Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much (...) more likely to influence a decision to pursue or reject aggressive life‐extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor—particularly in the context of an inadequate social safety net—robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision‐making, the irrational distinction between PAD and withdrawal of life‐sustaining care, and the more appropriate focus on the great flaws in the American health care system. (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)

What causes adolescents to develop consumer’ ethical beliefs? Prior research has largely focused on the negative influence of peers and negative patterns of parent–child interactions to explain risky and unethical consumer behaviors. We take a different perspective by focusing on the positive support of parents and peers in adolescent social development. An integrative model is developed that links parental and peer support with adolescents’ self-worth motives, their materialistic tendencies, and their consumer ethical beliefs. In a study of 984 adolescents, we (...) demonstrate support for a sequential mediation model in which peer and parental support is positively related to adolescents’ self-esteem and feelings of power, which are each associated with decreased materialism as a means of compensating for low self-worth. This reduced materialism is, in turn, associated with more ethical consumer beliefs. (shrink)

Transplantation research on samples and organs from deceased donors in England, Wales and Northern Ireland is under threat. The key problems relate to difficulties encountered in gaining consent for research projects, as distinct from consent to donation for clinical transplantation. They are due partly to the terms of the Human Tissue Act 2004 (the 2004 Act), and partly to its interpretation by the Human Tissue Authority (HTA). They include excessive interaction with donor representatives regarding ‘informed consent’ to research projects, uncertainty (...) as to the scope and duration of a donor's ‘authority’ over an organ, and restrictions caused by the apparent need for licensing of transplantation research under the 2004 Act, combined with lack of certainty, or guidance, as to the distinction between ‘research’, which requires a licence, and ‘service development’, which does not. In our view this confusion hinders and deters Specialist Nurses for Organ Donation in approaching donor representatives and discussing possible research projects with them. It has also, as we have reported elsewhere, led to abandonment of research projects for fear of liability, despite both Research Ethics Committee (REC) approval and donor consent. Such problems do not seem to occur under the transplant laws of most other comparable jurisdictions. The Transplantation Ethics Symposium, ‘The ethics of organ retrieval: goals, rights and responsibilities’, hosted by the MRC Centre for Transplantation at King's College London in December 2010, revealed that many senior clinicians and researchers, administrators, and lawyers are both unclear and in disagreement concerning the effects of the 2004 Act and the extent to which it is adhered to or ignored in practice. In this paper we examine the difficulties encountered and suggest solutions based on a less restrictive interpretation of the 2004 Act, or, more probably, a regulatory change under its authority. We propose that, in the long term, a law which includes consent for REC-approved research within the general consent for organ donation and transplantation seems preferable to the present system, both ethically and in practical terms. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

(2006). Screed or Scholarship: The Days of Whine and Roses: The Destruction of Young Lawyers: Beyond One L by Douglas Litowitz. Legal Ethics: Vol. 9, No. 2, pp. 233-243.

Alzheimer's disease is characterized by plaques of amyloid-beta peptide, cleaved from amyloid-beta protein precursor . Our hypothesis is that lifespan profiles of AD-associated mRNA and protein levels in monkeys would differ from mice and that differential lifespan expression profiles would be useful to understand human AD pathogenesis. We compared profiles of AbetaPP mRNA, AbetaPP protein, and Abeta levels in rodents and primates. We also tracked a transcriptional regulator of the AbetaPP gene, specificity protein 1 , and the beta amyloid precursor (...) cleaving enzyme . In mice, AbetaPP and SP1 mRNA and their protein products were elevated late in life; Abeta levels declined in old age. In monkeys, SP1, AbetaPP, and BACE1 mRNA declined in old age, while protein products and Abeta levels rose. Proteolytic processing in both species did not match production of Abeta. In primates, AbetaPP and SP1 mRNA levels coordinate, but an inverse relationship exists with corresponding protein products as well as Abeta levels. Comparison of human DNA and mRNA sequences to monkey and mouse counterparts revealed structural features that may explain differences in transcriptional and translational processing. These findings are important for selecting appropriate models for AD and other age-related diseases. (shrink)

