Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

Thomas Lyson argued that civic markets were possible and could have positive impacts on rural development. Increasingly local governments are being forced into market-based governance regimes of privatization, decentralization and free trade. This article explores the impacts of these trends on rural local governments in the US. These market trends can erode civic foundations, but recent data show local governments are balancing markets with civic concerns and giving increased attention to citizen interests in the service delivery process.

: A familiar criticism of bioethics charges it with being more conceptual than practical—having little application to the "real world." In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.

Big data and artificial intelligence (“AI”) promise to transform virtually all aspects of biomedical research and health care (Matheny et al. 2019), through facilitation of drug development, diagno...

Even though sign-systems are a crucial part of society, critical realism, as developed by Roy Bhaskar, does not yet have an adequate theory of signs and semiosis. The few suggestions that Bhaskar offers can be advanced through the semiotics of C.S. Peirce. In doing so, however, it becomes necessary to reconsider Bhaskar's ontological domains of the real, the actual, and the subjective, and expand the last domain into one of semiosis. This new understanding of ontological domains, incorporating Peirceian semiotics, provides (...) the basis for rethinking the ontology of society: the customary dyad structures/agents becomes the triad structures/agents/discourses, each of which possesses material, sociological, and meaningful aspects. (shrink)

The use of racial categories in biomedicine has had a long history in the United States. However, social hierarchy and discrimination, justified by purported scientific differences, has also plagued the history of racial categories. Because “race” has some correlation with biological and genetic characteristics, there has been a call not to “throw the baby out with the bathwater” by eliminating race as a research or clinical category. I argue that race is too undefined and fluid to be useful as a (...) proxy for biology or genetics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.2 (2001) 347-350 [Access article in PDF] Book Review The Sin of Knowledge: Ancient Themes and Modern Variations, The Sin of Knowledge: Ancient Themes and Modern Variations, by Theodore Ziolkowski; xvi & 222 pp. Princeton: Princeton University Press, $29.95. After thirty-five years of teaching and administrating at Princeton University, dozens of books, and innumerable articles, the eminent Germanist Theodore Ziolkowski has turned his attention to a (...) theme appropriate for someone so immersed in the intellectual life: the sorrow and grief that accompany human knowledge. Although Ziolkowski has made great contributions in standard studies of genre (notably the elegy and the twentieth-century novel) and authors (Mann, Hesse, and Broch), he became especially well known for his theorization and implementation of thematic studies, ranging from the sublime--fictionalizations of the life of Jesus--to the humorous--talking animals in literature. The figures whom Ziolkowski has selected for analysis of the sin of knowledge are Adam, Prometheus, and Faust, each of whom he views through both an ancient and a modern lens.All three of these mythic heroes violate "divine prohibitions against the new knowledge" (p. 69). Less heroically, all of these myths treat women misogynistically. Generally, Ziolkowski sees each of these stories as having emerged in a time of crisis, when new opportunities presented humanity with knowledge both alluring and disruptive. Because these are highly elastic myths, able to provide meaning in a variety of contexts, they have all mutated in modern times. Adam's Fall comes to represent the human transition from innocence to consciousness, Prometheus becomes a symbol for socialism's promise, and Faust turns into a representative of the American way of life.Looking at the ancient legend of Adam, Ziolkowski notes that sexuality and wisdom are linked in many of the oldest texts in humanity's recorded history. The emphasis on knowledge, however, is especially strong in the Hebrew myth. While many Near Eastern traditions have stories with similarities to the Biblical account of Adam and Eve, only Hebrew mythology has the Tree of Knowledge. For Ziolkowski, the fact that this story was probably set down during the reign of King Solomon explains this emphasis on knowledge. Because the Age of Solomon was a time of unparalleled wealth and power for the Hebrews, [End Page 347] Ziolkowski argues that the tale of Adam and Eve is the kind of myth "produced by cultures that have reached a certain level of sophistication... and look back with a degree of nostalgia at an imagined simpler, happier existence" (p. 23). According to Ziolkowski, knowledge becomes a sin for the Hebrews as they come to terms with the limitations of everything that their knowledge has brought them even at the height of their power and glory.In the modern era, Ziolkowski continues, the story of Adam has become secularized, representing the transition of humanity from a state of innocence to one of consciousness. He finds references to the Fall in Voltaire's Candide, Kleist's The Broken Pitcher, E. T. A. Hoffmann's The Golden Pot, Melville's Billy Budd, and Hesse's Demian. The overall trend of these representations of the rise of consciousness has been increasingly negative, culminating in sentiments like those expressed by the East German author Günter Kunter, who argues that "our whole present misery and all the problems of industrial civilization" can be linked to "the moment when man used the first firestone as a tool, the Fall" (p. 107). As Ziolkowski concludes: "Two centuries of secularization have brought the modern Adam to a depressing end" (p. 108).Citing Nietzsche, who compared Prometheus to Adam (and Pandora to Eve), Ziolkowski looks first at Hesiod's depiction of Prometheus as a trickster and then to Aeschylus' hero. Unlike the authors of the story of Adam and Eve, though, Aeschylus depicts Prometheus' claim to divine knowledge in a positive light: "Rather than a humankind declining from a glorious golden age to the present deplorable iron age, Aeschylus sees humanity progressing by means of knowledge--the crafts, arts, and sciences--from blindness and ignorance... (shrink)

