During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

The article aims to show the value of taking ecclesiology – the theology of the church – into account in the study of British imperial ideology by describing how Anglican intra-ecclesiological debates shaped mid-nineteenth-century discourse about the British Empire. It highlights the impact of the Oxford Movement on the mind of the British colonial administrator Sir Frederic Rogers, Lord Blachford (1811-1889), by revealing the connections between his imperial thought and concepts arising from Tractarian ecclesiology. In particular, it argues that Rogers’ (...) understanding of British colonial development builds on Tractarian ideas of balance and consistency. By retaining a sense of the importance of the historic connection with the colonies of settlement while respecting their right to be free, Rogers constituted the imperial relationship as a _ via media. _. (shrink)

The first critical edition of the _Syncategoreumata_ by the thirteenth-century philosopher Peter of Spain, accompanied by a facing-page English translation to make its contents accessible to modern readers. The introduction gives an account of all the manuscripts used for the edition. Extensive indexes have been added to facilitate the reader's orientation in the book.

Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

The basic reproduction ratio, R0, is a fundamental concept in epidemiology. It is defined as the total number of secondary infections brought on by a single primary infection, in a totally susceptible population. The value of R0 indicates whether a starting epidemic reaches a considerable part of the population and causes a lot of damage, or whether it remains restricted to a relatively small number of individuals. To calculate R0 one has to evaluate an integral that ranges over the duration (...) of the infection of the host. This duration is, of course, limited by remaining host longevity. So, R0 depends on remaining host longevity and in this paper we show that for long-lived hosts this aspect may not be ignored for long-lasting infections. We investigate in particular how this epidemiological measure of pathogen fitness depends on host longevity. For our analyses we adopt and combine a generic within- and between-host model from the literature. To find the optimal strategy for a pathogen from an evolutionary point of view, we focus on the indicator $$R_0^{{opt}}$$, i.e., the optimum of R0 as a function of its replication and mutation rates. These are the within-host parameters that the pathogen has at its disposal to optimize its strategy. We show that $$R_0^{{opt}}$$ is highly influenced by remaining host longevity in combination with the contact rate between hosts in a susceptible population. In addition, these two parameters determine whether a killer-like or a milker-like strategy is optimal for a given pathogen. In the killer-like strategy the pathogen has a high rate of reproduction within the host in a short time span causing a relatively short disease, whereas in the milker-like strategy the pathogen multiplies relatively slowly, producing a continuous small amount of offspring over time with a small effect on host health. The present research allows for the determination of a bifurcation line in the plane of host longevity versus contact rate that forms the boundary between the milker-like and killer-like regions. This plot shows that for short remaining host longevities the killer-like strategy is optimal, whereas for very long remaining host longevities the milker-like strategy is advantageous. For in-between values of host longevity, the contact rate determines which of both strategies is optimal. (shrink)

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

This paper investigates what choices teachers made and what rationales they offered related to the inclusion and exclusion of primary source photographs for a hypothetical unit about the U.S. Civil Rights Movement in order to better understand teachers’ curricular decision-making as it relates to representing the histories of oppressed people. Elementary and secondary social studies/history teachers from three different in-service and pre-service cohorts ( n=62) selected and discarded images from a bank of 25 famous and lesser-known photographs. Their decisions and (...) explanations were coded for emergent themes. Findings reveal that these teachers tended to be guided by criteria both technical (how they might teach using a particular photograph) and philosophical (why they might teach about a particular photograph), with narrow definitions of what they deemed relevant and appropriate for their students. Their choices constructed a sanitized narrative of the Civil Rights Movement that largely avoided a discussion of racism. (shrink)

Research from behavioural sciences shows that people reach decisions in a much less rational and well-considered way than was often assumed. The doctrine of informed consent, which is an important ethical principle and legal requirement in medical practice, is being challenged by these insights into decision-making and real-world choice behaviour. This article discusses the implications of recent insights of research on decision-making behaviour for the informed consent doctrine. It concludes that there is a significant tension between the often non-rational choice (...) behaviour and the traditional theory of informed consent. Responsible ways of dealing with or solving these problems are considered. To this end, patient decisions aids are discussed as suitable interventions to support autonomous decision-making. However, current PDAs demand certain improvements in order to protect and promote autonomous decision-making. Based on a conception of autonomy, we will argue which type of improvements are needed. (shrink)

Why do people think that someone living a morally bad life is less happy than someone living a good life? One possibility is that judging whether someone is happy involves not only attributing positive psychological states (i.e., lots of pleasant emotions, few unpleasant emotions, and satisfaction with life) but also forming an evaluative judgment. Another possibility is that moral considerations affect happiness attributions because they tacitly influence attributions of positive psychological states. In two studies, we found strong support for the (...) second hypothesis. Moral considerations only appear to affect happiness attributions when they also affect attributions of positive psychological states. Additionally, both studies supported a hypothesis about why moral judgments have these effects. Specifically, we found that when people judge that someone is living a bad life, they infer that the person is not at peace with themselves. However, when this inference is blocked, moral considerations do not affect attributions of happiness or positive psychological states. In sum, although “happiness” appears to be a purely psychological concept, happiness judgments are sensitive to moral considerations because people often assume that immorality disrupts intrapersonal harmony. (shrink)

