Biological science does not try to distinguish between health and disease. Biology is concerned with the interaction between living organisms and their environment. What we call health or disease is quite irrelevant.These reactions between the individual and his environment are complex. The individual and his surroundings form an integrated system which we can arbitrarily divide into two parts. There is an “external” component, by which we mean such factors as light, heat, percentage of oxygen in the air, quantity of minerals (...) or vitamins in food, micro-organisms in food or air, and so on. These can induce changes in what we arbitrarily call the “internal” component. Here we include such crude factors as anatomical structures, or finer details like composition of intercellular fluid, or secretions of glands, or changes of electrical potential in nerve or muscle. (shrink)

The aim of this thematic literature review is to explore nurses' perceptions of ethical issues in the care of older people. Electronic databases were searched from September 1997 to September 2007 using specific key words with tight inclusion criteria, which revealed 17 primary research reports. The data analysis involved repeated reading of the findings and sorting of those findings into four themes. These themes are: sources of ethical issues for nurses; differences in perceptions between nurses and patients/relatives; nurses' personal responses (...) to ethical issues; and the patient—nurse relationship. The findings reveal that ageism is one of the major sources of the ethical issues that arise for nurses caring for older people. Education and organizational change can combat ageist attitudes. Wider training is required in the care of older people, workplace skills, palliative care and pain management for older people. The demands of a changing global demography will necessitate further research in this field. (shrink)

As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may (...) be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests—and to what degree? (shrink)

Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain (...) the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent. (shrink)

Threshold- and signal-detection-based models have dominated theorizing about recognition memory. Building upon these theoretical frameworks, we have argued for a dual-process model in which conscious recollection and familiarity contribute to memory performance. In the current paper we assessed several memory models by examining the effects of levels of processing and the number of presentations on recognition memory receiver operating characteristics . In general, when the ROCs were plotted in probability space they exhibited an inverted U shape; however, when they were (...) plotted inzspace they exhibited a U shape. An examination of the ROCs showed that the dual-process model could account for the observed ROCs, but that models based solely on either threshold or signal-detection processes failed to provide a sufficient account of the data. Furthermore, an examination of subjects' introspective reports using the remember/know procedure showed that subjects were aware of recollection and familiarity and were able to consistently report on their occurrence. The remember/know data were used to accurately predict the shapes of the ROCs, and estimates of recollection and familiarity derived from the ROC data mirrored the subjective reports of these processes. (shrink)

concepts typically are defined in terms of lacking physical or perceptual referents. We argue instead that they are not devoid of perceptual information because knowledge of real-world situations is an important component of learning and using many abstract concepts. Although the relationship between perceptual information and abstract concepts is less straightforward than for concrete concepts, situation-based perceptual knowledge is part of many abstract concepts. In Experiment 1, participants made lexical decisions to abstract words that were preceded by related and unrelated (...) pictures of situations. For example, share was preceded by a picture of two girls sharing a cob of corn. When pictures were presented for 500 ms, latencies did not differ. However, when pictures were presented for 1,000 ms, decision latencies were significantly shorter for abstract words preceded by related versus unrelated pictures. Because the abstract concepts corresponded to the pictured situation as a whole, rather than a single concrete object or entity, the necessary relational processing takes time. In Experiment 2, on each trial, an abstract word was presented for 250 ms, immediately followed by a picture. Participants indicated whether or not the picture showed a normal situation. Decision latencies were significantly shorter for pictures preceded by related versus unrelated abstract words. Our experiments provide evidence that knowledge of events and situations is important for learning and using at least some types of abstract concepts. That is, abstract concepts are grounded in situations, but in a more complex manner than for concrete concepts. Although people's understanding of abstract concepts certainly includes knowledge gained from language describing situations and events for which those concepts are relevant, sensory and motor information experienced during real-life events is important as well. (shrink)

