Here is the story of Summerfield Grade School and Charles Kamm, a principal and teacher who devoted his entire professional career to this rural Illinois school. He created a school family, where each person was valued, and encouraged the development of a community family, where parents, grandparents, and citizens participated in the programs and activities of the school.

Objective: To present a narrative review of the history of bioethics in Latin America and of scientific output in this interdisciplinary field. Methods: This was a mixed-methods study. Results: A total of 1458 records were retrieved, of which 1167 met the inclusion criteria. According to the Web of Science classification, the predominant topics of study were medical ethics, social sciences and medicine, and environmental and public health topics. Four themes of bioethics output in the Latin American literature have emerged: issues (...) involving the beginning and end of life, ethics in human research, patient–provider relationships, and ethics training for health professionals. Conclusion: Although bioethics is a growing interdisciplinary field in Latin America, its academic impact is still very low, and programmes are highly concentrated in large urban centres in a few countries. Challenges includes the regional and international impact of local scientific output. (shrink)

In the future, policies surrounding end-of-life decisions will be faced with the question of whether competent people in a completely locked-in state should be enabled to make end-of-life decisions via brain-computer interfaces (BCI). This article raises ethical issues with acting through BCIs in the context of these decisions, specifically self-administration requirements within assisted suicide policies. We argue that enabling patients to end their life even once they have entered completely locked-in state might, paradoxically, prolong and uphold their quality of life.

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). (...) Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver “educational” talks to groups of physicians in the community to help market the company's brand-name drugs.Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic medical (...) centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver educational talks to groups of physicians in the community to help market the company's brand-name drugs. These speakers receive substantial compensation to lecture at events sponsored by pharmaceutical companies, a practice that has garnered attention, controversy, and scrutiny in recent years from legislators, professional associations, researchers, and ethicists on the issue of whether it is appropriate for academic physicians to serve in a promotional role. These relationships have (...) become so contentious that three years ago the pharmaceutical industry trade association, the Pharmaceutical Research and Manufacturers of America, adopted voluntary guidelines stating that drug companies should stop giving doctors free pens, calendars, sports bags, or tickets to entertainment events. Further, numerous medical associations, such as the Association of American Medical Colleges, the American Board of Internal Medicine and the Institute on Medicine as a Profession, and government bodies such as the Institute of Medicine have recommended that medical schools and teaching hospitals prohibit or strongly discourage faculty from participating in so-called industry Speakers Bureaus — promotional events designed solely to market pharmaceutical products. (shrink)

We describe the informed consent procedures in a research clinic in Santiago, Chile, and a qualitative study that evaluated these procedures. The recruitment process involves information, counseling and screening of volunteers, and three or four visits to the clinic. The study explored the decision‐making process of women participating in contraceptive trials through 36 interviews. Women understood the research as experimentation or progress. The decision to participate was facilitated by the information provided; time to consider it and to discuss it with (...) partners or relatives; and perceived benefits such as quality of care, non‐cost provision of methods and medical care. For some women, participation was an opportunity to express altruism. The main obstacles for participation were perceived side effects or risks. The final risk‐benefit balance was strongly influenced by women’s needs. Women perceived that the consent form benefited the clinic, proving that participants had made a free decision, and benefited the volunteers by warranting their right to free medical care. The most important problem detected was occasional misunderstanding of the information given on the form. We concluded that a full decision‐making process enhances women’s ability to exercise their right to choose, and assures research institutions that trials are conducted without coercion and that the participants are committed to the study. Researchers have the responsibility of conducting this process. (shrink)

BackgroundEvaluation of decision-making capacity to consent to medical treatment has proved to be difficult in patients with dementia. Studies showed that physicians are often insufficiently trained in the evaluation of decision-making capacity. In this study, we present findings from a secondary analysis of a qualitative interviews with physicians. These interviews were initially used to assess usability of an instrument for the evaluation of decision-making capacity. By looking at difficult cases of decision-making capacity evaluation in patients with dementia, we provide recommendations (...) for such evaluations in clinical practice.MethodsWe used thematic coding to analyse physicians’ narratives of problematic decision-making capacity evaluations in patients with dementia to uncover challenging issues of decision-making capacity evaluation.ResultsIn this study, decision-making capacity evaluations in patients with dementia were mainly perceived as challenging when they pertained to treatment refusals and treatment unrelated circumstances, such as psychiatric consultation, advance directives, and new living arrangements. Furthermore, the physicians reported training needs regarding situation-independent challenges with decision-making capacity evaluation.ConclusionsUpon further examining self-reported training needs and challenging cases, we have developed recommendations to improve decision-making capacity evaluations in clinical practice. In these recommendations, we argue that being able to evaluate decision-making capacity is an integral part of the informed consent process. (shrink)

