Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

We propose another positive illusion that fits with McKay & Dennett's (M&D's) criteria for adaptive misbeliefs. This illusion is pervasive in adult reasoning but we focus on its prevalence in children's developing theories. It is a strongly held conviction arising from normal functioning of the doxastic system that confers adaptive advantage on the individual.

hope of obtaining a comprehensive and coherent understand ing of the human condition, we must somehow weave together the biological, sociological, and psychological components of human nature and experience. And this cannot be done indeed, it is difficult to even make sense of an attempt to do it-without first settling our accounts with Darwin, Marx, and Freud. The legacy of these three thinkers continues to haunt us in other ways as well. Whatever their substantive philosophical differences in other respects, Darwin, (...) Marx, and Freud shared a common, overriding intellectual orientation: they taught us to see human things in historical, developmental terms. Phil osophically, questions of being were displaced in their works by questions of becoming. Methodologically, genesis replaced teleological and essentialist considerations in the explanatory logic of their theories. Darwin, Marx, and Freud were, above all, theorists of conflict, dynamism, and change. They em phasized the fragility of order, and their abiding concern was always to discover and to explicate the myriad ways in which order grows out of disorder. For these reasons their theories constantly confront and challenge the cardinal tenet of our modern secular faith: the notion of progress. To be sure, their emphasis on conflict and the flux of change within the flow of time was not unprecedented; its origins in Western thought can be traced back at least as far as Heraclitus. (shrink)

The genome is a stable repository of vastly intricate genetic information developed over eons of evolution; this information is replicated at the highest fidelity and expressed within each cell at the highest selectivity. Non‐leukemia cancers break this standard; the intricate genetic information qualitatively and progressively deteriorates, resulting in a somatic Darwinian free‐for‐all. In a process lasting several years, a genomically heterogeneous population replicates from a single cell that originally lost the ability to preserve its genomic integrity. Cells selected for their (...) abilities to proliferate and spread, while evading host defenses, inexorably expand their numbers. The clinical consequences of this become severe, as the genomically diverse cell population that evolves contains members that can evade most therapeutic approaches aimed at “the tumor cell”. BioEssays 23:1037–1046, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

The clinical ethicist met with Ms. H to clarify what information she wants and does not want to know. First, she wants to receive any treatment that could prolong her life, regardless of how the treatment affects her ability to engage in activities of daily living. Second, she wants to be included in the decision‐making process as much as possible, as long as clinicians use only “positive” language. Ms. H considers the words “dying,” “chemotherapy,” “radiation,” and “cancer” to be “bad (...) words.” For conversations in which these words cannot be avoided, she wants her clinicians to talk to her son. Her desired engagement includes hearing about risks, benefits, and alternatives to treatments if clinicians use only “positive” language. Finally, she says that she rarely sees doctors and that she is “very scared” of hospitals, despite exhibiting a comfortable demeanor.Should clinicians honor Ms. H's waiver of specified information and, if so, to what degree? (shrink)

We describe the ethics consultation service (ECS) at the Cleveland Clinic and report on its activities over a 24-month period in which 478 consultations were performed. To our knowledge, this is the largest case series of ethics consultations reported to date. Established more than 25 years ago, the ECS at the Cleveland Clinic is staffed by multiple consultants with advanced training in bioethics. Several of these ethicists work closely with specialized clinical units and research departments, where they participate in multidisciplinary (...) meetings and provide specialized assistance. This combination of historical experience, large numbers of consultation requests, and specialized clinical ethicists suggests that the experience at the Cleveland Clinic may be helpful to ethicists and others who may be considering how to structure and sustain a vibrant ECS. Our results highlight the diversity of activities performed by a high-volume ECS at a tertiary care facility. Our hope in sharing the inner workings of the ECS at the Cleveland Clinic is to promote dialogue on common practices and approaches across medical institutions that support ethics consultation. (shrink)