Recent empirical work has offered strong support for ‘biased pluralism’ and ‘economic elite’ accounts of political power in the United States, according a central role to ‘business interest groups’ as a mechanism through which corporate influence is exerted. Here, we propose an additional channel of influence for corporate interests: the ‘policy-planning network,’ consisting of corporate-dominated foundations, think tanks, and elite policy-discussion groups. To evaluate this assertion, we consider one key policy-discussion group, the Council on Foreign Relations. We first briefly review (...) the origins of this organization and then review earlier findings on its influence. We then code CFR policy preferences on 295 foreign policy issues during the 1981–2002 period. In logistic regression analyses, we find that the preferences of more affluent citizens and the CFR were positive, statistically significant predictors of foreign policy outcomes while business interest group preferences were not. These findings are discussed with a consideration of the patterns of CFR ‘successes’ and ‘failures’ for the issues in our dataset. Although a full demonstration of a causal connection between corporate interests, the policy-planning network and policy outcomes requires further research, we conclude that this has been shown to be a plausible mechanism through which corporate interests are represented and that ‘biased pluralism’ researchers should include it in their future investigations. (shrink)

Several prominent voices have called for a democratization of science through deliberative processes that include a diverse range of perspectives and values. We bring these scholars into conversation with extant research on democratic deliberation in political theory and the social sciences. In doing so, we identify systematic barriers to the effectiveness of inclusive deliberation in both scientific and political settings. We are particularly interested in what we call misidentified dissent, where deliberations are starkly framed at the outset in terms of (...) dissenting positions without properly distinguishing the kinds of difference and disagreement motivating dissent. (shrink)

Following Rawls, many political liberals hold reasonableness in high regard. Reasonable citizens can disagree, however, and some may find their arguments routinely ignored in elections and legislatures. Should we be troubled by such failures of institutional responsiveness as a matter of justice? The author argues that the expectation of such failures would lead parties in an original position to favor certain classes of institutions over others: A Theory of Justice and Political Liberalism together suggest a particular federal structure to a (...) republic of reasons. (shrink)

In the editor's notes, King explains students of color desire for social studies education that speaks to their humanity. He introduces the articles in this special issue and defines unofficial and unconventional social studies spaces. He also argues for a more complete social studies education that helps the field understand other places where social studies is performed.

The global city is a contested site of economic innovation and cultural production, as well as profound inequalities of wealth and life chances. These cities, and large cities that aspire to ‘global’ status, are often the point of entry for new immigrants. Yet for political theorists (and indeed many scholars of global institutions), these critical sites of global influence and inequality have not been a significant focus of attention. This is curious. Theorists have wrestled with the nature and demands of (...) global justice, but have for the most part supposed that the debate is between statist and cosmopolitan formulations. Questions of redistribution, immigration, humanitarian obligations, coercion at borders, and territorial rights have correspondingly been cast as either the domain of sovereign territorial states, or of the nascent web of supranational institutions that might bind those states and peoples, morally and legally. Examining some of these issues and arguments through the lens of the global city casts them in a new and informative light, and buttresses an associative turn in thinking about global justice. (shrink)

Liberal democracies encourage citizen participation and protect our freedoms, yet these regimes elect politicians and decide important issues with electoral and legislative systems that are less inclusive than other arrangements. Some citizens inevitably have more influence than others. Is this a problem? Yes, because similarly just but more inclusive systems are possible. Political theorists and philosophers should be arguing for particular institutional forms, with particular geographies, consistent with justice. -/- Les démocraties libérales encouragent la participation citoyenne et protègent nos libertés. (...) Pourtant, ces régimes élisent des politiciens et décident de problèmes importants via les systèmes électoral et législatif, qui sont moins inclusifs que d’autres arrangements. Certains citoyens ont inévitablement plus d’influence que d’autres. Est-ce un problème? Oui, parce que des systèmes similairement justes, mais plus inclusifs, sont possibles. Les théoriciens et philosophes politiques devraient ainsi plaider en faveur de formes institutionnelles particulières, aux géographies précises, en cohérence avec la justice. (shrink)

Residency selection is a challenging process for medical students, one further complicated in the USA by the recentDobbs v Jackson Women’s Health Organization(Dobbs) decision over-ruling the federal right to abortion. We surveyed medical students to examine howDobbsis influencing the ideological, personal and professional factors they must reconcile when choosing where and how to complete residency.Between 6 August and 22 October 2022, third-year and fourth-year US medical students applying to US residency programmes were surveyed through social media and direct outreach to (...) medical schools. Analysis of quantitative and qualitative data from 494 responses was performed to assess downstream effects ofDobbson residency applicants’ family, health and career choices.Most respondents said changes in abortion access would likely or very likely influence their decision regarding location of considered residency programme (76.9%), where to start a family (72.2%) and contraceptive planning for them or their partner (57.9%). Cis-gender females were more influenced byDobbsregarding where (5 (4, 5) p<0.001) and when (3 (3, 5) p<0.001) to start a family. In qualitative responses, medical trainees highlighted the importance of abortion access for their patients, themselves and their loved ones.Medical trainees are incorporating state abortion access into their residency programme choices. Future physicians care about both the quality of care they will be able to provide and their own health. For personal and professional reasons, reproductive healthcare access is now a key factor in residency match decisions. (shrink)

