In the shadowy world between philosophy of science and ethics lie the paired concepts of underdetermination and incommensurability. Typically, scientific evidence underdetermines the hypotheses tested in research studies, providing neither proof nor disproof. As a result, scientists must judge the weight of the evidence, and in doing so, bring scientific and extrascientific values to bear in their approaches to assessing and interpreting the evidence. When different scientists employ very different values, their views are said to be incommensurable. Less prominent differences (...) represent partial incommensurabilities. The definitions and analyses provided by McMullin and by Veatch and Stempsey lay the foundation for the description of partial incommensurabilities in the current practice of assessing and interpreting epidemiologic evidence. This practice is called "causal inference" and is undertaken for the purpose of making causal conclusions and public health recommendations from population-based studies of exposures and diseases. Following the work of Bayley and Longino, several suggestions are examined for dealing with the partial incommensurabilities found in the general practice of causal inference in contemporary epidemiology. Two specific examples illustrate these ideas: studies on the relationship between induced abortion and breast cancer and those on the relationship between moderate alcohol consumption and breast cancer. (shrink)

There are clear associations between the overall quantity of input children are exposed to and their vocabulary acquisition. However, by uncovering specific features of the input that matter, we can better understand the mechanisms involved in vocabulary learning. We examine whether exposure to wh-questions, a challenging quality of the communicative input, is associated with toddlers' vocabulary and later verbal reasoning skills in a sample of low-income, African-American fathers and their 24-month-old children. Dyads were videotaped in free play sessions at home. (...) Videotapes were transcribed and reliably coded for sheer quantity of fathers' input as well as the number of wh-questions fathers produce. Children's productive vocabulary was measured at 24 months using the McArthur Bates Communicative Development Inventory MCDI, and children's verbal reasoning skills were measured 1 year later using the Bayley Scales of Infant Development. Results indicate that the overall quantity of father talk did not relate to children's vocabulary or reasoning skills. However, fathers' use of wh-questions related to both vocabulary and reasoning outcomes. Children's responses to wh-questions were more frequent and more syntactically complex, measured using the mean length of utterance, than their responses to other questions. Thus, posing wh-questions to 2-year-olds is a challenging type of input, which elicits a verbal response from the child that likely helps build vocabulary and foster verbal reasoning abilities. (shrink)

The COVID-19 pandemic has necessitated innovations in data collection protocols, including use of virtual or remote visits. Although developmental scientists used virtual visits prior to COVID-19, validation of virtual assessments of infant socioemotional and language development are lacking. We aimed to fill this gap by validating a virtual visit protocol that assesses mother and infant behavior during the Still Face Paradigm and infant receptive and expressive communication using the Bayley-III Screening Test. Validation was accomplished through comparisons of data collected (...) during in-person laboratory visits and virtual visits conducted via Zoom. Of the 119 mother-infant dyads who participated, 73 participated in lab visits only, 13 participated in virtual visits only, and 33 dyads participated in a combination of lab and virtual visits across four time points. Maternal perspectives of, and preferences for, virtual visits were also assessed. Proportions of missing data were higher during virtual visits, particularly for assessments of infant receptive communication. Nonetheless, comparisons of virtual and laboratory visits within a given time point indicated that mothers and infants showed similar proportions of facial expressions, vocalizations and directions of gaze during the SFP and infants showed similar and expected patterns of behavioral change across SFP episodes. Infants also demonstrated comparable expressive and receptive communicative abilities across virtual and laboratory assessments. Maternal reports of ease and preference for virtual visits varied by infant age, with mothers of 12-month-old infants reporting, on average, less ease of virtual visits and a preference for in-person visits. Results are discussed in terms of feasibility and validity of virtual visits for assessing infant socioemotional and language development, and broader advantages and disadvantages of virtual visits are also considered. (shrink)

