This chapter describes the potential far‐reaching consequences of contemplative higher education for the fields of science and medicine.

Although activities in basic and applied research in developing countries (DCs) are guided by universal scientific principles, there are important differences in the way in which science is practiced from that of the industrialized world. Isolation from the mainstream of scientific activity, the need for the development of an indigenous scientific capacity, the lack of a critical mass of researchers with respect to most fields of knowledge, and the urgency of developing better and more efficient communication channels, are some of (...) the aspects that set apart the scientific activity of the developing world. In particular, the need to develop local "new" science aimed at solving pressing problems of a local nature suggests the existence of a different set of conditions from those found in scientifically-advanced countries. In the present article we look at the ways the special circumstances of science in DCs will affect the application of evaluation criteria, using bibliometric data on research in Mexico as an example. (shrink)

Power indices are commonly required to assign at least as much power to a player endowed with some given voting weight as to any player of the same game with smaller weight. This local monotonicity and a related global property however are frequently and for good reasons violated when indices take account of a priori unions amongst subsets of players (reflecting, e.g., ideological proximity). This paper introduces adaptations of the conventional monotonicity notions that are suitable for voting games with an (...) exogenous coalition structure. A taxonomy of old and new monotonicity concepts is provided, and different coalitional versions of the Banzhaf and Shapley–Shubik power indices are compared accordingly. (shrink)

This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the (...) context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed. (shrink)

The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries (...) without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

Médecins Sans Frontières is not morally required to continue providing the same therapeutic and preventative interventions for lead poisoning in Nigeria in the face of conditions that negatively impact on the achievement of their objectives. Nevertheless, Médecins Sans Frontières may have reasons to revise their objectives and adopt different interventions or methods.

The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s (...) Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and were organized (...) apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

In the midst of recent ethical decision-making failures in business in the past ten or more years, businesses are beginning to prioritize the moral fiber of their new-hire business graduates. In addition to academic performance, intellectual drive, and personality match, perhaps there are other key characteristics that employers seek which speak to the importance of ethical decision makers in practice. The question remains, how can academic institutions help instill such values into their students so that ethical decision making transcends their (...) lives? This article suggests that experiential learning through an institutional-sponsored business forum can help enhance an individual’s self-efficacy and awareness of the school’s value-based education, which ultimately will lead students towards ethical decision making in practice. Five years of survey data collected at business forum events suggests that business forums are making a difference in the students’ self-assessed abilities to show greater self-efficacy, better ethical decision making, and an increased awareness of their institution’s value-based education. Specifically, data collected illustrate a mediating effect of self-efficacy and awareness of a value-based education en route to ethical decision making. Further, support is found for the primary hypothesis that attendance at business forums does result in a higher propensity to make ethical decisions. Because of these positive findings, higher education institutions looking to place a greater emphasis on the ethical leadership of their business students may want to explore adding such experiential learning programs. (shrink)

This invaluable resource is the first one-volume, in-depth, comprehensive history of modern science ever published.

Argumentation as the public exchange of reasons is widely thought to enhance deliberative interactions that generate and justify reasonable public policies. Adopting an argumentation-theoretic perspective, we survey the norms that should govern public argumentation and address some of the complexities that scholarly treatments have identified. Our focus is on norms associated with the ideals of correctness and participation as sources of a politically legitimate deliberative outcome. In principle, both ideals are mutually coherent. If the information needed for a correct deliberative (...) outcome is distributed among agents, then maximising participation increases information diversity. But both ideals can also be in tension. If participants lack competence or are prone to biases, a correct deliberative outcome requires limiting participation. The central question for public argumentation, therefore, is how to strike a balance between both ideals. Rather than advocating a preferred normative framework, our main purpose is to illustrate the complexity of this theme. (shrink)

Napolitano (The epistemology of fake news, Oxford University Press, 2021) argues that the Minimalist Account of conspiracy theories—i.e., which defines conspiracy theories as explanations, or theories, about conspiracies—should be rejected. Instead, she proposes to define conspiracy theories as a certain kind of belief—i.e., an evidentially self-insulated belief in a conspiracy. Napolitano argues that her account should be favored over the Minimalist Account based on two considerations: ordinary language intuitions and theoretical fruitfulness. I show how Napolitano’s account fails its own purposes (...) with respect to these two considerations and so should not be favored over the Minimalist Account. Furthermore, I propose that the Minimalist Account is the best conception of ‘conspiracy theory’ if we share Napolitano’s goal of advancing the understanding of conspiracy theories. (shrink)

We present here a direct elementary construction of continuous utility functions on perfectly separable totally preordered sets that does not make use of the well-known Debreu’s open gap lemma. This new construction leans on the concept of a separating countable decreasing scale. Starting from a perfectly separable totally ordered structure, we give an explicit construction of a separating countable decreasing scale, from which we show how to get a continuous utility map.

Déjà vu is the striking sense that the present situation feels familiar, alongside the realization that it has to be new. According to the Gestalt familiarity hypothesis, déjà vu results when the configuration of elements within a scene maps onto a configuration previously seen, but the previous scene fails to come to mind. We examined this using virtual reality technology. When a new immersive VR scene resembled a previously-viewed scene in its configuration but people failed to recall the previously-viewed scene, (...) familiarity ratings and reports of déjà vu were indeed higher than for completely novel scenes. People also exhibited the contrasting sense of newness and of familiarity that is characteristic of déjà vu. Familiarity ratings and déjà vu reports among scenes recognized as new increased with increasing feature-match of a scene to one stored in memory, suggesting that feature-matching can produce familiarity and déjà vu when recall fails. (shrink)

Many in academic bioethics worry that robust theological traditions, when articulated in the public square, damage the prospect of serious reflection about tough cases. Here we challenge that prevailing exclusion-by-default methodological impulse by correcting prevalent stereotypes about one particular Christian tradition that may offer relevant conceptual resources for bioethics. We briefly examine the man, John Calvin, and the Calvinist/Reformed Protestant tradition to show how it has been misconstrued in academic bioethics but can be reconstrued as a constructive, substantive theological starting (...) point for tough bioethical questions of our age. Core Calvinist doctrines about the nature of an all-sovereign God and human beings’ relation to that God, as well as related prominent themes from elements of the broader Reformed tradition, including the glory/sovereignty/majesty of God; the created goodness of the world; human beings as desiring/worshiping/image-bearing creatures; the pervasive influence of sin; the limitations of humanity for self-improvement; the completely gratuitous nature of redemption; the comprehensiveness of God’s redemptive purposes; and the pending final completion of his redemptive work could and should influence the tone and content of moral deliberation that can be a positive influence on twenty-first-century bioethics. (shrink)

Philosophical arguments often assume that the folk tends towards moral objectivism. Although recent psychological studies have indicated that lay persons’ attitudes to morality are best characterized in terms of non-objectivism-leaning pluralism, it has been maintained that the folk may be committed to moral objectivism _implicitly_. Since the studies conducted so far almost exclusively assessed subjects’ metaethical attitudes via explicit cognitions, the strength of this rebuttal remains unclear. The current study attempts to test the folk’s implicit metaethical commitments. We present results (...) of a newly developed Implicit Association Test (IAT) for metaethical attitudes which indicate that the folk generally tend towards moral non-objectivism on the implicit level as well. We discuss implications of this finding for the philosophical debate. (shrink)