Orthodox game theory and social preference models cannot explain why people cooperate in many experimental games or how they manage to coordinate their choices. The theory of evidential decision making provides a solution, based on the idea that people tend to project their own choices onto others, whatever these choices might be. Evidential decision making preserves methodological individualism, and it works without recourse to social preferences. Rejecting methodological individualism, team reasoning is a thinly disguised resurgence of the group mind fallacy, (...) and the experiments reported by Colman et al. Colman, A. M., Pulford, B. D., & Rose, J. (this issue). Collective rationality in interactive decisions: Evidence for team reasoning. Acta Psychologica, do not offer evidence that uniquely supports team reasoning. (shrink)

Dans ce texte, Walter D. Mignolo, l’un des membres-fondateurs du groupe modernité/colonialité aux côtés d’Aníbal Quijano, revient sur la définition de la colonialité comme « face sombre de la modernité » et sur les formes non seulement politiques et économiques mais encore épistémiques et esthéSiques que doivent prendre les enquêtes et les luttes décoloniales. Renommant les ancêtres de ces luttes et dénonçant le « management colonial du savoir » qui a tenté de les faire disparaître, le texte de Mignolo célèbre (...) les travaux de Ottobah Cuogano, Felipe Guamán Poma et M. K. Gandhi comme autant d’appuis pour une pensée décoloniale et pluriverselle de la frontière. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 42.3 (2004) 297-326 [Access article in PDF] Wittgenstein, German Organicism, Chaos, and the Center of Life Richard Mcdonough No supposition seems to me more natural than that there is no process in the brain correlated with associating or with thinking; so that it would be impossible to read off thought processes from brain processes. I mean this: if I talk or write, there (...) is, I assume, a system of impulses going out from my brain and correlated with my spoken or written thoughts. But why should the system continue further in the direction of the center. Why should this order not proceed, so to speak, out of chaos? The case would be like the following-certain kinds of plants multiply by seed, so that a seed always produces a plant of the same kind as that from which it was produced—but nothing in the seed corresponds to the plant which comes out of it—this can only be done from the history of the seed. So an organism might come into being out of something quite amorphous, as it were, causelessly; and there is no reason why this should not really hold for our thoughts, and hence for our talking and writing. L. Wittgenstein, Zettel §608 Paragraph 608 of Zettel is one of the most remarkable passages in Wittgenstein, for it presents a more metaphysical view than one would associate with his later philosophy.1 [End Page 297] Despite Wittgenstein's well known opposition to metaphysics,2 Z §608 clearly endorses a doctrine of emergence, the view, that the order in our language and thought "arises" out of "chaos" or "nothing." The general idea in emergentism is that certain kinds of wholes, notably, organisms, are "greater than the sum of their parts."3 Although emergentism has suffered from neglect and abuse for a half century, it has recently become a live issue.4Klee, Kim, and McLaughlin emphasize the kind of emergence which involves "downward causation," the view that the emergent whole causally influences the behavior of its own parts.5 Such emergentism asserts that there is an "explanatory gap" between an organism's characteristics and its mechanical structure,6 where this gap is a matter of ontology rather than mere ignorance of the causes. The present paper argues that Wittgenstein's doctrine of emergence is central to his later philosophies of language and mind. The common view that Wittgenstein's later philosophy is primarily negative has proved a liability for Wittgenstein.7 Cognitive scientists respond that even if there are serious problems with their views, [End Page 298] "Remotely plausible theories are better than no theories at all."8 But Wittgenstein's remark at PI §109 that philosophy should not offer theories has been misunderstood. For Wittgenstein, the paradigm of a theory is mechanics (LAC28-29), and it is not the job of philosophy to explain the phenomena by adverting to hidden mechanisms (PI §435). But philosophy may offer a different kind of positive account, the kind of descriptive account appropriate to emergent organic phenomena.9 According to Z §608, this is a description of the phenomena as it emerges in a history. In order to appreciate Wittgenstein's emergentism, it is necessary to have the correct interpretation of the words "center" and "chaos" in Z §608. Many commentators take it as obvious that by "the center," Wittgenstein means the neural center.10 For in modern neuroscience, it is natural to view the brain as the control center of the organism. Wooldridge, Armstrong, Popper, Rose, Fodor, Dennett, Gillett, Greenfield, and Clark, all use "center" in this way.11Given the modern view, called "central state materialism" as background,12 Z §608 seems to claim, first, that the order of our thought and language cannot be [End Page 299] traced to the neural center, and, second, that intelligence must arise out of neural "chaos." Thus, McGinn thinks Wittgenstein is suggesting that the brain might turn out to be oatmeal.13 But careful attention to... (shrink)

