BackgroundThere are numerous ethical challenges that can impact patients and families in the health care setting. This paper reports on the results of a study conducted with a panel of clinical bioethicists in Toronto, Ontario, Canada, the purpose of which was to identify the top ethical challenges facing patients and their families in health care. A modified Delphi study was conducted with twelve clinical bioethicist members of the Clinical Ethics Group of the University of Toronto Joint Centre for Bioethics. The (...) panel was asked the question, what do you think are the top ten ethical challenges that Canadians may face in health care? The panel was asked to rank the top ten ethical challenges throughout the Delphi process and consensus was reached after three rounds.DiscussionThe top challenge ranked by the group was disagreement between patients/families and health care professionals about treatment decisions. The second highest ranked challenge was waiting lists. The third ranked challenge was access to needed resources for the aged, chronically ill, and mentally ill.SummaryAlthough many of the challenges listed by the panel have received significant public attention, there has been very little attention paid to the top ranked challenge. We propose several steps that can be taken to help address this key challenge. (shrink)

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

Research on women's preponderance among animal rights advocates explains it exclusively as a product of women's socialization, emphasizing a relational orientation of care and nurturing that extends to animals. The authors propose a more structural explanation: Women's experiences with structural oppression make them more disposed to egalitarian ideology, which creates concern for animal rights. Using data from a 1993 national sample, the authors find that an egalitarian gender ideology is a key difference in women's and men's routes to animal rights (...) advocacy: It differentiates those more likely to endorse animal rights among women but not among men. Neither this ideology nor other variables in the analysis, however, account for women's greater overall support of animal rights in the combined sample. Reasons for this latter finding are explored. (shrink)

This paper provides a description of the role of the clinical ethicist as it is generally experienced in Canada. It examines the activities of Canadian ethicists working in healthcare institutions and the way in which their work incorporates more than ethics case consultation. The Canadian Bioethics Society established a Taskforce on Working Conditions for Bioethics (hereafter referred to as the Taskforce), to make recommendations on a number of issues affecting ethicists and to develop a model role description. This essay carefully (...) assesses this model role description. (shrink)

This paper provides a description of the role of the clinical ethicist as it is generally experienced in Canada. It examines the activities of Canadian ethicists working in healthcare institutions and the way in which their work incorporates more than ethics case consultation. The Canadian Bioethics Society established a “Taskforce on Working Conditions for Bioethics” (hereafter referred to as the Taskforce), to make recommendations on a number of issues affecting ethicists and to develop a model role description. This essay carefully (...) assesses this model role description. (shrink)

Background: Mild traumatic brain injury results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within (...) the brain.Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population.Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations.Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial.Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279. (shrink)

Firms are under increasing pressure from external forces to do what is right and behave ethically. However, we have only a limited understanding of how ethical and responsible business practices impact the value of the firm, both in the short and the long term. In this study, we examine 196 firms that were recognized as the world's most ethical firms from 20 countries over a 14-year span. Results show that ethical behavior may have little effect on a firm's profitability in (...) the short term. However, it has a positive effect on a firm's market value, reflecting the market's positive assessment of its long-term performance. We also find that firms frequently listed among the world's most ethical companies tend to have higher market value than firms listed only once. (shrink)

The deontic model of justice and ethical behavior proposes that people care about justice simply for the sake of justice. This is an important consideration for business ethics because it implies that justice and ethical behavior are naturally occurring phenomena independent of system controls or individual self-interest. To date, research on the deontic model and third-party reactions to injustice has focused primarily on individuals’ tendency topunishtransgressors. This research has revealed that witnesses to injustice will consider sacrificing their own resources if (...) it is the only way to sanction an observed transgressor. In this paper we seek to extend this model by arguing that punishment may not be the only “deontic” reaction, and that in fact, third-party observers of injustice may engage in moral self-regulation that would lead them to conclude that the most ethical response is to do nothing. We provide preliminary evidence for our propositions using voiced cognitions data collected during a resource allocation task. Results indicate that deonance may be more complex than originally thought, and previous tests of the model conservative in nature. (shrink)

