RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

This textbook brings the humanities to students in order to evoke the humanity of students. It helps to form individuals who take charge of their own minds, who are free from narrow and unreflective forms of thought, and who act compassionately in their public and professional worlds. Using concepts and methods of the humanities, the book addresses undergraduate and premed students, medical students, and students in other health professions, as well as physicians and other healthcare practitioners. It encourages them to (...) consider the ethical and existential issues related to the experience of disease, care of the dying, health policy, religion and health, and medical technology. Case studies, images, questions for discussion, and role-playing exercises help readers to engage in the practical, interpretive, and analytical aspects of the material, developing skills for critical thinking as well as compassionate care. (shrink)

The suggested citation for this white paper is: University of Waterloo Working Group on Bibliometrics, Winter 2016. White Paper: Measuring Research Outputs through Bibliometrics, Waterloo, Ontario: University of Waterloo.

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

The aim of this article is to explain the transition from implicit CSR to explicit CSR that has taken place in Scandinavia over the last two decades. Matten and Moon’s distinction between implicit and explicit CSR is the point of departure for the analysis, which is based on case studies of two Norwegian companies: HÅG and Hydro. On the basis of these case studies, we identify two forces that are pushing the transition from implicit to explicit CSR in Scandinavia: Organizational (...) expressiveness and Re-legitimizing. Both of these measures are adjustments to the globalization of the economy, altering the competitive situation even in highly institutionalized, Scandinavian economies. HÅG, a midsized Norwegian manufacturer of office chairs, made CSR and environmental values an integral part of their expressive strategy in the early 1990s. Hydro, a big Norwegian aluminium producer, made CSR an explicit issue around the turn of the millennium, in an attempt to re-legitimize their business operations in a new market situation where plants in local communities in Norway were shut down and relocated to less regulated regimes in low-cost regions abroad. (shrink)

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 post-menopausal women (...) newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

Symbolic arithmetic is fundamental to science, technology and economics, but its acquisition by children typically requires years of effort, instruction and drill1,2. When adults perform mental arithmetic, they activate nonsymbolic, approximate number representations3,4, and their performance suffers if this nonsymbolic system is impaired5. Nonsymbolic number representations also allow adults, children, and even infants to add or subtract pairs of dot arrays and to compare the resulting sum or difference to a third array, provided that only approximate accuracy is required6–10. Here (...) we report that young children, who have mastered verbal counting and are on the threshold of arithmetic instruction, can build on their nonsymbolic number system to perform symbolic addition and subtraction11–15. Children across a broad socio-economic spectrum solved symbolic problems involving approximate addition or subtraction of large numbers, both in a laboratory test and in a school setting. Aspects of symbolic arithmetic therefore lie within the reach of children who have learned no algorithms for manipulating numerical symbols. Our findings help to delimit the sources of children’s difficulties learning symbolic arithmetic, and they suggest ways to enhance children’s engagement with formal mathematics. We presented children with approximate symbolic arithmetic problems in a format that parallels previous tests of non-symbolic arithmetic in preschool children8,9. In the first experiment, five- to six-year-old children were given problems such as ‘‘If you had twenty-four stickers and I gave you twenty-seven more, would you have more or less than thirty-five stickers?’’. Children performed well above chance (65.0%, t1952.77, P 5 0.012) without resorting to guessing or comparison strategies that could serve as alternatives to arithmetic. Children who have been taught no symbolic arithmetic therefore have some ability to perform symbolic addition problems. The children’s performance nevertheless fell short of performance on non-symbolic arithmetic tasks using equivalent addition problems with numbers presented as arrays of dots and with the addition operation conveyed by successive motions of the dots into a box (71.3% correct, F1,345 4.26, P 5 0.047)8.. (shrink)

State health departments are at the core of the United States public health infrastructure. Surveillance to monitor trends in disease and injury; the development, coordination, and delivery of services; and public education are some of the core functions health department employees oversee every day. As such, agencies and their employees are well positioned to inform policy decisions that affect the public’s health. However, little is known about the role of health department staff — a sizeable proportion of the public health (...) workforce — as advocates for public health policies, independent of their agency roles. Anecdotally, some health department employees with whom we have spoken expressed reluctance to engage in policy advocacy for fear of violating little known or understood agency or state rules. (shrink)

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do not lose (...) the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

_Essays on Beauvoir’s influences, contemporary engagements, and legacy in the philosophical tradition._.