From oral culture, through the advent of literacy, to the introduction of printing, to the development of electronic media, communication structures have radically altered culture in profound ways. As the first book to take a critical realist approach to culture, Theatre, Communication, Critical Realism examines theatre and its history through the interaction of society’s structures, agents, and discourses. Tobin Nellhaus shows that communication structure—a culture’s use and development of speech, handwriting, printing, and electronics—explains much about why, when, and how (...) theatre has transformed. (shrink)

Most work on reflexivity has focused on individuals exercising their reflexivity through discourse. However, agents have three major aspects (intentionality, causal efficacy and embodiment) and they are fundamentally social. This article examines the possibility of collective reflexivity conducted not just by saying, but also by doing—that is, through their embodiment. By expanding the concept of ‘performatives’ to encompass not just speech acts but also acts that speak (i.e. embodied activities as socially meaningful) and applying the work of Charles S. Peirce (...) in order to develop an ontology of embodied reflexivity, it becomes possible to determine several criteria defining embodied collective reflexivity. Assessing possibilities such as legislative debate, political demonstrations, religious ritual and dramatic performance reveals that a certain set of practices does in fact meet those criteria and discloses additional aspects of what constitutes embodied collective reflexivity. (shrink)

As we write, U.S. cities and states with extensive community transmission of Covid‐19 are in harm's way—not only because of the disease itself but also because of prior and current failures to act. During the 2009 influenza pandemic, public health agencies and hospitals developed but never adequately implemented preparedness plans. Focused on efficiency in a competitive market, health systems had few incentives to maintain stockpiles of essential medical equipment. Just‐in‐time economic models resulted in storage of only those supplies needed then. (...) At the same time, global purchasing in search of lower prices reduced the number of U.S. suppliers, with hospitals dependent on foreign companies. There is still a possibility that the pandemic will be manageably bad rather than unmanageably catastrophic in this country. Immediate, powerful, and sustained federal action could make the difference. (shrink)

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on (...) these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: Address the role of history and experience on trust, engage concerns about potential group harm, address cultural values and communication barriers, and integrate patient values and expectations into oversight and governance structures. (shrink)

Medical Officers serving with their national contingents in peacekeeping operations are faced with difficult ethical decisions in regard to their obligations to the local civilian population. Such populations may be under-resourced in regard to medical care, and vulnerable to abuse and exploitation. Though the medical officer may support the local medical services, he/she should never undermine these resources. Adopting a human rights approach and observing the requirements of ethical medicine, aids the doctor in prioritising his/her duties. At times there may (...) be conflict with one’s own military superiors. It is wise to discuss potential difficulties prior to setting out on the mission. Human rights abuses cannot be ignored. The medical officer has a duty to do his/her best to report their observations so as to prevent abuse or to bring it to an end. (shrink)