In recent years, protesters around the world have been calling for the removal of commemorations honouring those who are, by contemporary standards, generally regarded as seriously morally compromised by their racism. According to one line of thought, leaving racist memorials in place is profoundly disrespectful, and doing so tacitly condones, and perhaps even celebrates, the racism of those honoured and memorialized. The best response is to remove the monuments altogether. In this article, I first argue against a prominent offense-based account (...) of the wrong of simply leaving memorials in place, unaltered, before offering my own account of this wrong. In at least some cases, these memorials wrong insofar as they express and exemplify a morally objectionable attitude of race-based contempt. I go on to argue that the best way of answering this disrespect is through a process of expressively ‘dehonouring’ the subject. Removal of these commemorations is ultimately misguided, in many cases, because removal, by itself, cannot adequately dishonour, and simple removal does not fully answer the ways in which these memorials wrong. I defend a more nuanced approach to answering the wrong posed by these monuments, and I argue that public expressions of contempt through defacement have an ineliminable role to play in an apt dishonouring process. (shrink)

“I don’t believe what people say to me, I believe the way they say it,” Christian Bobin said. “This is where the sonic is located, in the manner of speaking, in the way in which bodies move and silences occur.”It would be hard to argue that sound is something the public or professionals, whose work is to create sound, actually think about carefully and consciously, as strange as this might seem. Sound in film is rarely addressed from a theoretical perspective. (...) Few books are dedicated to it beyond purely technical works, and those do not often consider the aesthetic conditions of sound production. The question of the existence of sound is abandoned in favor of normalizing procedures for producing it, absent any... (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Recent scholarship on John Stuart Mill has illuminated his arguments about the normative legitimacy of imperial rule. However, it has tended to ignore or downplay his extensive writings on settler colonialism: the attempt to create permanent "civilized" communities, mainly in North America and the South Pacific. Mill defended colonization throughout his life, although his arguments about its character and justification shifted over time. While initially he regarded it as a solution to the "social problem" in Britain, he increasingly came to (...) argue that its legitimacy resided in the universal benefits—civilization, peace, and prosperity—it generated for humanity. In the final years of his life Mill seemed to lose faith in the project. Finally recognizing the prevalence of colonial violence and the difficulty of realizing his grand ambitions, yet refusing to give up on colonization altogether, his colonial romance gave way to a form of melancholia. (shrink)

Forgiveness seems especially apt in cases where the wrongdoer first performs some act of reparation. Suppose Valerie betrays Madison's trust out of careerist self-interest. The betrayal is serious, no excusing or exempting conditions obtain, and Madison responds with justified resentment. In one world, Valerie never acknowledges the impropriety of her past act and continues on as before. In another world, Valerie apologizes and sends Madison a beautiful bouquet of flowers. All else being equal, forgiveness seems called for or apt in (...) the second case in a way that it does not in the first. Reparative activities have a certain power, and forgiving in response to the wrongdoer's reparation strikes many as especially apt. (shrink)

Moral stress is an increasingly significant concept in business ethics and the workplace environment. This study compares the impact of moral stress with other job stressors on three important employee variables—fatigue, job satisfaction, and turnover intentions—by utilizing survey data from 305 customer-contact employees of a financial institution’s call center. Statistical analysis on the interaction of moral stress and the three employee variables was performed while controlling for other types of job stress as well as demographic variables. The results reveal that (...) even after including the control variables in the statistical models, moral stress remains a statistically significant predictor of increased employee fatigue, decreased job satisfaction, and increased turnover intentions. Implications for future research and for organizations are discussed. (shrink)