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multi- and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about (...) what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods-mixing), and incorporating the empirical study of compassion into fields in which it may be missing. (shrink)

The emphasis on duly in Kant's ethics is widely held to constitute a defect. Marcia W. Baron develops and assesses the criticism, which she sees as comprising two objections: that duty plays too large a role, leaving no room for the supererogatory, and that Kant places too much value on acting from duty. Clearly written and cogently argued, Kantian Ethics Almost without Apology takes on the most philosophically intriguing objections to Kant's ethics and subjects them to a rigorous yet (...) sympathetic assessment. (shrink)

Gideon Rosen (2014) has drawn our attention to cases of duress of a particularly interesting sort: the person's ‘mind is not flooded with pain or fear’, she knows exactly what she is doing, and she makes a clear-headed choice to act in, as Rosen says, ‘awful ways’. The explanation of why we excuse such actions cannot be that the action was not voluntary. In addition, although some duress cases could also be viewed as necessity cases and thus as justified, Rosen (...) wisely sets aside that complicating factor by zeroing in on those cases where the action clearly is not justified. So why do we excuse in these cases, where the action is not justified and the agent acted voluntarily?Rosen thinks the key lies in the ‘ill will’ condition, ‘the idea that an act is blameworthy only if it manifests insufficient concern or regard for those affected’. He says this is relatively uncontroversial; much of my paper is taken up with calling the ‘ill will’ condition into question. I also take issue with Rosen on just how justifications and excuses differ. I argue in favour of understanding justifications (in a context where we are asking how justifications and excuses differ) as not requiring truth, but only reasonable belief. (shrink)

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT®, a contemplative intervention that is increasingly (...) used for both inter- and intrapersonal flourishing. The participants in this study were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself. (shrink)

Friends as well as foes of Kant have long been uneasy over his emphasis on duty, but lately the view that there is something morally repugnant about acting from duty seems to be gaining in popularity. More and more philosophers indicate their readiness to jettison duty and the moral 'ought' and to conceive of the perfectly moral person as someone who has all the right desires and acts accordingly without any notion that (s)he ought to act in this way. Elsewhere' (...) I have argued that such a picture of the perfectly moral person is flawed. In this paper I examine the claim that acting from duty is morally repugnant. There is some truth to this charge, but, I argue, the repugnance attaches not to acting from duty as such, but only to certain ways of acting from duty. In isolating the objectionable elements of acting from duty, I hope not only to vindicate the skeletal concept but also to offer illumination on the question of just how we should understand morally good conduct. (shrink)

Background This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received.Methods We adapted democratic deliberation, an approach to stakeholder engagement, for use with (...) three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation.Results A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement.Conclusion The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described. (shrink)

What is the relation between shame and shamelessness? It may seem obvious: shamelessness is simply the absence of shame. But on reflection, it becomes clear that the story is considerably more complicated. Michelle Mason's intriguing "On Shamelessness" prompts such reflection. Mason argues that we should be mindful of the "moral importance of shame" and "unapologetic in its defense", and she does so via an examination of shamelessness and an argument to the effect that shamelessness is a moral fault. The tacit (...) assumption is that insofar as shamelessness is a moral fault, the value of shame is vindicated. I challenge that assumption. (shrink)

Hume scholars have been anxious to point out that when Hume calls Justice, chastity and so on artificial virtues, he is in no way denying that they are real virtues. I shall argue that they are mistaken, and that anyone who wants to understand Hume's account of Justice and his category of artificial virtues must take seriously his choice of the word ‘artifice,’ recognizing that it means not only ‘Skill in designing and employing expedients,’ but also ‘address, cunning, trickery.'My suggestion (...) will seem strange given Hume's own repeated plea that we not take the term ‘artifice’ too seriously. Yet while it is generally good policy to take people - at least philosophers - at their word, this is a Justified exception, Justified not only by Hume's known proclivities to irony and subtlety, but also by the implications of hearkening to his plea. To see the implications of not taking the terms ‘artificial’ and ‘artifice’ seriously, one can read either Duncan Forbes’ or Barry Stroud's criticisms of Hume's account of Justice. (shrink)