Across Europe, countries are reducing CO2 emissions and energy demand by lowering the temperature in public office buildings. These measures affect men and women unequally because the latter prefer and, indeed, perform better under higher temperatures than the standard temperature. Lowering the temperature thus further increases an already existing inequality. We show that the philosophical literature on discrimination provides an interesting theoretical approach to understanding such measures. On prominent understandings of what discrimination is, the policy would be considered direct discrimination (...) against women if it could be shown to reflect a broader inattentiveness to the needs of women in society. Alternatively, and more straightforwardly, the policies can be considered indirect discrimination because of their disparate effects on men and women. The final part of the paper shows that the policies are also wrong for the reasons it is often argued that discrimination is wrong—to wit, that it harms or disrespects those who are discriminated against. The final section suggests a range of measures to offset the discriminatory aspects of the policy. (shrink)

The best-interests standard is a widely used ethical, legal, and social basis for policy and decision-making involving children and other incompetent persons. It is under attack, however, as self-defeating, individualistic, unknowable, vague, dangerous, and open to abuse. The author defends this standard by identifying its employment, first, as a threshold for intervention and judgment (as in child abuse and neglect rulings), second, as an ideal to establish policies or prima facie duties, and, third, as a standard of reasonableness. Criticisms of (...) the best-interests standard are reconsidered after clarifying these different meanings. (shrink)

The concept of evolvability—the capacity of a population to produce and maintain evolutionarily relevant variation—has become increasingly prominent in evolutionary biology. Paleontology has a long history of investigating questions of evolvability, but paleontological thinking has tended to neglect recent discussions, because many tools used in the current evolvability literature are challenging to apply to the fossil record. The fundamental difficulty is how to disentangle whether the causes of evolutionary patterns arise from variational properties of traits or lineages rather than being (...) due to selection and ecological success. Despite these obstacles, the fossil record offers unique and growing sources of data that capture evolutionary patterns of sustained duration and significance otherwise inaccessible to evolutionary biologists. Additionally, there exist a variety of strategic possibilities for combining prominent neontological approaches to evolvability with those from paleontology. We illustrate three of these possibilities with quantitative genetics, evolutionary developmental biology, and phylogenetic models of macroevolution. In conclusion, we provide a methodological schema that focuses on the conceptualization, measurement, and testing of hypotheses to motivate and provide guidance for future empirical and theoretical studies of evolvability in the fossil record. (shrink)

Social scientific reasoning (SSR) is essential to social science education and to a democratic society as a whole. Students are challenged to analyze and reason about social problems such as social inequality, crime, and poverty. However, students experience difficulties with SSR. This study addresses the research question: Which design principles can guide teachers in designing lessons that promote social scientific reasoning? In this design-based research, four social science teachers employed a conceptualization of SSR and its levels together with three initial (...) design principles to develop curriculum materials and activities. These design principles and curriculum materials were piloted in two secondary education classes (9th and 10th grades) and evaluated by four social science teachers, four social science teacher educators and 90 students. The study produced six design principles that can promote students’ SSR. In combination with the curriculum materials, those design principles can help develop teachers’ pedagogical content knowledge and guide the design of tasks and units that develop SSR. (shrink)

McCoy and colleagues (2023) offer a reflective framework for data ethics and governance with several historical bioethics principles as a foundation. Their framework is one among a plethora of othe...

Recent scientific and technological developments enable the generation of increasingly sophisticated organoids: three-dimensional, lab-grown stem cell-based entities that model human organs anatomi...

Autonomous sensory meridian response is a complex sensory-emotional experience characterized by pleasant tingling sensations initiating at the scalp. ASMR is triggered in some people by stimuli including whispering, personal attention, and crisp sounds. Since its inception, ASMR has been likened to synesthesia, but convincing empirical data directly linking ASMR with synesthesia is lacking. In this study, we examined whether the prevalence of synesthesia is indeed significantly higher in ASMR-responders than non-responders. A sample of working adults and students were surveyed about (...) their experience with ASMR and common types of synesthesia. The proportion of synesthetes who were classified as ASMR-responders was 52%, whereas 22% of ASMR-responders were also synesthetes. These results suggest that: over half of those identifying as synesthetes also experience ASMR, and that synesthesia is up to four times as common among ASMR-responders as among non-responders. Findings also suggest a prevalence rate for ASMR of approximately 20%. Overall, the co-occurrence of ASMR and synesthesia lends empirical support to the idea that ASMR may be driven by synesthetic mechanisms, but future research would benefit from examining how ASMR and synesthesia are different, as well as similar. (shrink)