Since 1981 AIDS has illuminated, like a roving searchlight, a series of ethical questions, which extend far beyond the apparently narrow limits of one disease. It has revealed, one by one, human attitudes and behaviours that were previously unquestioned, or unobserved - based on unidentified but shaky pre-suppositions.This commentary offers two contrasting perspectives on the problems facing developing countries. In the first part, I comment on the preceding article, from the perspective of a clinician who has worked for many years (...) in Africa, and who witnessed the emergence of AIDS in the early 1980s and its medical, social, political and economic consequences.1 In the second, I comment on a conference in Lusaka in September 1999 that addressed many of the issues.Narrowing the gap?“Narrowing the gap” raises questions about truth or transparency in the activities of multinational companies, the ethics and economics of health care in global society and the distribution of responsibility for unwanted side effects of new treatments. The scale of HIV infection in developing countries draws attention to weaknesses or instability in theoretical and practical structures, which serve - or should serve - human wellbeing, whenever it is disturbed by disease.Truth and transparencyDuring the last 60 years, combined with improved standards of living, the products of pharmaceutical effort and ingenuity have resulted in large gains in life expectancy. These were most marked in rich northern societies, but even poor southern countries had seen it extended by 15 to 20 years, until recently.However, “the costs of drug development are not small”.2 A detailed study of costs of clinical trials found that the total cost of new drug development can be as high as $500 million per drug.3 Patent laws allow a temporary monopoly for the production and sale for a number of years. During this “protected” …. (shrink)

What is ugly? One of the leading cultural commentators of our times, Stephen Bayley, takes us on a journey of discovery by skillfully weaving centuries of art and design history into a discourse on the nature of beauty and its polar opposite, ugly.

Two articles in this issue of the Hastings Center Report explore two sides of the same problematic coin. In “The Limits of Surrogates’ Moral Authority and Physician Professionalism,” Jeffrey Berger discusses the moral problem of a surrogate refusing a treatment, palliative sedation, on behalf of a patient whose suffering is refractory to intensive palliative efforts provided by a multidisciplinary team. In “After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation,” Ellen Robinson and her colleagues analyze data from a study (...) of cases in which physicians wished not to perform cardiopulmonary resuscitation on patients whom they thought it would harm. Both articles begin from the idea of a professional determination about a physician's duty to a patient that conflicted with a surrogate's determination about what should or should not be done for that patient. Berger's argument stops just short of a solution, however, because a physician's professional obligation to help patients, even within guidelines set by other professionals, is insufficient protection for patients. But if Berger's theory is right—that sometimes surrogates lack moral authority to make decisions on behalf of patients—then the Robinson team has developed a careful and public process for attending to that conflict. (shrink)

In focusing their view on Kuhn, Robert Veatch and William Stempsey ignore alternative sources of insight from other voices that could help move us beyond incommensurability. Richard Rorty and Helen Longino, for example, offer another view of science and objectivity with constructive insight for the practice of science and medicine. Keywords: positivism, relativism, scientific knowledge, incommensurability, Kuhn, Rorty, Longino CiteULike Connotea Del.icio.us What's this?

This book investigates transdisciplinary, arts-based approaches to developing innovative and pertinent higher education pedagogy. Introducing timely critical thinking strategies, the author addresses some of the key issues facing educators today in an increasingly complex digital, technological and ecological world. The author combines emerging ideas in the New Materialism and Posthumanism schools of thought with arts-based teaching and learning, including Practice-as-Research, for Social Science contexts, thus exploring how this approach can be used to productively create new pedagogical strategies. Drawing on a (...) rich repertoire of real-life examples, the volume suggests transferrable routes into practice that are suitable for lecturers, researchers and students. This practical and innovative volume will appeal to researchers and practitioners interested in Posthuman and New Materialist theories, and how these can be applied to the educational landscape in future. (shrink)

The Quality Attestation Presidential Task Force has made a thoughtful and thorough contribution to the establishment of clinical ethics consultation as a professional field. As Eric Kodish, Joseph J. Fins, and colleagues indicate, quality attestation is another step in bringing greater accountability and transparency to CEC. To complete this process, however, the work of the QAPTF must be situated within a larger project. As the field further develops, there will be a move toward restricting CEC to those who have demonstrated, (...) by means of this version of the quality attestation or an eventual iteration of it, that they are capable of conducting an ethics consultation with the skill, knowledge, and rigor necessary. This raises the question of how potential consultants will gain the experience required to produce a portfolio of cases when only those who are qualified are permitted to perform CECs, either by their institution or by some external evaluator, such as The Joint Commission. Now may be the time to begin thinking about further developments in the field that will complement both current academic training programs and the quality attestation process. For this, we might look to the Association for Clinical Pastoral Education for its model for certifying educators of chaplains who wish to become professionals. (shrink)

