics—as a counter narrative to the myth of perpetual innovation that shapes the technological imaginary. (shrink)

This comment focuses on the informational distinction Brian Skyrms makes between rational choice theories of the social contract and theories based on evolutionary dynamics. The basic point is that to dismiss the rational choice method because of the restrictive informational assumptions may discount interesting work done in the area of bounded rationality. Further, the comment argues that combining the best elements of both approaches into an evolutionary theory of boundedly rational agents can improve the power of social contract theories. To (...) illustrate the point, we work through an example of analysing the data from a bargaining experiment. (shrink)

Beyond Consent examines the concept of justice, and its application to human subject research, through the different lenses of various research populations: children, the vulnerable sick, captive and convenient populations, women, people of colour, and subjects in international settings. Separate chapters address the evolution of research policies, implications of the concept of justice for the future of human subject research, and the ramifications of this concept throughout the research enterprise.

“The Zadeh Scenario,” when taken together with the subsequent layers of peer review and commentary on that peer review, highlights two crucial insights regarding peer review for clinical ethics. The first is one that most of Finder’s peer reviewers miss: peer-reviewers who would give attestation to quality need to be critically attentive to, and reflective about, the evidence supplied to them by candidates. The second is a more significant point: the kind of doing that is clinical ethics consultation is a (...) local form of moral enquiry, seeking not just to achieve medical – or clinical ethical – goals, but to enact human goods. Good peer review thus turns on being clear regarding the goods of ethics consultation. Buried inside “The Zadeh Scenario” one can find several goods of clinical ethics. These goods are subjective, idiosyncratically named and defined by patients, and embedded in an institution of healthcare that purports to be of service to the goods of health. The clinical ethics consultant, at her best, acts as a careful mid-wife, attempting to bring forth the goods desired, the goods possible, and perhaps even the goods that, while desired, are not possible. After all, some goods pursued by patients are not possible due to the limits of medicine. On the other hand, some goods pursued by medicine are not desired by patients. And equally, some goods pursued by clinical ethicists might be limited, provisional, and local. “The Zadeh Scenario” thus acts to problematize the goals of clinical ethics consultation, asking it to focus on the goods that the practice might bring forth. (shrink)

Christians are not immune to psychological and psychiatric illness. Yet, Christians should also be careful not to permit popular cultural trends to shape the way that they think about the use of psychiatric treatment with medication. In this essay, I suggest that the tendencies for default usage of psychiatric medication can be problematic for Christians in contemporary culture where a technological imaginary exists. Modern scientific studies of psychiatric medication are partly constructive of how we imagine ourselves. The typical justification for (...) the usage of technology in contemporary culture is the theme of cocreation with God, where Christians see any usage of technology as equivalent to our participating in God’s ongoing creative activity. I challenge these ideas in the foregoing paper, noting that the modern technological imaginary that animates modern psychiatry is as constricting as it is enabling. I conclude with a different take on what it might mean for Christians to be cocreators with God. (shrink)

Technology is evolving at a rate faster than human evolution, especially human moral evolution. There are those who claim that we must morally bioenhance the human due to existential threats (such as climate change and the looming possibility of cognitive enhancement) and due to the fact that the human animal has a weak moral will. To address these existential threats, we must design human morality into human beings technologically. By moral bioenhancement, these authors mean that we must intervene technologically in (...) the biology of the human animal in order to get it to behave morally to address these existential threats. I will bring the idea of moral bioenhancement into conversation with two philosophers of technology. Bernard Stiegler has argued that technology and culture, and thus technology and human beings, have always evolved hand in hand. Peter-Paul Verbeek notes that we have always designed morality into technology, and thus he sees technology as mediating human morality. When we offload human intentionality onto technology, Verbeek argues, technological objects and systems participate in shaping the moral subjectivity of the human actor. I will show that modern technological bioenhancement obliterates human being. Whereas in the past, human culture was handed from generation to generation through the mediation of technology, in the modern era, the human becomes the raw material upon which a technological will (imperative) rides. (shrink)