A standard view in philosophy is that knowledge entails justification. Yet recent research suggests otherwise. We argue that this admirable and striking research suffers from an important limitation: participants were asked about knowledge but not justification. Thus it is possible that people attributed knowledge partly because they thought the belief was justified. Perhaps though, if given the opportunity, people would deny justification while still attributing knowledge. It is also possible that earlier findings were due to perspective taking. This paper reports (...) further research that directly addresses these questions. Our findings support the hypothesis that knowledge entails justification on the ordinary view. (shrink)

The aim of this article is (1) to investigate the ‘neurosciences’ as an object of study for historical and genealogical approaches and (2) to characterize what we identify as a particular ‘style of thought’ that consolidated with the birth of this new thought community and that we term the ‘neuromolecular gaze’. This article argues that while there is a long history of research on the brain, the neurosciences formed in the 1960s, in a socio-historical context characterized by political change, faith (...) in scientific and technological progress, and the rise of a molecular gaze in the life sciences. They flourished in part because these epistemological and technological developments were accompanied by multiple projects of institution-building. An array of stakeholders was mobilized around the belief that breakthroughs in understanding the brain were not only crucial, they were possible by means of collaborative efforts, cross-disciplinary approaches and the use of a predominantly reductionist neuromolecular method. The first part of the article considers some of the different approaches that have been adopted to writing the history of the brain sciences. After a brief outline of our own approach, the second part of the article uses this in a preliminary exploration of the birth of the neurosciences in three contexts. We conclude by arguing that the 1960s constitute an important ‘break’ in the long path of the history of the brain sciences that needs further analysis. We believe this epistemological shift we term the ‘neuromolecular gaze’ will shape the future intellectual development and social role of the neurosciences. (shrink)

This paper employs theory of normal organizational wrongdoing and investigates the joint effects of management tone and the slippery slope on financial reporting misbehavior. In Study 1, we investigate assumptions about the effects of sliding down the slippery slope and tone at the top on financial executives’ decisions to misreport earnings. Results of Study 1 indicate that executives are willing to engage in misreporting behavior when there is a positive tone set by the Chief Financial Officer, regardless of the presence (...) or absence of a slippery slope. A negative tone set by the CFO does not facilitate the transition from minor indiscretions to financial misreporting. In Study 2, we find that auditors evaluating executives’ decisions under the same conditions as those in Study 1 do not react to the slippery slope condition, but auditors assess higher risks of fraud when the CFO sets a negative tone. Overall, our results indicate that many assumptions about the slippery slope and tone at the top should be questioned. We provide evidence that pro-organizational behaviors and incrementalism yield new insights into the causes of ethical failures, financial misreporting behavior, and failures of corporate governance mechanisms. (shrink)

Cet article s’intéresse à l’évolution non seulement quantitative mais aussi qualitative du phénomène du divorce. Dans le divorce, d’un cas à l’autre, on observe de grandes différences suivant le degré d’accomplissement du travail psychique de deuil des ex-partenaires. Mais son extrême banalisation entraîne aussi un important changement d’état d’esprit général, avec des problèmes nouveaux, voire des mutations d’ordre psycho-culturel concernant la vie de couple. La puissante médiatisation contemporaine contribue à amplifier les transformations en cours, modifiant considérablement non seulement les comportements (...) et les mœurs, mais aussi certaines représentations, y compris dans leurs dimensions inconscientes. On voit poindre, entre autres, la représentation d’un « destin » inéluctable qui condamnerait à l’avance tout projet de vie amoureuse durable. Certaines conséquences cliniques en sont perceptibles dans le choix amoureux des couples actuels, où s’atténue parfois la distinction entre couple projeté à long terme et aventure passagère. (shrink)

We consider the relation between past and future events from the perspective of the constructive episodic simulation hypothesis, which holds that episodic simulation of future events requires a memory system that allows the flexible recombination of details from past events into novel scenarios. We discuss recent neuroimaging and behavioral evidence that support this hypothesis in relation to the theater production metaphor.

