Background Recent publications reveal shortcomings in evidence review and summarization methods for patient decision aids. In the large-scale "Share to Care (S2C)" Shared Decision Making (SDM) project at the University Hospital Kiel, Germany, one of 4 SDM interventions was to develop up to 80 decision aids for patients. Best available evidence on the treatments' impact on patient-relevant outcomes was systematically appraised to feed this information into the decision aids. Aims of this paper were to (1) describe how PtDAs are developed (...) and how S2C evidence reviews for each PtDA are conducted, (2) appraise the quality of the best available evidence identified and (3) identify challenges associated with identified evidence. Methods The quality of the identified evidence was assessed based on GRADE quality criteria and categorized into high-, moderate-, low-, very low-quality evidence. Evidence appraisal was conducted across all outcomes assessed in an evidence review and for specific groups of outcomes, namely mortality, morbidity, quality of life, and treatment harms. Challenges in evidence interpretation and summarization resulting from the characteristics of decision aids and the type and quality of evidence are identified and discussed. Conclusions Evidence reviews in this project were carefully conducted and summarized. However, the evidence identified for our decision aids was indeed a "scattered landscape" and often poor quality. Facing a high prevalence of low-quality, non-directly comparative evidence for treatment alternatives doesn't mean it is not necessary to choose an evidence-based approach to inform patients. While there is an urgent need for high quality comparative trials, best available evidence nevertheless has to be appraised and transparently communicated to patients. (shrink)

This brief essay describes the purpose, the content, and the development, by a group of Hastings Center fellows and a scholar at the Center, of the Hastings Center Bioethics Timeline. The timeline covers the wide range of contemporary events pertaining to the intersection of bioethics with the medical and biological sciences, health care, and health policy, as well as the medical arts and medical humanities. A collaborative effort that documents events in a collaborative field, the timeline is meant to be (...) updated and edited so that it improves over time. (shrink)

Scientific endeavor is the pursuit of knowledge with the aim of advancing the welfare of all human beings. This endeavor is built on the ideology of science; thus, society relies on the integrity of the practice of science and of scientists themselves. The responsible conduct of research is the essence of good science; however, many of the pedagogical approaches used to instill integrity in science accentuate the negative rather than exemplify ideal professionalism. This paper makes an argument for the inculcation (...) of the appropriate conduct of research via a positive approach. We address the acclimation to the culture of science that supersedes diverse cultural backgrounds of students. We suggest techniques for the implementation of positive strategies and reinforce the benefit of approaching the teaching of ethical behavior as a competitive advantage. We highlight ways in which this approach can empower the individual scientist and the scientific community as a whole. Transmission of the culture of scientific professionalism formalizes the aims of an ideal scientific professional and encourages assimilation and identification as a member of the scientific profession. We purport that instilling scientific professionalism will spur responsible conduct of research. (shrink)

WHO II low grade glioma evolves inevitably to anaplastic transformation. Magnetic resonance imaging is a good non-invasive way to watch it, by hemodynamic and metabolic modifications, thanks to multinuclear spectroscopy 1H/31P. In this work we study a multi-scale minimal model of hemodynamics and metabolism applied to the study of gliomas. This mathematical analysis leads us to a fast-slow system. The control of the position of the stationary point brings to the concept of domain of viability. Starting from this system, the (...) equations bring to light the parameters that push glioma cells out of their domain of viability. Four fundamental factors are highlighted. The first two are cerebral blood flow and the rate of lactate transport through monocarboxylate transporters, which must be reduced in order to push glioma out of its domain of viability. Another factor is the intra arterial lactate, which must be increased. The last factor is pH, indeed a decrease of intra cellular pH could interfere with glioma growth. These reflections suggest that these four parameters could lead to new therapeutic strategies for the management of low grade gliomas. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Robert Yerkes is a pivotal figure in American psychology and primatology in the first half of the twentieth century. As is well known, Yerkes first studied ape intelligence in 1915, on a visit to the private California laboratory of the psychiatrist Gilbert Hamilton, a former student. Less widely appreciated is how far the work done at the Hamilton lab, in its aims and ambitions as well as its techniques, served as a template for much of Yerkes’s research thereafter. This paper (...) uses the Hamilton–Yerkes relationship to re-examine Yerkes’s career and, more generally, that of American psychology in the early twentieth century. Three points especially are emphasized: first, the role of Freudian psychoanalysis as a spur to Hamilton’s experimental studies of ape intelligence; second, the importance of Hamilton’s laboratory, with its semi-wild population of monkeys and ape, as a model for Yerkes’s efforts to create a laboratory of his own; and third, the influence on Yerkes of Hamilton’s optimism about experimental psychological studies of nonhuman primates as a source of lessons beneficial to a troubled human world. (shrink)