The essays in this issue of JMP are devoted to critical engagement of my book, The Anticipatory Corpse. The essays, for the most part, accept the main thrust of my critique of medicine. The main thrust of the criticism is whether the scope of the critique is too totalizing, and whether the proposed remedy is sufficient. I greatly appreciate these interventions because they allow me this occasion to respond and clarify, and to even further extend the argument of my book. (...) In this response essay, I maintain that the regnant social imaginary of medicine is the regnant social imaginary of our time. It is grounded in a specific ontotheology: where ontology is a power ontology; where material is malleable to the open-ended organization of power and dependent only on working out the efficient mechanisms of its enactment; where ethically it is oriented only to the immanent telos of utility maximization in the short run, and ultimately to some posthuman future in the long run. This ontotheology originates in the anticipatory corpse and is ordered toward some god-like posthuman being. The entire ontotheology finds enactment through the political economy of neoliberalism. This social imaginary constantly works to insulate itself from other social imaginaries through the use of its institutional power, through marginalization, circumscription, or absorption. The modern social imaginary of neoliberal societies marginalizes and politically isolates other social imaginaries, or transforms them into something acceptable to the neoliberal imaginary. Yet, these other social imaginaries could influence the larger social imaginary in novel ways, sometimes through withdrawal and sometimes through challenges. These other practices—again, usually practices ordered according to different ontological and teleological purposes—might serve as a source of renewal and transformation, but only if the practitioners of these other social imaginaries understand the ontotheological powers that they are up against. (shrink)

It is commonly held that Christian ethics generally and Christian bioethics particularly is the application of Christian moral systems to novel problems engaged by contemporary culture and created by contemporary technology. On this view, Christianity adds its moral vision to a technology, baptizing it for use. In this essay, I show that modern technology is a metaphysical moral worldview that enacts its own moral vision, shaping a moral imaginary, shaping our moral perception, creating moral subjects, and shaping what we imagine (...) as moral intentions. In fact, modern technics has its own liturgics, which is foreign to Christian Divine Liturgy. Divine Liturgy is world forming, showing us a different world than the one that comes into relief in the ersatz liturgy of modern medical technics. (shrink)

I, along with others, have been critical of the social construction of brain death and the various social factors that led to redefining death from cardiopulmonary failure to irreversible loss of brain functioning, or brain death. Yet this does not mean that brain death is not the best threshold to permit organ harvesting—or, as people today prefer to call it, organ procurement. Here I defend whole-brain death as a morally legitimate line that, once crossed, is grounds for families to give (...) permission for organ donation. I do so in five moves. First, I make the case that whole-brain death is a social construction that transformed one thing, coma dépassé, into another thing, brain death, as a result of social pressures. Second, I explore the way that the 1981 President’s Commission tried to establish the epistemological certainty of brain death, hoping to avoid making arcane metaphysical claims and yet still utilizing metaphysical claims about human beings. Third, I explore the moral meaning of the social construction of a definition that cannot offer metaphysical certainty about the point at which somebody becomes just some body. Fourth, I describe how two moral communities—Jewish and Catholic—actually ground their metaphysical positions with regard to brain death in the normativity of prior social relations. Finally, I conclude with a reflection on the aesthetic-moral enterprise of the metaphysical-epistemological apparatus of brain death, concluding that only such an aesthetic-moral approach is sufficiently strong to stave off the utility-maximizing tendencies of late-modern Western cultures. (shrink)

This chapter contains sections titled: Introduction Investing in Science: Child Health and U.S. Medicine in the Twentieth Century The Impact of Specific Medical Interventions The Changing Definition of ID The “Flynn Effect” and the Impact of Improved Public Health Conclusion References.

Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment.Returning the locus of capacity assessment to the attending, the primary care doctor, and (...) even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 13-15, August 2012.

Belief in free will is widespread. The present research considered one reason why people may believe that actions are freely chosen rather than determined: they attribute randomness in behavior to free will. Experiment 1 found that participants who were prompted to perform a random sequence of actions experienced their behavior as more freely chosen than those who were prompted to perform a deterministic sequence. Likewise, Experiment 2 found that, all else equal, the behavior of animated agents was perceived to be (...) more freely chosen if it consisted of a random sequence of actions than if it consisted of a deterministic sequence; this was true even when the degree of randomness in agents’ behavior was largely a product of their environments. Together, these findings suggest that randomness in behavior—one’s own or another’s—can be mistaken for free will. (shrink)

In this paper I explore the nature, varieties, causes and meanings of comebacks related to sport. I argue that comebacks have an axiological dimension, and that the best comebacks involve personal growth. I attempt to show that a major reason that comebacks connected to sport are often inspiring is that we are all in need of a comeback at some point in our lives. When improbable comebacks occur in the world of sport, they expand our sense of possibility.