Marketing research on adolescents’ ethical predispositions and risky behaviors has focused primarily on individual difference variables. The present study, in contrast, examines the social network positions that an adolescent occupies within a group. A survey of 984 adolescents demonstrates that EP and RB stem from a balance between assimilation and individuation. In particular, we show that adolescents with close first-degree relationships within a specific peer group and/or high need for uniqueness have lower EP and engage in more RB, while adolescents (...) that are more central to the entire network have higher EP. The theoretic and practical implications of these findings are discussed. (shrink)

There is a popular hypothesis that performance on implicit and explicit memory tasks reflects 2 distinct memory systems. Explicit memory is said to store those experiences that can be consciously recollected, and implicit memory is said to store experiences and affect subsequent behavior but to be unavailable to conscious awareness. Although this division based on awareness is a useful taxonomy for memory tasks, the authors review the evidence that the unconscious character of implicit memory does not necessitate that it be (...) treated as a separate system of human memory. They also argue that some implicit and explicit memory tasks share the same memory representations and that the important distinction is whether the task (implicit or explicit) requires the formation of a new association. The authors review and critique dissociations from the behavioral, amnesia, and neuroimaging literatures that have been advanced in support of separate explicit and implicit memory systems by highlighting contradictory evidence and by illustrating how the data can be accounted for using a simple computational memory model that assumes the same memory representation for those disparate tasks. (shrink)

After a time of scientific discoveries, technological revolutions and cultural upheavals, after a time of elevation of the human genius to the highest peaks, it was time for deep anxiety for his own fragile future and the realization of the rather fragile state of many seemingly settled things. The development of the information space leads to the practice of mass indignation of the population, especially of children and adolescents, misunderstandings on the basis of economic and social achievements give rise to (...) protracted interethnic conflicts. Breakthroughs in the field of medicine often lead to repeated explosive effects in society. In addition, rapid environmental pollution has resulted from the intensive development of human activity. It should be noted that not only nature has become contaminated, but human and soul bodies and bodies become more polluted. (shrink)

The urgency of the issues discussed in the article is due to the fact that a person always stood and will be at the center of the interests of any religious structure, and especially if that structure is such an authoritative, powerful and influential Church as the Roman Catholic one. Today, centralized Catholicism presents its social position as a moral improvement of a person through cooperation with other people for the sake of a common and perfect future. The purpose of (...) the article is to examine the social concept of Catholicism, which is pervaded by the ideas of providentialism. The latter is characteristic of considering the social development of mankind in accordance with God's plan. The crown of creation of the Most High is man, so "the Church implements her plan through man, but not in the abstract, but in a concrete, living, social dimension," - says Cardinal Joseph Goffner. Through the constant evangelization of humanity, the Church seeks to influence the improvement of human life and seeks to point to Christianity as a faithful way of life. But a world where the horrors of war have been replaced by the "war of civilizations," you will not call the "war of cultures" perfect. Nor can one see the great desire of mankind for moral development, spiritual perfection, but only the desire for the accumulation of material goods. (shrink)

In this paper we focus on the modularity of visual functions in the human visual cortex, that is, the specific problems that the visual system must solve in order to achieve recognition of objects and visual space. The computational theory of early visual functions is briefly reviewed and is then used as a basis for suggesting computational constraints on the higher-level visual computations. The remainder of the paper presents neurological evidence for the existence of two visual systems in man, one (...) specialized for spatial vision and the other for object vision. We show further clinical evidence for the computational hypothesis that these two systems consist of several visual modules, some of which can be isolated on the basis of specific visual deficts which occur after lesions to selected areas in the visually responsive brain. We will provide examples of visual modules which solve information processing tasks that are mediated by specific anatomic areas. We will show that the clinical data from behavioral studies of monkeys (Ungerleider and Mishkin 1984) supports the distinction between two visual systems in monkeys, the 'what' system, involved in object vision, and the 'where' system, involved in spatial vision. (shrink)