The duality or separation of self and me is central to the thinking of Emmanuel Levinas, but it is difficult to understand, not least because of the powerful hold that John Locke’s account of personal identity still has on our thinking of the self. By drawing on Augustine and especially Jean-Luc Marion’s reading of Augustine in In the Self’s Place, it is possible to gain insight into Augustine’s not yet Lockean account of the self so as to arrive at (...) Levinas’s no longer Lockean account. (shrink)

This superb new translation of Nietzsche's mature masterpiece, Beyond Good and Evil, offers the most comprehensively annotated text, complemented by a lucid introduction by one of the most eminent of Nietzsche scholars, Robert C. Holub.

Essays on a wide range of areas and topics in Asian studies for scholars looking to incorporate Asia into their worldview and teaching. Contributors give contemporary presence to Asian studies through a variety of themes and topics in this multidisciplined and interdisciplinary volume. In an era of globalization, scholars trained in Western traditions increasingly see the need to add materials and perspectives that have been lacking in the past. Accessibly written and void of jargon, this work provides an adaptable entrée (...) to Asia for the integration of topics into courses in the humanities, social sciences, cultural studies, and global studies. Guiding principles, developed at the East-West Center, include noting uncommon differences, the interplay among Asian societies and traditions, the erosion of authenticity and cultural tradition as an Asian phenomenon as well as a Western one, and the possibilities Asian concepts offer for conceiving culture outside Asian contexts. The work ranges from South to Southeast to East Asia. Essays deal with art, aesthetics, popular culture, religion, geopolitical realities, geography, history, and contemporary times. “This volume truly lies at the intersection of scholarship and teaching. Each essay has the potential to help rethink approaches to scholarly issues, and there is a great deal of material for classroom discussion and examples. The book’s breadth—covering India, China, Korea, the Sea of Malay, Bhutan, and other locations—is impressive.” — Robert André LaFleur, Beloit College. (shrink)

One of the central worries raised in relation to ecological restoration concerns the problem of authenticity. Robert Elliot, for example, has argued that restoration “fakes nature.” On this view, restoration is like art forgery: it deceptively suggests that its product was produced in a certain way, when in fact, it was not. Restored landscapes present themselves as the product of “natural processes,” when in actuality, they have been significantly shaped by human intervention. For Elliott, there seem to be two sources (...) of inauthenticity in ecological restoration: first, the restored landscape is inauthentic because its natural genealogy has been disrupted by the intervention of humans: it has lost its authentic natural identity; second, the restored landscape is inauthentic because it pretends to be something it is not: it obscures its own history. We argue that the first sense of authenticity is problematic; however, the second concern—about obscuring history—is important. Case studies involving the naturalization of former military lands can be used to tease out more fully the ways in which landscapes can be “inauthentic” by misleading observers about their genealogy. In such landscapes, it is not departure from “the original” per se that is the source of inauthenticity; rather, restored landscapes fail to be authentic when they deceptively obscure critical elements of their past. (shrink)

Mathematics is one of the many domains where the adoption of a form of realism has traditionally been challenged. Behaviorism and phenomenalism, opposed to realism about, respectively, mental entities and the existence of material objects, are other well‐known examples. The realism debate, as initiated by Dummett's challenge, appears to have run its course, at least on its original terms, and difficulties have been raised with respect to both antirealist and anti‐antirealist readings of Wittgenstein within that debate. Realism about meaning did (...) not remain unchallenged, however, as successor debates took its place, surrounding Robert Brandom's “inferentialism” or Price's generalized form of quasi‐realism, called “pragmatism”. Brandom also espouses “non‐representationalism” and predictably made use of Wittgenstein, with a reading akin to Kripke's of the rule‐following argument. He was criticized by McDowell largely for failing to account for Wittgenstein's quietism. (shrink)

This review essay discusses two recent attempts to reform the framework in which issues of international and global justice are discussed: Iris Marion Young's ?social connection' model and the practice-dependent approach, here exemplified by Ayelet Banai, Miriam Ronzoni and Christian Schemmel's edited collection. I argue that while Young's model may fit some issues of international or global justice, it misconceives the problems that many of them pose. Indeed, its difficulties point precisely in the direction of practice dependence as it (...) is presented by Banai et al. I go on to discuss what seem to be the strengths of that method, and particularly Banai et al.'s defence of it against the common claim that it is biased towards the status quo. I also discuss Andrea Sangiovanni and Kate MacDonald's contributions to the collection. (shrink)