The year 2013 may someday be seen as the year a new profession was born. Clinical ethics consultation has been practiced in different ways for roughly 30 years, originally initiated by a group of h...

Of Goals and Goods and Floundering About: A Dissensus Report on Clinical Ethics Consultation Content Type Journal Article Pages 275-291 DOI 10.1007/s10730-009-9101-1 Authors Jeffrey P. Bishop, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Mark J. Bliton, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, (...) Suite 400 Nashville Tennessee 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 3. (shrink)

E. Haavi Morreim's book, Holding Health Care Accountable , insightfully describes several features of the current crisis in malpractice in relation to the health care marketplace. In this essay, I delineate the key and eminently practical guide for reform that she lays out. I argue that her insights bring us to more fundamental aspects than immanent medical economy and accountability - aspects that are ignored at present. I describe the features of immanent economy and how they tend to cover over (...) epistemological and existential finitude in medicine, show how economy can in fact create new medical knowledge, and show that necessary error is a real feature of day-to-day medical practice. The current system, even with Morreim's reforms, remains at the level of immanent economy, but with modifications may point to the features of medicine that transcend medical knowledge and economy. The gifts of medicine cannot be reduced to the immanent medical economy, and any attempt to do so results in crisis. A health care that points to finitude and fallibility is one that points to the mystery of human existence and mortality. Any health care financing system that helps to delineate finitude - both epistemological and existential - is one that will give patients a new lease on living and dying. (shrink)

Tolerance is at the heart of Western liberalism, permitting mutually exclusive ideas and practices to coexist peacefully with one another, without the proponents of the differing ideas and practices killing one another. Yet, nothing challenges tolerance like the practice of sunna, female circumcision, clitorectomy, or genital mutilation. In this essay, I critique the Western critics of the practices, not in order to defend these practices, but rather to show that Western liberalism itself does not offer transcultural and transtemporal principles, for (...) these principles only cohere within the tradition of liberalism. The Western critique of sunna often maps onto the bodies of African women Western symbolic notions of sexual and political freedom, as symbolized in the clitoris. The practices of sunna cohere within the web of beliefs, the tradition, of those who practice them and, thus, are rationally justified within those traditions. I offer Alasdair MacIntyre's notion of moral inquiry as a guide through the complex world of cultural and moral dialogue between differing traditions. (shrink)

In this paper, a new method of quantitatively assessing continuity and discontinuity of visual attention is developed. The method is based on representing narrative information using graph theory. It is applicable to any type of narrative report. Since dream reports are often described as bizarre, and since bizarreness is partially characterized by discontinuities in plot, we chose to test our method on a set of dream data. Using specific criteria for identifying and arranging objects of visual attention, dream narratives from (...) 10 subjects were obtained and mapped onto graphs. The interrater reliabilities were 76% and 91% . Discontinuities in visual attention were quantified by plotting transitions from one part of a graph to another, which provided a spatiotemporal map of attention shifts within a narrative. This procedure was compared with other approaches to discontinuity and also applied to a set of 10 fantasy reports from the same subjects. The results showed that our method includes but transcends other approaches and has the capability to distinguish dream and fantasy reports. To our knowledge, the method provides the most rigorous and reliable measure to date of continuity and discontinuity of attention in narrative reports. (shrink)

A fourteen year old is diagnosed with aplastic anemia. The teen and his parents are Jehovah’s Witnesses. An ethics consult is called on the day of admission by an ethically sophisticated social worker and attending. The patient and his parents see this diagnosis as “a test of their faith.” The ethical analysis focuses on the mature minor doctrine, i.e. whether the teen has the capacity to make this decision. The hospital chooses to take the case to court, with a result (...) that is at odds with the ethics consultation recommendations. Ethics was never deposed or otherwise invited to be involved with the hearing. Thus the larger question of the relation of ethics and law was brought into stark relief. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

A reader confronting this collection of essays might wonder if something went awry in Jacksonville, Florida, in February 2014, when conference organizers gathered pediatric bioethicists and international child rights advocates to discuss the application of the U.N. Convention on the Rights of the Child to the work of clinical bioethics in the United States. Surely a document proclaiming a worldwide consensus on child rights would strengthen the hand of ethicists advising clinicians and researchers who face difficult decisions. Yet the conference (...) discussion—and resulting manuscripts—depict a deep divide: bioethicists largely rejected the notion that the CRC is a useful.. (shrink)