“There's glory for you!”“I don't know what you mean by ‘glory,’ ” Alice said.Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’”“But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected.“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said (...) Humpty Dumpty, “which is to be master, that's all.”When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn? (shrink)

This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual cli but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history (...) and rationale for this approach, its goals, pedagogical assumptions, and design. (shrink)

Across the world, an authoritarian and exclusionary form of populism is gaining political traction. Historically, some populist movements have been democratic and based on a sense of inclusive justice and the common good. But the populism on the rise at present speaks and acts otherwise. It is challenging constitutional democracies. The polarization seen in authoritarian populism goes beyond the familiar left-right political spectrum and generates disturbing forms of extremism, including the so-called alternative right in the United States and similar ethnic (...) and nationalistic political movements in other countries. The field of bioethics will be profoundly affected if authoritarian populism displaces constitutional democracy. But the field has a significant contribution to make to rebuilding the communal and civic foundations upon which constitutional democracy rests. (shrink)

Physically frail, badly educated girls, brought up to lead useless lives as idle gentlewomen, married to dominant husbands, and relegated to "separate spheres" of life—these phrases have often been used to describe Victorian upper-middle-class women. M. Jeanne Peterson rejects such formulations and the received wisdom they embody in favor of a careful examination of Victorian ladies and their lives. Focusing on a network of urban professional families over three generations, this book examines the scope and quality of gentlewomen's education, their (...) physical lives, their relationship to money, their experience of family illness and death, and their relationships to men (brothers and friends as well as fathers and husbands). Peterson also examines the prominent place of work in the lives of these "leisured" Victorian ladies, both single and married. Far from idle, the mothers, wives, and daughters of Victorian clergymen, doctors, lawyers, university dons, and others were accomplished and productive members of society who made substantial public and private contributions to virtually every sphere of Victorian life. (shrink)

Human genetic and genomic research can yield information that may be of clinical relevance to the individuals who participate as subjects of the research. It has been common practice among researchers to notify participants during the informed consent process that no individual results will be disclosed, “incidental” or otherwise. However, as genetic information obtained in research becomes orders of magnitude more voluminous, increasingly accessible online, and more informative, this precedent may no longer be appropriate. There is not yet consensus on (...) the responsibilities of researchers to disclose individual research results to research participants. Empirical research suggests that participants want to know individual research results. On the other hand, the increased resolution and power aforded by new genomic analyses may lead to fndings of statistical, but not necessarily clinical, signifcance. This paper addresses the issues to be considered in deciding whether and how to disclose “incidental” fndings or other fndings of clinical signifcance that arise in the course of human genomic and genetic research. What research results should be ofered, and what should not be ofered? For which research should individual results be ofered to research participants, when should they be ofered, how, and to whom? (shrink)

Mathematics educators suggest that students of all ages need to participate in productive forms of mathematical argument (NCTM, 2000). Accordingly, we developed two complementary frameworks for analyzing the emergence of mathematical argumentation in one second‐grade classroom. Children attempted to resolve contesting claims about the “space covered” by three different‐looking rectangles of equal area measure. Our first analysis renders the topology of the semantic structure of the classroom conversation as a directed graph. The graph affords clear “at a glance” visualization of (...) how various senses of mathematics—as imagined, as performed, and as historically rooted—were interrelated. The graph represents the emergence and intercoordination between conceptual and procedural knowledge in the ebb and flow of classroom conversation. The graph has not just descriptive, but also predictive power: Interconnectedness among the nodes of the graph representing the first 40 min of conversation predicted the structure of recall in the final ten minutes by children who had played little overt role in the conversation up to that point. The second, complementary framework draws upon Goffman's expanded repertoire of roles in speech to demonstrate how the teacher orchestrated this classroom conversation to establish coherent argument. In this second analysis, we establish how the teacher mediated between the everyday talk of her students and the discourse of mathematics. Her revoicing of student talk created interstices for identity and participation in the formation of the argument. Together, the two forms of analysis illuminate the emergence of mathematical argument at two levels: as collective structure and concurrently, as individual activity. (shrink)

Human genetic and genomic research can yield information that may be of clinical relevance to the individuals who participate as subjects of the research. However, no consensus exists as yet on the responsibilities of researchers to disclose individual research results to participants in human subjects research. “Genetic and genomic research” on humans varies widely, including association studies, examination of allele frequencies, and studies of natural selection, human migration, and genetic variation. For the purposes of this article, it is defined broadly (...) to include analysis of DNA collected from humans that has implications for human health. This paper addresses both research results of individual research participants that may be an intended product of the research, as well as unanticipated, “incidental” findings. (shrink)

A familiar criticism of bioethics charges it with being more conceptual than practical—having little application to the “real world.” In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.