The last few years have seen an explosion of medieval images in digital form, chiefly as a result of photo-library and manuscript digitisation projects. An entire corpus of images, even selected solely by scene or iconography, becomes an unwieldy object of study by traditional art-historical means. This is even more the case for medieval images, where authorship and dating are often cloudy and unclear, and the image itself is in many cases the first resource for scholarly inquiry.We take the digital (...) image – in particular, the digital image of the body – as our object of study in a wide-ranging computationally-augmented reading of an image-corpus; ours is made up of thousands of depictions of the ‘Annunciation’ and ‘Baptism’, selected not only for their primacy in Christian art but for their dialogical interaction. Our corpus of 6,564 ‘Annunciations’ and 883 ‘Baptisms’, whilst not necessarily representative in density, includes a wide range of stylistic, theological and historical tendencies.We computationally extract not only body images but poses, gestures and interactions. Such a range of gestures allows for a morphological treatment of bodily motifs, whose multi-dimensional, quantitative nature allows us to complicate and problematise iconographic taxonomies, populating the spaces between categories. Finally, our gestural manifolds provide a morphological pointer to dissecting the microtemporalities of the scenes, and their relative dynamics and inconsistencies. (shrink)

Dear Jacques Derrider,Today is my birthday. I received a considerable number of messages, almost all written and sent by computer programs. Because most of my contacts have died, or else they are too busy to write me.I'm not bothered by the fact that these letters were written by programs. I am troubled, however, when they remind me of all of those who have died. And especially when I am no longer able to distinguish between the programs that speak for the (...) living and those that speak for the dead.These digital mummies are called necrobots. The archive of conversations of the deceased person serves as a training database for a neural network. Once it is deployed in the email and social network accounts of the... (shrink)

Why did Bernhard Riemann, arguably the most original mathematician of his generation, spend the last year of life investigating the mechanism of hearing? Fighting tuberculosis and the hostility of eminent scientists such as Hermann Helmholtz, he appeared to forsake mathematics to prosecute a case close to his heart. Only sketchy pages from his last paper remain, but here we assemble some significant clues and triangulate from them to build a broad picture of what he might have been driving at. Our (...) interpretation is that Riemann was a committed idealist and from this philosophical standpoint saw that the scientific enterprise was lame without the “poetry of hypothesis”. He believed that human thought was fundamentally the dynamics of “mind-masses” and that the human mind interpenetrated, and became part of, the microscopic physical domain of the cochlea. Therefore, a full description of hearing must necessarily include the perceptual dimensions of what he saw as a single manifold. The manifold contains all the psychophysical aspects of hearing, including the logarithmic transformations that arise from Fechner’s law, faithfully preserving all the subtle perceptual qualities of sound. For Riemann, hearing was a unitary physical and mental event, and parallels with modern ideas about consciousness and quantum biology are made. A unifying quantum mechanical model for an atom of consciousness—drawing on Riemann’s mind-masses and the similar “psychons” proposed by Eccles—is put forward. (shrink)

It is estimated that more than half of all online transactions are abandoned before completion. This paper investigates the psychological factors that influence online shopping behavior, with a view to improving transactional success rates. Through a critical review of the literature, we identify a range of factors which predict abandonment of online shopping, highlighting affective and motivational dimensions in addition to processing style and characteristics of the consumer, device, and product. We conclude that online purchasing and payment systems that boost (...) consumers’ motivation to buy and prevent or attenuate negative affective states will demonstrate the greatest rates of transactional success. However, with rapid advancement in technology, continued research is needed to fully understand the potential impact on future online purchasing behavior. (shrink)

This narrative provides insight into medical education for Black physicians in South Carolina in the 1960s, during the civil rights movement. It also discusses the many rewards and challenges of being a physician of color, describes what has been done to develop programs that benefit minority communities, and argues that more such programs are needed.

Based upon research done by evolutionary psychologists into the reason why human beings feel depression in social situations, I argue that philosophers have significant warrant to consider depression as an important feature conditioning moral imagination. The moral imagination come up with new enterprises and new ways of organizing social life. This reorganization would meet many of the goals put forth by pragmatist philosopher John Dewey. I argue that depression will work as a leading clue and unique imaginative “space” to reconstruct (...) various social situations. (shrink)