I evaluate the claim that modern urban regions are desirable sites for inclusive forms of democratic governance. Although certain features of city life do hold such promise, I argue that these same features coincide with exclusionary attitudes and activities that undermine democratic hopes. I then clarify the necessary conditions for more inclusive urban democracy, distinguishing my account from prominent criticisms of suburban culture and urban sprawl advanced by, among others, advocates of the new urbanism. I conclude with proposals for reform (...) that emphasize creative uses of existing and emerging technologies and institutions, and a more democratic conception of eminent domain authority. (shrink)

Recent changes in access to contraceptive and infertility treatments in the state of Illinois, and across the United States more generally, have heightened class cleavages in access to reproductive health care benefits in the United States. Using data gleaned from government testimonies, public documents, and telephone interviews, the authors found that poor women have broad access to contraceptive coverage but very little access to infertility treatments, while working-and middle-class women have increasingly broad coverage of infertility treatments but spare coverage of (...) contraceptives. These findings suggest that while the extreme measures of the eugenics movement are less frequently in evidence, class differences in access to reproductive services lead to an equally dualistic, albeit unstated, fertility policy in the United States: encouraging births among working- and middle-class families and discouraging births among the poor, particularly those on Medicaid. (shrink)

Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is it unfair (...) for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does “just reproduction” look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies? In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues—such as whether women ought to be allowed to access pregnancy termination—are more contested than they have been in decades, while new technologies—like those used to edit the genes of human embryos—suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report. (shrink)

The majority of obstetrician‐gynecologists in practice operate very infrequently. Most residents graduate with strong surgical skill sets, given residency requirements. Nonetheless, their practices become dominated by obstetrics, and their gynecologic surgical skills deteriorate. While cesarean sections are surgical in nature, the skill sets needed in these surgeries differ from the skills used in general gynecologic surgery. As gynecology has taken a back seat to obstetrics in our specialty, not only surgical skills but also diagnostic and management skills have deteriorated.

G.A. Cohen argues that Rawlsian constructivism mistakenly conflates principles of justice with optimal rules of regulation, a confusion that arises out of how Rawls has us think about justice. I use the concepts/conceptions distinction to argue that while citizens may reasonably disagree about the substance and demands of justice, some principled convergence may be possible: we can agree upon regulative principles consistent with justice, as each of us understands it. Rawlian constructivism helps us find that principled convergence, and this too (...) is a conception of justice. (shrink)

This book evaluates some of the most common ethical issues confronted by reproductive endocrinologists, embryologists, and their teams. The authors apply core ethical principles and approaches to problem solving to each of the cases raised. This work is a guide for both those on the front lines of patient care as well as for students in the field, whatever their background. By outlining sample cases, the book is an instigator for ethical discussions among ethicists, medical practitioners and students.

Critics fault rational choice theory for dubious assumptions and limited explanatory power. The aims of rational choice are, however, as much normative as explanatory, and I argue that an abiding concern of political thought—the wrong of exploitation—gives moral weight to some of the more substantive assumptions underlying many rational choice prescriptions.