Homeopathy is a form of complementary medicine which relies heavily on observation and experience. The three distinguishing characteristics of homeopathy are that remedies are prescribed on the totality of a person's symptoms, that the remedy likely to cure a person is a dilution of that substance which would cause the same symptoms in a healthy person, and that remedies are prepared using microdoses of substances which are diluted and then vigorously shaken. Mainstream medicine criticizes homeopathy by saying that its gentleness (...) has outlived its usefulness and treatment successes are probably no more than placebo action. In addition, its critics charge that homeopathy is unscientific, runs counter to the "laws of nature" and will not stand up to scientific scrutiny. Homeopaths reply that mainstream medicine is dangerous, that homeopathy works in children and animals (usually thought resistant to placebo), and that several good controlled clinical trials have shown positive results. There is a difference between showing that homeopathy works and adequately accounting for its mechanism of action. Clinical trials have concentrated on the former and remain unexplained in the latter. Keywords: complementary medicine, empirical homeopathy CiteULike Connotea Del.icio.us What's this? (shrink)

A woman admitted to the emergency room of a hospital died because no surgeon could be found to stop the bleeding from injuries she sustained in a farming accident. The case points to ethical shortcomings both institutionally and professionally. The call system is inadequate, and physician fears of being sued or insufficiently compensated contribute to the overall problem. Potential responses include the institutional equivalent of a root cause analysis and an understanding of the pressures brought to bear on physicians to (...) treat emergencies. (shrink)

Clinicians, operating within complex systems, make mistakes, as people do in every human endeavor, and when they do, patients are sometimes harmed. One important question is how we as clinicians can find resolution in the wake of an error. The published literature has divided errors into those caused by “systems” and by “individuals.” But whereas both “systems” and “individual” approaches are important in understanding the cause of an error, neither alone can fully lead to resolution once an error has occurred. (...) Instead, both are necessary to understand, resolve, and prevent errors. (shrink)

Since the industrial revolution, when everything ran by clockwork, people have understood how important it is to live in the moment. But over time our world has grown increasingly busy, and we've lost our ability to truly savour each unique experience and the simple pleasures the world has to offer. Cultural commentator and critic Stephen Bayley seeks to explain what real value is: it's about taking the time and making the effort to appreciate things, of understanding the permanent charm (...) of modest daily rituals performed with care and feeling. Of caring about appearances and meaning. Of being bold in matters of taste. Of fully understanding the source of lasting pleasure. Of making every encounter with an object or person meaningful. Value is an elegiac account of what's recently been lost in the digital apocalypse. But also an enthusiastic anticipation of what we can regain in a post-viral, more analogue and more thoughtful world. (shrink)

In this book nine philosophers and one literary critic address aspects of the relativism issue currently of philosophic interest.

This book closely examines our commonly held beliefs about human suffering, and offers unique insights into God's role in why we suffer. Dr. Perri critically examines what it means to be human from a Judeo-Christian perspective, and extrapolates from the work of Carl Gustav Jung showing a deeply complex development of human transcendence in human suffering. On an interpersonal level, Dr. Perri elaborates on the work of Martin Buber and Emanuel Levinas and shows how our suffering can be shared and (...) lessened by our unconditionality and presence for the other. Scriptural passages are quoted from both the Hebrew and New Testament texts, and are used to depict the suffering of humankind as seen in the face of Job. It was this face, according to Perri, that Jesus saw in the faces of those He came to redeem, and that ultimately brought Him to the crucifix of redemption. Dr. Perri challenges Sartre's position that our existence precedes our essence, and draws on the work of Abraham Joshua Heschel and Christian theology in this regard. He further elaborates a neurodevelopmental paradigm that creates essence as the basis of our freedom to choose. This book can be read and studied by both professionals in the helping and healing professions, and lay persons seeking to better understand our suffering, and how to better help those who suffer. Dr. Perri offers specific ways in how to be present for those who suffer, how to read and receive the hidden language of human suffering, and how to use silence as a communication skill. (shrink)