Out of 288 Hong Kong cancer patients, 92.3% include themselves in decision-making, 71% prefer joint decision-making: with family, with doctor, with doctor plus family, with family minus doctor, and with doctor minus family. <5% want decision-making by “doctor-alone” and <1% desire decision-making by “family-alone”. Harmony, communication and responsibility are reasons for family participation. Most patients prefer “specialist” for information, followed by “family”, “friends”, and “GP”. Trust in doctors and prospects for controlling/curing disease are important factors in decision-making. Patients want to (...) participate and be listened to rather than make decisions. Doctors should not disclose information to family without patients’ permission, nor withhold information from patient [End Page 109] on family’s request. Only 25% of patients have discussed post-competent treatment with others and 7% have heard of Advance Directive ; 24% refuse to discuss it. After AD has been explained to them, 66% remain reluctant to sign one, preferring to leave oral instructions or appoint family as proxy decision-makers. The family’s decision-making role increases when patients become incompetent. The top reason for signing AD is to receive preferred post-competent treatments, and for not signing it, difficulty with making a prospective decision. The implications of these findings will be discussed. (shrink)

Graphical AbstractScience and technology consortia provide a viable solution for the recent unsustainable academic growth in biomedical research.

Coregulation refers to the process by which relationship partners form a dyadic emotional system involving an oscillating pattern of affective arousal and dampening that dynamically maintains an optimal emotional state. Coregulation may represent an important form of interpersonal emotion regulation, but confusion exists in the literature due to a lack of precision in the usage of the term. We propose an operational definition for coregulation as a bidirectional linkage of oscillating emotional channels between partners, which contributes to emotional stability for (...) both partners. We propose several distinctions and raise unanswered questions that will need to be addressed in order to understand the relevance of coregulation for well-being in adulthood. (shrink)

The lack of consensus in American society regarding the permissibility of assisted suicide and euthanasia is due in large part to a failure to address the nature of the human person involved in the ethical act itself. For Karol Wojtyla, philosopher and Pope, ethical action finds meaning only in an authentic understanding of the person; but it is through acting ( actus humanus ) alone that the human person reveals himself. Knowing what the person ought to be cannot be divorced (...) from what he ought to do; forWojtyla, the structure of the ethical “do” – the act itself – comes first. The current paper will focus on four arguments used to justify assisted suicide and euthanasia: (1) the argument from autonomy, (2) the argument from compassion, (3) the argument from the evil of suffering, and (4) the argument from the loss of dignity. It will seek to answer each claim from the perspective of Karol Wojtyla's philosophical anthropology. Much of this will come from his defining work in pure philosophy, The Acting Person (1969). The final part of the paper will suggest some positive solutions to the stalemate over the euthanasia debate, again drawn from Wojtyla's idea of human fulfillment through participation with the other, and with the community itself. (shrink)

As the issue of assisted dying continues toward more expanded legal standing, we shift our primary focus from questions of patients' rights to the largely overlooked challenges that face physicians who elect to assist patients in ending their lives. Dr. Howard Grossman, a Manhattan internist and plaintiff in the unsuccessful New York lawsuit to the Supreme Court, came forward to say, “Anybody who has done it knows that it is a tremendous decision that you carry with you forever.”1 We focus (...) our attention on the psychological experience and philosophical conflicts faced by physicians engaged in physician-assisted dying. Based on those potential conflicts, we argue for a new model of the physician and patient relationship in assisted dying: a medical friendship. a. (shrink)

Philosophical theories of agency have focused primarily on actions and activities. But, besides acting, we often omit to do or refrain from doing certain things. How is this aspect of our agency to be conceived? This book offers a comprehensive account of omitting and refraining, addressing issues ranging from the nature of agency and moral responsibility to the metaphysics of absences and causation. Topics addressed include the role of intention in intentional omission, the connection between negligence and omission, the distinction (...) between doing and allowing, and the distinction in law between act and omission. (shrink)

Physicians, nurses, and healthcare professional students openly participated in the medical atrocities of the Shoah. In this paper, a physician-bioethicist and nurse-bioethicist examine the role of hierarchical power imbalances in medical education, which often occur because trainees are instructed ‘to do so’ by their superiors during medical education and clinical care. We will first examine the nature of medical and nursing education under National Socialism: were there cultural, educational, moral and legal pressures which entrenched professional hierarchies and thereby commanded obedience (...) in the face of an ever-diminishing individual and collective conscience? We will then outline relevant parallel features in modern medical education, including the effects of hierarchy in shaping ethical decision making and conscience formation. We then propose several solutions for the prevention of the negative effects of hierarchical power imbalances in medical education: universal Holocaust education in medical and nursing schools; formative and experiential ethics instruction, which teaches students to ‘speak up’ when ethical issues arise; acceptance of, and adherence to, a personalistic philosophical anthropology in healthcare; support for rigorous conscience protection laws for minority ethical views that respect the role of integrity without compromising patient care. (shrink)