Quantum theory offers mathematical descriptions of measurable phenomena with great facility and accuracy, but it provides absolutely no understanding of why any particular quantum outcome is observed. It is the province of genuine explanations to tell us how things actually work—that is, why such descriptions hold and why such predictions are true. Quantum theory is long on the what, both mathematically and observationally, but almost completely silent on the how and the why. What is even more interesting is that, in (...) some sense, this state of affairs seems to be a necessary consequence of the empirical adequacy of quantum descriptions. One of the most noteworthy achievements of quantum theory is the accurate prediction of phenomena that, on pain of experimental contradiction, have no physical explanation. It is the purpose of this essay to make clear why quantum mechanics and quantum field theory are complete physical descriptions that describe the metaphysical incompleteness of the physical world, then to press the negative implications of this fact for naturalistic metaphysics. (shrink)

The current paper synthesizes theory and data from the field of life history (LH) evolution to advance a new developmental theory of variation in human LH strategies. The theory posits that clusters of correlated LH traits (e.g., timing of puberty, age at sexual debut and first birth, parental investment strategies) lie on a slow-to-fast continuum; that harshness (externally caused levels of morbidity-mortality) and unpredictability (spatial-temporal variation in harshness) are the most fundamental environmental influences on the evolution and development of LH (...) strategies; and that these influences depend on population densities and related levels of intraspecific competition and resource scarcity, on age schedules of mortality, on the sensitivity of morbidity-mortality to the organism’s resource-allocation decisions, and on the extent to which environmental fluctuations affect individuals versus populations over short versus long timescales. These interrelated factors operate at evolutionary and developmental levels and should be distinguished because they exert distinctive effects on LH traits and are hierarchically operative in terms of primacy of influence. Although converging lines of evidence support core assumptions of the theory, many questions remain unanswered. This review demonstrates the value of applying a multilevel evolutionary-developmental approach to the analysis of a central feature of human phenotypic variation: LH strategy. (shrink)

What is the nature of the decision-related personal values of corporate management? Managers' attitudes and behaviors are built upon their personal value systems (PVS). Knowledge about the structure of management's PVS assists in understanding the attributes of corporate decision making. Utilizing a survey instrument developed and used by England (1967, 1975), this article updates this research into corporate managers' personal value systems. England's PVS consists of sixty-six pre-tested values clustered into five groups. As one could expect with personal values, statistical (...) tests reveal that even with dramatic changes in the business environment the overall personal values structure has not changed over the intervening three decades. The results also reveal that corporate managers retain their pragmatic value orientation as discussed by England. (shrink)

Atherosclerosis is the major cause of death in the industrialised world. Though much work on the pathogenesis of atherosclerosis points to 'oxidised' low density lipoprotein (LDL) as a key aetiological feature in the generation of the atherosclerotic plaque, the nature of this 'oxidised' LDL in vivo remains an enigma. We argue here that glycated LDL shows many of the characteristics attributed to 'oxidised LDL' and may be the source of the latter in vivo. These include the increased uptake and impaired (...) degradation of glycated LDL by macrophages and the stimulation of transendothelial chemotaxis of monocytes, cytokine secretion and platelet aggregation. We hypothesise that the covalent binding of glycated LDL to the endothelial cell wall may result in the formation of the early atherosclerotic lesion of the fatty streak and that apolipoprotein E may mediate the physiological clearance of glycated moieties. The proposed role of glycation in the pathogenesis of atherosclerosis would explain its high incidence among diabetics and the contentious epidemiological and experimental correlations between dietary sugar and atherosclerosis. (shrink)

America's research universities, approximately 125 in number,play important roles in the nation's research system, and help toset the tone for all institutions of research and higherlearning. As the research universities have formed closer linkswith industry, new problems have arisen that have precipitated amajor debate. The academic medical centres and related lifescience departments present some of the most challenging newissues, which are analysed in this paper within the framework ofthe biomedical research system that has evolved in the UnitedStates since the Second (...) World War. (shrink)

Bruce L. Kinzer offers a rich examination of personal and political themes in the life of John Stuart Mill, one of the most influential liberal thinkers of the nineteenth century. By investigating young Mill's formative period and his relations with his father, Harriet Taylor, and Thomas Carlyle, Kinzer casts light on the challenges Mill faced in understanding himself and what he wished to become. Kinzer's political explorations probe issues central to the appreciation of Mill as an engaged political thinker (...) and actor and offers an insightful portrait of a complex and towering figure."--BOOK JACKET. (shrink)

The language $L_A(\Finv)$ is formed by adding the quantifier $\Finv x$ , "few x", to the infinitary logic L A on an admissible set A. A complete axiomatization is obtained for models whose universe is the set of ordinals of A and where $\Finv x$ is interpreted as there exist A-finitely many x. For well-behaved A, every consistent sentence has a model with an A-recursive diagram. A principal tool is forcing for $L_A(\Finv)$.