Bioethics in the twenty‐first century is confronting what one might call “collective‐impact problems.” The ethics guidance and policies that are developed to address these kinds of problems will affect not only individuals but everyone living and future generations too. With many collective‐impact problems, all parties will eventually be worse off if there is a failure to develop solutions to head off damage to the shared environment. However, the effects are not felt equally throughout and across societies; some groups are hit (...) far worse. To address collective‐impact problems, bioethics needs to recalibrate. Our field, and especially American bioethics, should find a better balance between individual rights and the best interests of the group, develop more robust tools for examining structural inequities that damage people's health and well‐being, and study how to engage the public in learning about and shaping ethics guidance for these complex problems. (shrink)

Le thème de la femme dans les pays en voie de développement continue à faire couler beaucoup d’encre dans les universités américaines où la division d’hier entre chercheurs confirmant l’exploitation de la femme et leurs collègues prouvant l’éveil de la conscience féministe se mue aujourd’hui en une analyse plus nuancée qui met en évidence la complexité et les contradictions du vécu féminin. En tant que chercheurs examinant la situation de la femme au Maghreb, que nous soyons « insider » ou (...) «... (shrink)

Le thème de la femme dans les pays en voie de développement continue à faire couler beaucoup d’encre dans les universités américaines où la division d’hier entre chercheurs confirmant l’exploitation de la femme et leurs collègues prouvant l’éveil de la conscience féministe se mue aujourd’hui en une analyse plus nuancée qui met en évidence la complexité et les contradictions du vécu féminin. En tant que chercheurs examinant la situation de la femme au Maghreb, que nous soyons « insider » ou (...) «... (shrink)

The primacy of practice in the development of knowledge is one of materialism’s fundamental tenets. Most arguments supporting it have been strictly philosophical. However, over the past thirty years cognitive science has provided mounting evidence supporting the primacy of practice. Particularly striking is its finding that thought is fundamentally metaphoric—that images emerging from everyday embodied activities not only make ordinary experiences intelligible, but also underpin our more abstract engagements with the world, elaborated in disciplines such as ethics and science. Cognitive (...) science’s implications must now be absorbed into critical realism. Cognitive science bolsters critical realism by providing a scientifically-grounded analysis of the passage from body to mind and the fundamental unity between them, while sustaining their distinctiveness. Its implications for critical realism ripple out in four waves: first, critical realism’s understanding of the mind/body relationship; second, its concepts of the process that connects theory and practice, and what that means for critical realism’s view of intellectual production, the place of metaphor in scientific theorization, and cultural development; its view of culture as a complexwhole; and finally, its theory of human agency as embodied and intentional. (shrink)

The primacy of practice in the development of knowledge is one of materialism's fundamental tenets. Most arguments supporting it have been strictly philosophical. However, over the past thirty years cognitive science has provided mounting evidence supporting the primacy of practice. Particularly striking is its finding that thought is fundamentally metaphoric—that images emerging from everyday embodied activities not only make ordinary experiences intelligible, but also underpin our more abstract engagements with the world, elaborated in disciplines such as ethics and science. Cognitive (...) science's implications must now be absorbed into critical realism. Cognitive science bolsters critical realism by providing a scientifically-grounded analysis of the passage from body to mind and the fundamental unity between them, while sustaining their distinctiveness. Its implications for critical realism ripple out in four waves: first, critical realism's understanding of the mind/body relationship; second, its concepts of the process that connects theory and practice, and what that means for critical realism's view of intellectual production, the place of metaphor in scientific theorization, and cultural development; its view of culture as a complex whole; and finally, its theory of human agency as embodied and intentional. (shrink)