Der kürzlich verstorbene US-amerikanische Soziologe Robert K. Merton war der prominenteste und einflußreichste Anomie-Theoretiker nach Emile Durkheim. Seine Typologie der Arten individueller Anpassung an anomische gesellschaftliche Situationen bietet heute noch eine wertvolle Grundlage zur Analyse von Gesellschaften. Dieser Beitrag konzentriert sich auf einen dieser Anpassungstypen, den Ritualismus, der Merton zufolge beinhaltet, daß einerseits die kulturellen Ziele, allen voran das des wirtschaftlichen Wohlstands, heruntergeschraubt oder aufgegeben und andererseits die institutionellen Normen zur Erreichung dieser Ziele beinahe zwanghaft befolgt werden. Diese Definition überdenkend (...) versucht der vorliegende Beitrag herauszuarbeiten, daß innerhalb des Systems der Anpassungsformen das Herunterschrauben der kulturellen Ziele nicht das Hauptcharakteristikum ritualistischen, sondern konformen Verhaltens darstellt. Ritualisten haben den Prozeß des Herunterschraubens vielmehr bereits beendet, indem sie jegliche kulturellen Ziele aufgegeben haben, bis auf den einen Wert an sich, nämlich die institutionellen Regeln einzuhalten.Ritualistische Anpassung ist aus Merton`s Sicht für die Soziologie abweichenden Verhaltens, ganz zu schweigen von den Kriminalwissenschaften, nicht von Interesse. Im Gegensatz zu dieser Einschätzung versucht dieser Artikel die verschiedenen soziologischen und sogar kriminologischen Implikationen ritualistischen Verhaltens darzustellen, mit dem Ergebnis, daß Ritualismus sehr wohl ein soziales Problem darstellt. Der Ritualist unterwirft sich nicht nur selbst den institutionellen Normen, sondern fühlt sich auch dazu berufen, andere ständig an die Einhaltung der Regeln zu gemahnen und sie zu überwachen. Deshalb gibt es viele typisch ritualistische Formen abweichenden Verhaltens, wie Denunziation, erzieherischer Tadel oder Mobbing, die sogar in kriminelles Verhalten wie falsche Verdächtigung, Nötigung oder Beleidigung kulminieren können.Am schillerndsten ist die Rolle des Ritualisten in der Kriminalpolitik, nicht zuletzt heute in der Bundesrepublik. Repression jeglicher Art ist seine Antwort auf Regelverstöße und die Kriminalpolitik macht zunehmend Zugeständnisse an ritualistische Forderungen nach härterer und schnellerer Bestrafung oder umfassender Überwachung des öffentlichen Raumes. Ritualisten dominieren den sozialen Diskurs und die allgemeine Wahrnehmung von Kriminalität nicht nur, weil sie wichtige Nutzer und damit Zielgruppe gewisser Massenmedien sind und gerne Leserbriefe schreiben. Sie sind so dominant, weil ihre Art der Anpassung bei zunehmender wirtschaftlicher Krise die Konformität der Wirtschaftswunderzeit zurückgedrängt hat und heute die am weitesten verbreitete in der deutschen Gesellschaft ist. Daher ist auch die schon seit Jahrzehnten zu beobachtende Verschiebung der theoretischen Strafzweckbegründung hin zur Positiven Generalprävention alles andere als ein Zufall. The recently deceased US-sociologist Robert K. Merton has been the most prominent and influential anomie theorist since Emile Durkheim. His typology of modes of adaptation to anomic social situations still constitutes a valuable basis for analyzing society. This contribution focuses on one of these types of adaptation, ritualism, which according to Merton, involves the scaling down or abandoning of the cultural goals, above all economic wealth, on the one hand and to abide almost compulsively by institutional norms to attain these goals on the other. In reconsidering this definition, this contribution attempts to elaborate that within the system of adaptive modes scaling down does not describe the main characteristic of ritualistic behaviour, but first of all characterizes conformity. Ritualists, on the contrary, have already completed the process of scaling down by finally abandoning any cultural goal except the one end-in-itself, that is to comply with the institutional rules.Ritualistic adaptation, in Merton`s view, is of no interest to the sociology of deviant behaviour, not to mention criminal sciences. In contrast to this evaluation this contribution tries to delineate the various sociological and even criminological implications of ritualistic behaviour, leading to the conclusion that Ritualism does indeed present a social problem. The ritualist does not only surrender himself to the institutional means but feels competent to constantly reminding others of abiding by the institutional norms and supervising them. Hence there are many typically ritualistic forms of deviant behaviour like denunciation, disciplinary reproof or mobbing that may even culminate in criminal behaviour like false suspicion, duress or insult.Most ambiguous is the ritualist`s part in criminal policy, not at least in contemporary Germany. Repression of any kind is his answer to breaches of the rules and criminal policy more and more concedes to ritualistic demands for more severe and rapid punishment or extensive supervision of public facilities. Ritualists dominate the social discourse and general perception of criminality, not only because they are important users and therefore the target group of certain mass media, and like to write letters to the editor. They do dominate because in times of increasing economic crisis their mode of adaptation has forced back the conformity of the German economic miracle era and is now the most common one in contemporary German society. Thus, the shift in the theoretical justification of punishment towards a theory of positive general prevention, noticeable for decades, is anything but accidental. (shrink)