This chapter explores the relations of different kinds of power, philosophically understood – sovereign power, disciplinary power, and biopower – and argues that the politics of the Star Wars galaxy is animated by an ontology, or metaphysical picture, centered on power. It further argues that The Mandalorian criticizes this power ontology with the introduction of the Child, Grogu, who generates a different kind of Force: a relational ontology of love. Grogu and the love he generates point to a different way (...) of being in the world than power. Ultimately, The Mandalorian offers a different ontology of power – an ontology of love – as a radical alternative to the bindings of political power. Palpatine is correct that power dynamics shape the confrontational relationship between the Jedi and Sith, which is fed by the Jedi's disavowal of strong attachments. (shrink)

It is a common refrain in sports discourse that one should try one's hardest in sports, or some other variation on this theme. In this paper I argue that there is no generalized duty to try one's hardest in sports, and that the claim that one should do so is ambiguous. Although a number of factors point in the direction of my conclusion, particularly salient is the claim that, in the end, the putative requirement is too stringent for creatures like (...) human beings. The putative duty to try one's hardest in sports does not comport with psychological realism. That being said, there are contexts in which it is reasonable to expect athletes to try hard. Perhaps there is even a duty to put forth such effort. Even so, this obligation does not rise to the level of a generalized duty to try one's hardest in sports. (shrink)

Those supporting laws permitting assisted suicide seem to enact a thin morality, one that permits people who desire AS to get it in the terminal stages of an illness, and that provide safeguards both for those who desire AS and do not desire it. This article explores the way in which all AS legislation subtly frames the question of AS such that AS becomes the clearest option; ensconcing AS in law also gives a moral legitimacy to suicide. Thus, the morality (...) of laws permitting AS are not morally thin. I describe how AS laws create a different social imaginary for dying in Western cultures, one that competes with the traditional Christian understanding. Legalized AS is inevitable in Western liberal democracies, and I claim that the Church, which transformed the ancient Greco-Roman culture, will once again have to create alternative structures, creating a new Ars moriendi, in order to challenge the modern statecraft for killing. (shrink)

Transhumanism traces its roots to Enlightenment humanism and claims to be the harbinger of the next phase of humanistic activity through designer evolution. In this essay, I briefly trace medicine’s relationship with transhumanist philosophy to the philosophy of medicine and show that each accepts a kind of ambiguity of the body at the heart of its metaphysical assumptions. I show that these metaphysical assumptions are committed to a power ontology, and that this power ontology is fundamentally at odds with the (...) traditional Christian lifeworld. (shrink)

After years of skepticism and denials regarding the significance of concussions in sport, the issue is now front and center. This is fitting, given that the impact of concussions in sport is profound. Thus, it is with trepidation that one ventures to direct some attention onto brain injuries other than concussions incurred through sport. Given a closer look, however, it may be that considering various kinds of brain injuries, with different causes, will help us better understand the range and seriousness (...) of brain injuries in sport. My focus is on emotional trauma in sport. I argue that severe emotional pathology is evidence of underlying brain injury. Any attempt to minimize the significance of emotional disturbance that results from emotional trauma as ‘merely’ psychological in nature is thus misguided. (shrink)

This paper explores three phenomena in sport that are connected to narratives of hope: underdogs, upsets, and overachievers. Each of these phenomena is complex. I seek not only to understand the intrinsic nature of these phenomena, but also to explain why they captivate the imagination. After exploring some partial explanations of their enduring appeal, I focus on how the drama associated with underdogs, upsets, and overachievers in sport illuminates the human condition and awakens our sense of possibility when the odds (...) are against us. (shrink)

Research aimed at developing and validating an instrument to assess secondary school students? perceptions of assessment tasks was conducted. Following a review of literature, a five?scale instrument of 40 items was trialled with a sample of 658 science students in 11 English secondary schools. Based on internal consistency reliability data and exploratory factor analysis, refinement decisions resulted in a five?scale instrument called the Perceptions of assessment tasks inventory (PATI). The scales of the PATI are Congruence with planned learning, Authenticity, Student (...) consultation, Transparency and Diversity. (shrink)