OBJECTIVES: To study the resuscitation preferences, choice of decision-maker, views on the seeking of patients' wishes and determinants of these of elderly hospital in-patients. DESIGN: Questionnaire administered on admission and prior to discharge. SETTING: Two acute geriatric medicine units (Southampton and Poole). PARTICIPANTS: Two hundred and fourteen consecutive consenting mentally competent patients admitted to hospital as emergencies. RESULTS: Resuscitation was wanted by 60%, particularly married and functionally independent patients and those who had not already considered it. Not wanted resuscitation was (...) associated with lack of social contacts. Sixty-seven per cent welcomed enquiry about their preferences and 78% wanted participation in decision, 43% as sole decision-maker. Wishing to choose oneself was associated with not wanting resuscitation, prior knowledge of it, and lack of a spouse. Patients' opinions remained stable during their admission. CONCLUSIONS: Discussion of resuscitation is practical on hospital admission without causing distress and the views expressed endure through the period of hospitalisation. Elderly patients' attitudes depend partly on personal health and social circumstances. This may assist doctors when patients are unable to participate themselves. (shrink)

Transcriptional enhancer sequences have been shown to play a pivotal role in the regulation of some highly expressed genes. First described in eukaryotic viruses, the discovery of enhancers has augmented the previously defined control‐sequence motifs to give a more complete understanding of eukaryotic transcriptional regulatory mechanisms. Some properties of enhancers that distinguish them from other regulatory sequences include their ability to function in a position‐ and orientation‐independent manner. Furthermore, the observation that some enhancers and transcriptional promoters exhibit tissue specificity in (...) their activity has generated considerable interest. Enhancer activation is thought to involve sequence‐specific DNA‐binding proteins but the process by which this leads to an increase in the initiation of transcription remains obscure. Although viral enhancers are more fully characterized, several cellular enhancers have recently been identified. One such enhancer sequence has been detected in a 3′ flanking region of a highly expressed human placental lactogen gene. This enhancer can increase the transcriptional rate of an adjacent gene by at least 50‐fold. (shrink)

Schools of Faith represents a diversity of essays from scholars in several continents. The contributors, all leading theologians and ethicists, offer reflections on historical and contemporary themes which are significant for wider debates in theological education and church life in today's world. The range of contributor and content provides a fitting tribute to the work of Iain R. Torrance over many years. Amid the numerous subjects discussed, the authors focus on liturgy, textual criticism, public theology, the ethics of war, Christian (...) doctrine, divine action, ecumenism, inter-faith dialogue, spiritual formation, the office of the minister, and the interface between religion and literature. The multi-faceted nature of this collection signifies its importance for historical, systematic and practical theology. (shrink)

This detailed study places the political and personal beliefs and behaviour of Britain's leading philosopher in the context of the crucial changes resulting from the growing democratization of society and culture in Britain.

Data from 590 college graduates are used to assess the relationship between family employment status and gender role attitudes for a predominately European American sample. The women in this study are employed full time, part time, or are full-time homemakers, and all report being married to men employed full time. The men in the study are all employed full time and report having wives who are employed full time, part time, or are full-time homemakers. Controlling for the effects of selected (...) background factors, full-time employed women are the most supportive of nontraditional family gender roles, followed by part-time employed women. The attitudes of homemakers are more similar to those of the men. Few significant differences exist when comparing the men with full-time employed wives, those with part-time employed wives, and men married to homemakers. The findings suggest an important link between work experiences, lifestyle choices, and gender role attitudes, particularly for women. (shrink)