In referendum elections, voters are often required to register simultaneous votes on multiple proposals. The separability problem occurs when a voter’s preferred outcome on one proposal depends on the outcomes of other proposals. This type of interdependence can lead to unsatisfactory or even paradoxical election outcomes, such as a winning outcome that is the last choice of every voter. Here we propose an iterative voting scheme that allows voters to revise their voting strategies based on the outcomes of previous iterations. (...) Using a robust computer simulation, we investigate the potential of this approach to solve the separability problem. (shrink)

People in an emotional exchange form a temporal interpersonal emotion system (TIES), in which their emotions are interconnected over time (Butler, 2011). These systems can be in various states, defined by the pattern of emotional interconnections. We have defined coregulation as one such state involving coupled dampened oscillations between partners’ emotions that converge on a stable level. Coregulation could be distinguished from other states, such as stress buffering, by comparing statistical models that represent the theoretical distinctions between states. Optimal data (...) for such modeling includes assessments of both partners’ emotions over time and a contrast between securely attached partners, strangers, and being alone. Research of this sort is needed to uncover the mechanisms by which emotional interdependence promotes well-being. (shrink)

When firm misconduct comes to light, CEOs are often faced with difficult decisions regarding whether and how to respond to stakeholder demands as they attempt to restore their firms’ legitimacy. Prior research largely assumes that such decisions are motivated by CEOs’ calculated attempts to manage stakeholder impressions. Yet, there are likely other motives, particularly those of a morally-relevant nature, that might also be influencing CEOs’ decisions. To address this limitation, we advance moral cleansing as an alternative explanation for how and (...) why CEOs lead their firms to respond to stakeholder demands following the firm’s misconduct and, in turn, whether they can successfully restore their firm’s legitimacy. In the context of firm misconduct, moral cleansing motives reflect CEOs’ desire to restore their threatened moral self-image resulting from the misconduct. We theorize that a CEO’s moral cleansing motives increase the likelihood that their firm will engage in a series of reparative responses that can restore the firm’s legitimacy (i.e., discovery, explanation, penance, and rehabilitation). In addition, we explicate the unique implications of CEOs’ moral cleansing in a post-misconduct context by theorizing how such motives may simultaneously improve one form of their firms’ legitimacy while hindering another. Specifically, we theorize that CEOs’ moral cleansing motives increase (decreases) the authenticity (strategic cognition) of their firm responses, which strengthens (weakens) the effectiveness of those responses on the firms’ ability to restore its moral (pragmatic) legitimacy with stakeholders. We conclude with a discussion of the implications of this work. (shrink)

The meta-problem of consciousness (Chalmers, 2018) is the problem of explaining the behaviours and verbal reports that we associate with the so-called 'hard problem of consciousness'. These may include reports of puzzlement, of the attractiveness of dualism, of explanatory gaps, and the like. We present and defend a solution to the meta-problem. Our solution takes as its starting point the emerging picture of the brain as a hierarchical inference engine. We show why such a device, operating under familiar forms of (...) adaptive pressure, may come to represent some of its mid-level inferences as especially certain. These mid-level states confidently re-code raw sensory stimulation in ways that (they are able to realize) fall short of fully determining how properties and states of affairs are arranged in the distal world. This drives a wedge between experience and the world. Advanced agents then represent these mid-level inferences as irreducibly special, becoming increasingly puzzled as a result. (shrink)

The debate over euthanasia and physician-assisted suicide continues to ignore the philosophical anthropology on which certain critical claims rest. In this paper, I offer several anthropologically based arguments against one prominent justification for EPAS: the Argument from the Evil of Suffering. I demonstrate that the argument is, at its core, a utilitarian one, and that a sound rebuttal can be found by examining Karol Wojtyla/Pope John Paul II's view of suffering as a transformative experience for the human person. Wojtyla both (...) rejects the secular bioethics vision of meaningless, quantifiable suffering, but also offers to take Christian bioethics far beyond the story of Job and into the realm of phenomenological change. By focusing on participation of the suffering sick in community with others, and rejecting alienation, Christians can arrive at a more complete conception of suffering that embraces the complementarities of philosophy and theology. (shrink)