Volume 19, Issue 9, September 2019, Page 54-56.

Christians look to Scripture to inform their ethical decision-making, believing that God speaks through it. However, disagreement as to what the Bible requires us to do can often lead to acrimonious splits within the church. So long as sharp divisions amongst Christians over ethical issues remain, injustices continue, and the reputation of the church is undermined. This article suggests that lessons may be learned from the story of the use of the Bible in the American Abolitionism debate which can help (...) the contemporary church to discuss and perhaps even resolve some enduring ethical questions which are dividing Christians today. (shrink)

Hedgehog (Hh) signaling is a widely studied signaling pathway because of its critical roles during development and in cell homeostasis. Vertebrate canonical and non‐canonical Hh signaling are typically assumed to be distinct and occur in different cellular compartments. While research has primarily focused on the canonical form of Hh signaling and its dependency on primary cilia – microtubule‐based signaling hubs – an extensive list of crucial functions mediated by non‐canonical Hh signaling has emerged. Moreover, amounting evidence indicates that canonical and (...) non‐canonical modes of Hh signaling are interlinked, and that they can overlap spatially, and in many cases interact functionally. Here, we discuss some of the many cellular effects of non‐canonical signaling and discuss new evidence indicating inter‐relationships with canonical signaling. We discuss how Smoothened (Smo), a key component of the Hh pathway, might coordinate such diverse downstream effects. Collectively, pursuit of questions such as those proposed here will aid in elucidating the full extent of Smo function in development and advance its use as a target for cancer therapeutics. (shrink)

Interpreters are less univocal than one might think in assessing Søren Kierkegaard's attitude toward eudaimonism. Through an analysis of several key texts from across Kierkegaard's authorship, I argue that existing interpretations do not convincingly address the relationship between Kierkegaard's critique of eudaimonism and his mid-nineteenth-century context, which was dominated by post-Kantian idealists. While I am sympathetic to aspects of deontological and aretaic interpretations, a contextual reading shows that his critique centers on what he diagnoses as the enclosure of the modern (...) self. This puts his critique of eudaimonism in the purview of his moral psychology and in continuity with his critique of romanticism. (shrink)

This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking (...) about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (shrink)

An Institute of Medicine panel charged with reviewing the system for overseeing research involving children concluded in 2004 that Institutional Review Boards, institutions engaged in research, and study sponsors should “adopt explicit written policies on acceptable and unacceptable types and amounts of payments related to [children’s] research participation.” We previously reported data on practices and policies in the U.S. regarding payments to children who participate in research and their parents. Here, we report additional results from our study and identify some (...) of the decisions that must be made in developing payment plans and on which payment policies will be expected to offer guidance. We conclude that further conceptual analysis and empirical research are necessary before IRBs, institutions, and sponsors can develop specific rules on numerous aspects of payment. Nevertheless, payment policies that promote the ethical treatment of children in research and their parents can be developed. We propose a structure for such policies. (shrink)

How should we distinguish between ethical and unethical ways of pursuing profit in a market? The market failures approach (MFA) to business ethics purports to provide an answer to this question. I argue that it fails to do so. The source of this failure is the MFA’s reliance on Pareto efficiency as a core ethical principle. Many ethically “preferred” tactics for seeking profit cannot be justified by appeal to Pareto efficiency. One important reason for this is that Pareto efficiency, as (...) understood by the theory of welfare economics upon which the MFA relies, assumes a static conception of efficiency. This is a problem because many ethically “preferred” tactics can only be justified by appeal to dynamic efficiency considerations. I argue that, instead of Pareto efficiency, we should look to the value of wealth creation to understand the ethical constraints on how market actors may pursue profit. (shrink)

Firearm violence is a major public health problem in the United States. In 2000, firearms were used in 10,801 homicides – two-thirds of all homicides in the U.S. – and 533,470 non-fatal criminal victimizations including rapes, robberies, and assaults. The social costs of gun violence in the United States are also staggering, and have been estimated to be on the order of $100 billion per year.Illegal gun carrying, usually concealed, in public places is an important risk factor for firearm-related crime. (...) In the 1980s and 1990s, police departments across the country began to develop and implement strategies to address illegal weapons carrying. Often these strategies have involved aggressive efforts to identify and physically search individuals suspected of illegally carrying a firearm. (shrink)