While sociologists and political scientists have become interested in the role of ideas in the political process, relatively little work looks at how ideological claims are actually deployed in political discourse. This article examines the economic claims made in two pairs of Congressional debates over tax cuts, one generally associated with Keynesian economic theories, and one tied to supply-side ideas. While these bills were indeed initiated by groups subscribing to different economic ideologies, subsequent debates look surprisingly similar. The bills were (...) closer in substance than one might expect, and while their proponents came from opposite political camps, in both cases supporters focused more on supply-side than demand-side effects and emphasized tax cuts’ ability to pay for themselves through economic stimulation. The authors propose that politically acceptable economic claims may evolve more slowly than the economic theories that inspire policy entrepreneurs, and that this “discursive opportunity structure” may not only constrain the political process but may potentially shape the political effects of expert knowledge. (shrink)

Recent scholarship in science, technology, and society has emphasized the neoliberal character of science today. This article draws on the history of US science and technology policy to argue against thinking of recent changes in science as fundamentally neoliberal, and for thinking of them instead as reflecting a process of “economization.” The policies that changed the organization of science in the United States included some that intervened in markets and others that expanded their reach, and were promoted by some groups (...) who were skeptical of free markets and others who embraced them. In both cases, however, new policies reflected growing political concern with “the economy” and related abstractions and a new understanding of S&T as inputs into a larger economic system that government could manipulate through policy. Understanding trends in US S&T policy as resulting from economization, not just neoliberalism, has implications for thinking about the present and likely future of science and S&T policy. (shrink)

Marcia Cavell draws on philosophy, psychoanalysis, and the sciences of the mind in a fascinating and original investigation of human subjectivity. A "subject" is a creature, we may say, who recognizes herself as an "I," taking in the world from a subjective perspective; an agent, doing things for reasons, sometimes self-reflective, and able to assume responsibility for herself and some of her actions. If this is an ideal, how does a person become a subject, and what might stand in (...) the way? One of Marcia Cavell's guiding premises is that philosophical investigation into the specifically human way of being in the world cannot separate itself from investigations of a more empirical sort. Cavell brings together for the first time reflections in philosophy, findings in neuroscience, studies in infant development, psychoanalytic theory, and clinical vignettes from her own psychoanalytic practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:25 MORALITY AS A BACK-UP SYSTEM: HUME'S VIEW? The sense of duty is a useful device for helping men to do what a really good man would do without a sense of duty..... Nowell-Smith A certain picture of morality — arguably a Humean one — has come to have a prominent place in contemporary philosophy. On this picture, morality, as Richard Brandt asserts, is "a back-up system, which operates (...) when spontaneous personal caring fails 2 to motivate us to do as we ought." Morality — at least in the form of moral principles, whose force is felt through one's sense of duty — is, on this view, ideally superfluous. As a guide for one's own conduct it is needed only insofar as the agent's affective network is deficient. If one only spontaneously desired a, cared about b, cared for c, felt aversion towards d as, ideally, one should, moral principles and a sense of duty would be of no use. There are good reasons for supposing that this is Hume's view. After all, his characterization of acting from duty is more than a little disparaging: When any virtuous motive or principle is common in human nature, a person, who feels his heart devoid of that motive, may hate himself upon that account, and may perform the action without the motive, from a certain sense of duty, in order to acquire by practice, that virtuous principle, or at least, to disguise to himself,,as much as possible, his want of it. I will argue, however, that there is tension in Hume's ethics between two lines of thought. According to the first line of thought, and the one 26 usually associated with Hume, good conduct is conduct which is spontaneously prompted by virtuous desires. Unless our desires either are not what they should be or are motivationally weak, there is no need for mediation or tempering by a sense of duty or moral principles. According to the second line, the very good desires of a very good person may nonetheless need to be filtered, tempered, redirected or checked. This line is most evident in "Of the Origin of the Natural Virtues and Vices." Before arguing that these strains of thought are in tension in Hume's ethics, I need to clarify what is at issue and to develop the two competing pictures of moral motivation. First the issue. The issue is not 'Who is better: someone with a sense of duty but corrupt desires or someone with no sense of duty but ideal desires?' Nor is the issue one of the moral worth of actions ('Can an action have moral worth if it is not performed out of duty?') The issue, rather, is how to characterize morally good (or right) conduct. What role, if any, does a sense of duty or a Butlerian principle of reflection, i.e., an overarching, guiding conception of what is right or good which is 'juridically' supreme within the self, play in good conduct? Is morally good conduct ideally a matter of acting as one should from the proper desires? Or should the desires be governed and guided by moral principles? Consider two models of moral conduct. Model I: Morality as a Back-Up System On this picture, wrongness in conduct is traceable to an affective deficiency. The claim underlying this picture seems to be as follows: One 27 acts wrongly because one's passions are not quite what they should be. One person cheats in her business dealings because she cares too little about the welfare of others (and too much about her own); another is harsh and abrupt to a student because he cares too little about his students' concerns and is jealous and possessive when it comes to 'his time.' In each case the problem can be traced to an affective deficiency. Hume appears to be supporting this view when he asserts, "it may be establish'd as an undoubted maxim, that no act can be virtuous, or morally good, unless there be in human nature some motive to produce it, distinct from a sense of its morality' (T 479). A few pages later he writes, "[E]very immorality... (shrink)