Two arguments have recently been advanced that Maxwell-Boltzmann particles areindistinguishable just like Bose–Einstein and Fermi–Dirac particles. Bringing modalmetaphysics to bear on these arguments shows that ontological indistinguishabilityfor classical (MB) particles does not follow. The first argument, resting on symmetryin the occupation representation for all three cases, fails since peculiar correlationsexist in the quantum (BE and FD) context as harbingers of ontic indistinguishability,while the indistinguishability of classical particles remains purely epistemic. The secondargument, deriving from the classical limits of quantum statistical partition (...) functions,embodies a conceptual confusion. After clarifying the doctrine of haecceitism, a thirdargument is considered that attempts to deflate metaphysical concerns altogether byshowing that the phase-space and distribution-space representations of MB-statisticshave contrary haecceitistic import. Careful analysis shows this argument to fail as well,leaving de re modality unproblematically grounding particle identity in the classicalcontext while genuine puzzlement about the underlying ontology remains for quantumstatistics. (shrink)

It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients’ medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees (...) in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation. (shrink)

The language $L_A$ is formed by adding the quantifier $\Finv x$ , "few x", to the infinitary logic L A on an admissible set A. A complete axiomatization is obtained for models whose universe is the set of ordinals of A and where $\Finv x$ is interpreted as there exist A-finitely many x. For well-behaved A, every consistent sentence has a model with an A-recursive diagram. A principal tool is forcing for $L_A$.

Two arguments have recently been advanced that Maxwell-Boltzmann particles areindistinguishable just like Bose–Einstein and Fermi–Dirac particles. Bringing modalmetaphysics to bear on these arguments shows that ontological indistinguishabilityfor classical (MB) particles does not follow. The first argument, resting on symmetryin the occupation representation for all three cases, fails since peculiar correlationsexist in the quantum (BE and FD) context as harbingers of ontic indistinguishability,while the indistinguishability of classical particles remains purely epistemic. The secondargument, deriving from the classical limits of quantum statistical partition (...) functions,embodies a conceptual confusion. After clarifying the doctrine of haecceitism, a thirdargument is considered that attempts to deflate metaphysical concerns altogether byshowing that the phase-space and distribution-space representations of MB-statisticshave contrary haecceitistic import. Careful analysis shows this argument to fail as well,leaving de re modality unproblematically grounding particle identity in the classicalcontext while genuine puzzlement about the underlying ontology remains for quantumstatistics. (shrink)

In two studies we investigated whether people evidence an effect of moral contamination with respect to hypothetical organ transplants. This was achieved by asking participants to make judgements after presenting either positive or negative background information about the donor. In the first study, positive/negative background information had a corresponding effect on three judgements with attitudes to a heart transplant most pronounced by negative background information relative to good information and controls. This effect was replicated in the second study with both (...) heart and liver transplantation. Negative effects were stronger than positive effects in all conditions consistent with a negativity bias, but again stronger with regards to organs than controls. These results confirm findings from surveys that reveal real patients are concerned about moral contamination following organ transplantation and show that this bias in evident even in hypothetical, non-life-threatening scenarios. In a third study we found a significantly stronger moral contagion effect in Japanese relative to English participants, suggesting that concerns about moral contagion may be moderated by culture. (shrink)

Responding to volatile criticisms frequently leveled at Leo Strauss and those he influenced, the prominent contributors to this volume demonstrate the profound influence that Strauss and his students have exerted on American liberal democracy and contemporary political thought. By stressing the enduring vitality of classic books and by articulating the theoretical and practical flaws of relativism and historicism, the contributors argue that Strauss and the Straussians have identified fundamental crises of modernity and liberal democracy.

A common quest among theoretical psychologists is the transformation of psychology to accommodate human agency and meaning. Several strong experimental methods are used in cognitive neuroscience but are based almost entirely upon a mechanistic ontology. A step toward rapprochement is proposed using precise and powerful experimental methods that are holistic, individualized, and compatible with an agentive ontology. Such methods must be applicable to all aspects of human experience, the subjective and agentive aspects, as well as the behavioural and the neurophysiological (...) Multivariate methods are capable of expressing and capturing the holistic isomorphism among multiple aspects of human existence and might even help provide insight into the mind-body problem. Results from a cognitive neuroscience study are used to illustrate this approach. 2012 APA, all rights reserved). (shrink)