Firearm violence is a major public health problem in the United States. In 2000, firearms were used in 10,801 homicides – two-thirds of all homicides in the U.S. – and 533,470 non-fatal criminal victimizations including rapes, robberies, and assaults. The social costs of gun violence in the United States are also staggering, and have been estimated to be on the order of $100 billion per year.Illegal gun carrying, usually concealed, in public places is an important risk factor for firearm-related crime. (...) In the 1980s and 1990s, police departments across the country began to develop and implement strategies to address illegal weapons carrying. Often these strategies have involved aggressive efforts to identify and physically search individuals suspected of illegally carrying a firearm. (shrink)

Many business ethicists assume that if a type of conduct is illegal, then it is also unethical. This article scrutinizes that assumption, using the rideshare company Uber’s illegal operation in the city of Philadelphia as a case study. I argue that Uber’s unlawful conduct was permissible. I also argue that this position is not an extreme one: it is consistent with a variety of theoretical commitments in the analytic philosophical tradition regarding political obligation. I conclude by showing why business ethicists (...) would have a better rejoinder to the “dominant view” of business ethics associated with Milton Friedman if they dispensed with the assumption that illegal implies unethical. (shrink)

The 2017 codetection of electromagnetic radiation and gravitational waves was the first of its kind and marked the beginning of multimessenger astronomy. But this event has been treated within recent literature as something of an end as well. The 2017 detection is often regarded as an instance of falsification for all theories of modified gravity which postulate gravitational waves propagate along separate geodesics from electromagnetic radiation, perhaps most notably Jacob Bekenstein’s Tensor-Vector-Scalar gravity. I critically examine this explicit endorsement of falsification (...) by astronomers and astrophysicists. While the current state of multimetric modified gravity theories is dim, recent developments in multimessenger observation do not offer a deductive falsification. Rather such evidence should be regarded as a corroboration of the null hypothesis, following Deborah Mayo's error-statistical account. (shrink)

Buying local is a prominent form of ethical consumption. We commonly assume that products that are local are in some respect ethically superior to ones that are not. This article contributes to research on local food by scrutinizing this assumption in light of some central values of the locavore movement. It identifies four central ethical causes from prior literature on locavorism: protecting the environment, promoting community, promoting small business, and contributing to the prosperity of one’s local economy. It then analyzes (...) whether the contribution of buying local to these causes can justify the general perception that buying local is a good way to be an ethical consumer. Its main finding is that these justifications fail to provide a strong positive ethical reason for consumers in general to adopt the practice of buying local. (shrink)

In most testimonial transactions between adults, the hearer’s obligation is to accord the speaker a level of credibility that matches the evidence that what she is saying is true. When the speaker...

I defend the view that a significant ethical distinction can be made between justified killing in self-defense and police use of lethal force. I start by opposing the belief that police use of lethal force is morally justified on the basis of self-defense. Then I demonstrate that the state’s monopoly on the use of force within a given jurisdiction invests police officers with responsibilities that go beyond what morality requires of the average person. I argue that the police should primarily (...) be concerned with preserving public safety. As a consequence, police have additional moral permissions to use lethal force. But this also means that the principle of restraint is inherent to the policing function and therefore police are obliged to go to greater lengths to avoid killing. I concede that the just use of police force can be made difficult in extreme situations such as a mass riot. In such cases, police should take proportionate actions necessary to protect the lives of inhabitants by restoring order, which might include calling on military support. I conclude with a cautionary note opposing militarization of the policing role. (shrink)

While training design choices seem amoral, they interact to determine training (in)effectiveness, potentially harming/benefiting trainees and organizations. These moral implications intensify when training is administered at scale (e.g., e-training) and focuses on social issues like sexual harassment (hereafter, SH). In fact, research on SH training shows it can elicit trainees’ gender-based biases against content messengers. We suggest that one such bias, resulting from messenger gender-occupation incongruence and influencing training effectiveness, is lowered perceptions of the messenger’s integrity. We also investigate whether (...) rich media will increase or decrease this perceived integrity penalty. Using an excerpt from real SH e-training and a sample [_N_ = _210_] consistent with the targeted training audience, we conducted a 2 × 2 × 2 relative comparison experiment (messenger gender x messenger occupation x media richness) and tested a moderated mediation model of the interactive effects of messenger gender-occupation incongruence and media richness on trainees’ perceptions of messenger integrity and training outcomes. Results suggest that trainees’ perceptions of messenger integrity decrease when the messenger’s gender is incongruent with their occupation, leading to worse outcomes in text-based training. These effects, however, are mitigated by increased media richness, providing support for media richness theory. Implications for researchers and practitioners are discussed. (shrink)