In a recent article, Iris Marion Young raises several challenges to deliberative democracy on behalf of political activists. In this paper, the author defends a version of deliberative democracy against the activist challenges raised by Young and devises challenges to activism on behalf of the deliberative democrat. Key Words: activism • deliberative democracy • Discourse • Ideology • public sphere • I. M. Young.

Recent structural innovations in global commerce present difficult challenges for legacy understandings of responsibility. The rise of outsourcing, sub-contracting, and mobile app-based platforms have dramatically restructured relationships between and among economic actors. Though not entirely new, the remarkable rise in the prevalence of these “not-quite-arm’s-length” relationships present difficulties for conceptions of responsibility based on interrogating the past for specifiable actions by blameworthy actors. Iris Marion Young invites investigation of a “social connection model of responsibility” (SCMR) that is, in many (...) ways, better suited to this new commercial reality. Scholars working to understand corporate responsibility have invoked Young’s model to some good effect, though often superficially and uncritically. In this paper, we look closely at Young’s social connection model and its potential for helping us understand corporate responsibility in a radically networked world. (shrink)

In a recent article, Iris Marion Young raises several challenges to deliberative democracy on behalf of political activists. In this paper, the author defends a version of deliberative democracy against the activist challenges raised by Young and devises challenges to activism on behalf of the deliberative democrat.

Dans le judaïsme, l'homme commence ses prières quotidiennes en remerciant Dieu de ne pas l'avoir fait femme. Il n'est pas étonnant alors de trouver les femmes juives reléguées au fond de la synagogue et exclues de tous les rites, ainsi que de toute prise de décision au sein de la communauté. Les domaines, que la tradition veut bien leur accorder, sont le foyer et la famille. Ainsi écartées (a priori) de la vie de la cité au sein de l'univers juif, (...) elles le sont aussi de l'historiograph... (shrink)

Existing economic models of prosociality have been rather silent in terms of proximate psychological mechanisms. We nevertheless identify the psychologically most informed accounts and offer a critical discussion of their hypotheses for the proximate psychological explanations. Based on convergent evidence from several fields of research, we argue that there nevertheless is a more plausible alternative proximate account available: the social motivation hypothesis. The hypothesis represents a more basic explanation of the appeal of prosocial behavior, which is in terms of anticipated (...) social rewards. We also argue in favor of our own social motivation hypothesis over Robert Sugden’s fellow-feeling account (due originally to Adam Smith). We suggest that social motivation not only stands as a proximate account in its own right but also provides a plausible scaffold for other more sophisticated motivations (e.g., fellow-feelings). We conclude by discussing some possible implications of the social motivation hypothesis on existing modeling practice. (shrink)