Decision making during reproduction is complex for a variety of medical and social reasons. Anyone who has had a conversation with a family member about the “best time” to have a baby can attest to this — there is no “best time” or “best way.” Multiple pressures from any number of sources combine in a minefield of hazards made ever more complicated by restrictive laws in the US. Add to this a screening result of potential chromosomal aneuploidy and decision making (...) becomes ever more complex. Societal stigma and lack of adequate and accurate information during counseling certainly plays a role in the high number of terminations in the setting of diagnosed chromosomal aneuploidy, yet other factors also push families in this direction including medical considerations and the abysmal lack of social support programs. (shrink)

It is an interesting paradox that on the one hand intemperate enthusiasm greets new medical discoveries. On the other hand, the lack of science in medicine is paraded from time to time, usually as a matter of apologetics, as, when a physician wishes to excuse an error, a lawyer to discredit a physician, or a jury to render a verdict contrary to medical evidence. Philosophers who insist on the mathematical or quantitative aspects in any definition of science ascribe very little (...) that is truly scientific to biology in general or to its daughter medicine in particular. Jerome Frank comments approvingly that “many scientific-minded physicians today deny that medicine is, or is likely ever to be, a science.” Articulate physicians themselves may be highly critical. Dr. Ian Stevenson, for example, declares, “Medicine will not achieve the status of a science until the basic laws of health and disease have been disclosed. But the search for these laws has hardly begun.” Stevenson goes on to point out that instead of seeking basic laws, medicine is concentrating on facts, from which no laws emerge. (shrink)

Reading Henry Greely's wonderful book, The End of Sex and the Future of Human Reproduction, while riding public transport sparked awkward looks and equally awkward discussions. I thought of removing the dust jacket, yet I was reminded that Greely's stated purpose in writing the book was to spark conversation. The title is, of course, intentionally provocative. Greely does not, in fact, believe that humans will stop having sex for the multitude of reasons that we do already. Quite the contrary; he (...) proposes that sex for reproduction will become a technical endeavor, while sex for pleasure or other purposes beyond reproduction will remain as it is. In a not-too-distant future, advances in genomics and assisted reproduction, especially preimplantation genetic diagnosis, will allow us to control the genetic makeup of embryos. To a limited degree, PGD already makes this possible, but what Greely proposes is slightly different. His vision of the future depends on the potential for further advances of today's already fairly complex biotechnology. Greely does an excellent job of making this cutting-edge science easy to understand. (shrink)

In a recent article in Space & Polity, Nezar AlSayyad and Ananya Roy draw suggestive analogies between medieval urban forms and troubling contemporary realities, such as gated urban enclaves and impoverished squatter settlements. Invoking the medieval city as an analytical device, they show how several prevalent urban practices of citizenship are in tension with, and sometimes flatly contradict, liberal complacencies and democratic hopes. However, this article suggests that there is another story to be told, using some of the medieval cities (...) they invoke to critical ends. The narrative highlights the ways in which certain medieval spatial and civic forms might enrich liberal and democratic aspirations, helping us to re-imagine at least two core values of liberal democratic citizenship. (shrink)

Both John Henry Newman and Vincent Gasser offered influential interpretations of the First Vatican Council’s teaching on infallibility. In contrast to many of theircontemporaries, Gasser and Newman placed papal infallibility alongside episcopal infallibility and the infallibility of the Catholic faithful. After exploring the views of Gasser and Newman, this essay compares their views to the Second Vatican Council’s teaching on infallibility in Lumen Gentium and concludes that even though Lumen Gentium cited Gasser, its theology is closer to Newman’s.

This paper describes a case study of a program called WATCH: Workshop for Actively Thinking Computationally and Historically. The focus of the program and this paper was on using mobile application development to promote historical thinking using a plantation site visit as the focus of inquiry. WATCH was delivered during an academic enrichment youth program at a major research university in the Southeast and served a total of 30 African American and Latino high school students from low socio-economic backgrounds. Through (...) the theoretical framework of historical thinking, this case study provides descriptions of the class sessions, students’ perceptions of and interests in history and students level of historical thinking through their apps. We make suggestions about how the instructional activities could be adapted for classrooms, discuss the tensions of using technology and inquiry pedagogy to support and promote historical learning, and review the program's impact on students’ agency as learners and critical consumers and producers of historical accounts. (shrink)

The neoliberal-inspired “shock therapy” policies were designed to allow efficiency considerations to shape the new capitalist economies. Most experts theorized that these policies would enable postcommunist countries to close the gap with the West. After more than a decade, this prediction has been falsified. Fieldwork in 25 Russian firms demonstrates that the neoliberal prescription of mass privatization creates shocks that make successful enterprise restructuring almost impossible. Instead, most firms lower their technological level of production and retreat to nonmarket activity to (...) survive. The result is a poorer economy with less growth potential and thus increased divergence with the West. (shrink)