Forming intimate relationships is a fundamental human motive. Emotions play a critical role in intimate relationships—they are central to the development and maintenance of these bonds, and these very bonds can influence both individual and interpersonal emotional dynamics across time. Investigating emotional dynamics in an interpersonal context provides unique insight into the functioning of intimate relationships and, at the same time, provides a window into the interdependence of partners’ daily experiences. Reviewing a selection of the literature involving emotional dynamics in (...) intimate relationships, we explore how intimate relationships shape partner’s emotional experiences and the implications this may have for their relationship across time. (shrink)

What is it to be morally responsible for something? Recent philosophical work reveals considerable disagreement on the question. Indeed, some theorists claim to distinguish several varieties of moral responsibility, with different conditions that must be satisfied if one is to bear responsibility of one or another of these kinds. -/- Debate on this point turns partly on disagreement about the kinds of responses made appropriate when one is blameworthy or praiseworthy. It is generally agreed that these include "reactive attitudes" such (...) as resentment and gratitude, but theorists disagree about the nature of these attitudes. They dispute the connections between moral responsibility, desert, and the justification of punishment as well. -/- Many theorists take it that, whatever the appropriate responses are, they are responses to an agent's "quality of will," but there is no consensus on what this comes to. Are the agent's beliefs about the moral status of her behavior what matter, or is it what she cares about, or what she judges important? -/- This volume presents twelve original essays from participants in these debates. The contributors include prominent established figures as well as influential younger philosophers. A substantive introduction by the editors surveys recent debates and situates the contributions within it. (shrink)

Dominant food systems, based on industrial methods and corporate control, are in a state of flux. To enable the transition towards more sustainable and just food systems, food movements are claiming new roles in governance. These movements, and the initiatives they spearhead, are associated with a range of labels (e.g., food sovereignty, food justice, and community food security) and use a variety of strategies to enact change. In this paper, we use the concept of relational fields to conduct a post-hoc (...) analysis of nine cases, examining how social movement organizations and other actors actively create new deliberative governance spaces. We argue that successes are related to the “power to convene,” a process-oriented approach that increases movements’ capacity to mobilize; leverage different types of power; and integrate, coordinate, and build a systems-oriented vision. The power to convene and create deliberative spaces is demonstrated in a variety of contexts and often results in outcomes that further movement aims, including policy change and repositioning food movement actors vis-à-vis others in the field. Our findings suggest that success is not only measured as policy outcomes, but as an advantageous repositioning of social movement actors that enables them to be part of governance processes beyond simple policy advocacy. (shrink)

Volume 20, Issue 10, October 2020, Page 63-65.

In Empirical Realism David K. Clark asks, simply: is there a moral structure to the universe?

As demand for locally grown food increases there have been calls to ‘scale-up’ local food production to regionally distribute food and to sell into more mainstream grocery and retail venues where consumers are already shopping. Growing research and practice focusing on how to improve, expand and conceptualize regional distribution systems includes strategies such as value chain development using the Agriculture of the Middle framework. When the Ohio Food Policy Advisory Council asked how they could scale-up the distribution of Ohio fresh (...) fruits and vegetables to Ohioans, we decided to use this practical opportunity to not only provide recommendations to this council, but to simultaneously contribute to the literature on AOTM, value-based and spatially–proximate relationships, and conceptualizations of food system hybridity. We do this while examining an entire sub-sector of the Ohio agricultural economy, namely fruit and vegetables and applying the AOTM framework beyond the farm, namely to distributors and retailers. Through interviews with Ohio retailers and a survey of all fresh fruit and vegetable distributors Ohio we: Describe current distribution systems within the state; Identify firms interested in scaling-up distribution, and; Inform state-level policy efforts by identifying opportunities to better target any state-level policy and program efforts. We demonstrate support for the concept of AOTM applied beyond the farm, for value chain development strategies that can transmit ‘quality’ via spatially proximate supply chains, and support for considering hybrid solutions, such as piggybacking for scaling-up local food systems. This work highlights the role a statewide food policy council can have in facilitating market development and their unique position to provide public sector and institutional support to facilitate meaningful connections in the food system. (shrink)

The author narrates briefly the friendship that developed from his instruction of James Dean in the art of photography and documents the Dean personality with exclusive portraits.

Bioethicists in healthcare institutions have the skills and insights and can and must facilitate and promote measures that address deeply ingrained structural issues that exacerbate health inequity...