Anniversaries and funding crises prompt periodic calls to reevaluate the mission and public perceptions of the U.S. Land-Grant University system. One such call was issued by the Kellogg Commission on the Future of State Colleges and Land Grant Universities in their 1999 report, “Returning to Our Roots: the Engaged Institution.” Written by leaders of state universities and land-grant colleges, this report urges these institutions to engage more authentically and equitably in two-way relationships with their local constituents. Twenty years later, Land-Grant (...) Universities continue to struggle with building widespread public support for their missions and equitable involvement in research, teaching, and extension functions across diverse constituencies. While largely discounted by the Kellogg Commission, a fresh look at the role originally envisioned for the extension arm of the trifold land-grant mandate suggests that we may be conceiving of this system too narrowly. The establishment of statewide extension systems was once seen as a way to ensure that Land-Grant Universities would be accessible and responsive to all of a state’s residents. Extension systems continue to offer a front-door to a major public university in almost every county of the United States, but they tend to be viewed primarily as a way to translate science or distribute information from the university to the public. This discussion uses a historical and modern lens to reimagine the role that Extension could potentially play in catalyzing reciprocal, co-learning relationships between Land-Grant Universities and their diverse local constituencies. (shrink)

Wives contribute both directly and indirectly to their husbands' careers. For men in some occupations, wives' contributions should lead to higher salaries. In addition, if wives who are not employed contribute more to their husbands' careers than employed wives, men with nonemployed wives should enjoy greater financial benefits than men with employed wives. This study examines data for a national sample of faculty men to determine whether marital status and wives' employment appear to affect men's salary levels. Findings reveal a (...) monotonic increase in earnings corresponding to the hypothesized levels of contributions that men received from wives: men with employed wives had higher salaries than never-married men, while men with nonemployed wives had the highest salaries. This pattern is partly attributable to differences in employment characteristics and achievement levels between these categories of men. However, a direct relationship between salary, and marital status and wives' employment remains after controlling many variables known to affect faculty salaries. (shrink)

Roche, Marcia Sectarianism has been defined as 'adherence or excessive devotion to a particular religious denomination or sect'.1 However, as Kildea notes, dictionary definitions of the term fail to square with its 'distinctive' meaning in the Australian context.2A more accurate representation of the Australian connotation is conveyed by Hogan, who says that it refers to 'the hostility between different churches or "sects" which has manifested itself in the wider arena of social and political conflict'.3 The social, political and economic (...) discrimination and exclusion that has existed in Australia between Catholics and Protestants was most intense from the beginning of European settlement until the 1960s, when the Catholic Church's endorsement of ecumenism offered a means of positive engagement with members of other Christian denominations. (shrink)

Justifications and excuses are defenses that exculpate. They are therefore much more like each other than like such defenses as diplomatic immunity, which does not exculpate. But they exculpate in different ways, and it has proven difficult to agree on just what that difference consists in. In this paper I take a step back from justification and excuse as concepts in criminal law, and look at the concepts as they arise in everyday life. To keep the task manageable, I focus (...) primarily on excuses and excusing activities, distinguishing them from justifications as well as from other close relatives, in particular, forgiving and pardoning. I draw upon J.L. Austin’s classic A Plea for Excuses, but expand on his account, suggesting that we offer excuses for reasons besides those he mentions. My hope is that my examination of excuses and excusing activities will help us rethink our views on just how justifications and excuses differ, views which often are worked out without much attention to how these concepts function in everyday life and to the connection between offers of excuses and justifications and the rules of civility. (shrink)