Can God be the efficient cause of himself (causa sui,)? It is well known that Descartes answers this question in the affirmative, but it is considerably less clear why. The main contention of the essay is that Descartes advances the causa sui doctrine because he came to think that the ontological proof of Meditation V required it. We argue these contentions through a close analysis of Descartes' initial articulation of causa sui in response to Caterus, followed by attention to the (...) reformulation of the doctrine in response to the logical objections posed by Arnauld. Our understanding of causa sui as a move made within the horizon of the ontological proof not only illuminates why Descartes would have defended a doctrine as conceptually problematic as causa sui, but also provides an alternative to Jean-Luc Marion's view that causa sui constitutes a third, distinct proof for the existence of God. /// Pode Deus ser a causa eficiente de si mesmo (causa sui,)? É bem sabido que Descartes responde aflrmativamente a esta questão, mas é consideravelmente menos claro porquê. O principal conteúdo do ensaio é que Descartes apresenta a doutrina da causa sui porque pensou que a prova ontológica da Meditação V precisava dela. Demonstramos estas afirmações através de uma análise rigorosa da articulação inicial de Descartes da causa sui em resposta a Caterus, seguida de uma atenção à reformulação da doutrina em resposta às objecções logicas apresentadas por Arnauld. A nossa compreensão da causa sui como proposta feita no horizonte da prova ontológica não ilumina apenas porque é que Descartes teria defendido uma doutrina conceptualmente tão problemática como a causa sui, mas também providencia uma alternativa ao ponto de vista de Jean-Luc Marion de que a causa sui constitui a terceira, prova distintapara a existência de Deus. (shrink)

What makes it hard to dance? Twentieth-century phenomenologists drew attention to the importance of the lived body, and dance is the art form for which the lived body is literally central. Why then isn’t dance the easiest art form to engage in? Phenomenologists are drawn to situations where a phenomenon breaks down, which can open insights into the phenomenon itself. Here the phenomenon is the ability to dance where one might normally expect to. This paper invokes Marion Milner’s book (...) On Not Being Able to Paint. It discusses views of David Kleinberg-Levin, Maxine Sheets-Johnstone, Iris Young, and others. Parallel to Heidegger’s notion of the Enframing, what causes the disappearing dimensions of animate formanimate form is the Interring. (shrink)

Some of the most invidious injustices are seemingly the results of impersonal workings of rigged social structures. Who bears responsibility for the injustices perpetrated through them? Iris Marion...

The first part of this essay presents Patrick Masterson’s exposition of the phenomenology of religion developed by Jean-Luc Marion, and his exposition of the Thomistic philosophy of religion. Masterson argues that phenomenology can be helpful as an analysis of faith and religious experience, but it remains within subjective immanence. It needs to be complemented by a metaphysical analysis that deals with causation and explanation, as Thomism does. The essay then makes three points: first, that phenomenology need not be limited (...) to the merely subjective domain nor need it fail to speak about being; second, that Thomistic “cognitional existence,” as developed by Joseph Owens, can be fruitfully compared with the domain studied by phenomenology as the analysis of being as truth; third, that the “saturated phenomena” introduced by Marion and used by Masterson involve categorial articulation and hence some initiative on the part of the knower, even in matters of religious faith. The essay discusses issues such as the nature of philosophical discourse, the differences between the modern and the premodern understandings of appearance; and the nature of cognitional existence in words and images. (shrink)

Global structural injustices are harms caused by structural processes, involving multiple individuals, acting across more than one state. Young (2011) developed the concept of ‘political responsibility,’ to allocate responsibility for structural injustice. In this paper, I am going to argue that when considering the climate crisis Young’s model needs to be adapted— to have agency as a basis for allocating political responsibility instead of contribution. This is a more intuitive way to allocate responsibility for the climate crisis given its nature (...) as a threshold problem, and the subtle structural positions occupied by the individuals involved. (shrink)

This chapter contains sections titled: Emmanuel Levinas Michel Henry Jacques Derrida Jean‐Luc Marion Jacques Derrida The Saturated Phenomenon According to Jean‐Luc Marion The Face According to Levinas The Auto‐Revelation of the Figure of Christ in Michel Henry.

In this article we argue that duties towards future generations are situated on the collective level and that they should be understood in terms of collective responsibility for structural injustice. In the context of climate change, it seems self‐evident that our moral duties pertain not only to the current generation but to future generations as well. However, conceptualizing this leads to the non‐identity problem: future persons cannot be harmed by present‐day choices because they would not have existed if other choices (...) had been made. Recently, Charlotte Franziska Unruh has proposed a solution that places the duties not on the individual level but on the collective level. The current generation has a responsibility for future generations as a whole. This solution is promising, but we argue that it problematically overlooks the existence of unjust relations within the contemporary collective, as we all contribute differently to bringing future generations into existence. Therefore, we propose to graft Iris Marion Young's Social Connection Model, which is concerned with structural injustice, on to the discussion of responsibility for future generations. Our proposal incorporates the strengths of Unruh's arguments, while also allowing for a differentiated responsibility based on different implications in unjust structures. (shrink)