The problem of global climate changes has raised fundamental questions of justice in world politics centered around the vast discrepancies between the causes and the effects of global warming and the uneven levels of consumption/enjoyment of fossil fuels. The overwhelming majority of approaches in environmental ethics have focused on either distributive justice or rights-based frameworks. Climate change justice, however, can be explored through an alternative framework, an approach based on the recognition theory of Axel Honneth that has not been systematically (...) engaged with in this field. A critique of John Rawls’ The Law of Peoples as an exemplar of distributive approaches reveals a number of limitations inherent in Rawlsian models of climate-change justice. Honneth’s theory of recognition is an advance on distributive models toward a notion of climate justice in which the conditions necessary for the “functioning and flourishment” of human freedom includes climatic stability as a basic social condition. The ideal of mutual recognition provides a basis for environmental protections, including but not limited to the global atmosphere as a necessary condition for the realization of self-autonomy for all human kind. (shrink)

This chapter argues that a Peircean philosophy of sex offers a non-reductionist approach to sex as a biological category. The chapter surveys traditional biological accounts of sex categories and several social constructivist accounts of sex. It then provides an overview of Peirce’s scholastic realism and his ethics of inquiry. While Peirce regarded the distinction between the sexes as a rare “polar distinction”, the chapter works to recover the nuanced view of sex that Peirce ought to have adopted had he extended (...) his scholastic realism to reproductive biology. Ultimately, the Peircean account offered treats sex differences as norms expressed as bimodal distributions. The chapter concludes by illustrating some applications of this Peircean philosophy of sex, and gesturing to those that we can yet barely imagine. (shrink)

Name der Zeitschrift: Kierkegaard Studies Yearbook Jahrgang: 19 Heft: 1 Seiten: 231-252.

In our everyday social interactions, we try to make sense of what people are thinking, why they act as they do, and what they are likely to do next. This process is called mindreading. Mindreading, Shannon Spaulding argues in this book, is central to our ability to understand and interact with others. Philosophers and cognitive scientists have converged on the idea that mindreading involves theorizing about and simulating others’ mental states. She argues that this view of mindreading is limiting (...) and outdated. Most contemporary views of mindreading vastly underrepresent the diversity and complexity of mindreading. She articulates a new theory of mindreading that takes into account cutting edge philosophical and empirical research on in-group/out-group dynamics, social biases, and how our goals and the situational context influence how we interpret others’ behavior. -/- Spaulding's resulting theory of mindreading provides a more accurate, comprehensive, and perhaps pessimistic view of our abilities to understand others, with important epistemological and ethical implications. Deciding who is trustworthy, knowledgeable, and competent are epistemically and ethically fraught judgments: her new theory of mindreading sheds light on how these judgments are made and the conditions under which they are unreliable. -/- This book will be of great interest to students of philosophy of psychology, philosophy of mind, applied epistemology, cognitive science and moral psychology, as well as those interested in conceptual issues in psychology. (shrink)

Psychiatric practice is often faced with complex situations that seem to pose serious moral dilemmas for practitioners. Methods for solving these dilemmas have included the development of more objective rules to guide the practitioner such as utilitarianism and deontology. A more modern variant on this objective model has been 'Principlism' where 4 mid level rules are used to help solve these complex problems. In opposition to this, there has recently been a focus on more subjective criteria for resolving complex moral (...) dilemmas. In particular, virtue ethics has been posited as a more sensitive method for helping doctors to reason their way through difficult ethical issues. Here the focus is on the character traits of the practitioner. Bloch and Green advocated another way whereby more objective methods such as Principlism and virtue ethics are combined to produce what they considered sound moral reasoning in psychiatrists. This paper points out some difficulties with this approach and instead suggests that a better model of ethical judgment could be developed through the use of narratives or stories. This idea puts equal prima facie value on the patient's and the psychiatrist's version of the dilemma they are faced with. It has the potential to lead to a more genuine empathy and reflective decision-making. (shrink)