Against the background assumptions that knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through (...) a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect – the reason for request – raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating ‘moral space’ for colleagues to process their moral experiences. (shrink)

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

Volume 19, Issue 10, October 2019, Page 43-46.

Bruno and Arora (2018) present a range of important ethical issues emerging from the development of procedures for uterine transplant (UT). They approach those issues by drawing on parallels to oth...

Clinical ethics consultants (CECs) work in complex environments ripe with multiple types of expectations. Significantly, some are due to the perspectives of professional colleagues and the patients and families with whom CECs consult and concern how CECs can, do, or should function, thus adding to the moral complexity faced by CECs in those particular circumstances. We outline six such common expectations: Ethics Police, Ethics Equalizer, Ethics Superhero, Ethics Expediter, Ethics Healer or Ameliorator, and, finally, Ethics Expert. Framed by examples of (...) requests for ethics consultation that illustrate each kind, along with brief descriptions, we argue that while these expectations ought to be resisted for clear and practical reasons, they also create opportunities for CECs to articulate, educate, and ultimately be responsible to the professional demands of clinical ethics work. Recognizing, acknowledging, and at times resisting those expectations thus become key activities and responsibilities in the performance of ethics consultation. (shrink)

Despite increased attention to the question of how best to evaluate clinical ethics consultations and emphasis on external evaluation, there has been little sustained focus on how we, as clinicians, make sense of and learn from our own experiences in the midst of any one consultation. Questions of how we evaluate the request for, unfolding of, and conclusion of any specific ethics consultation are often overlooked, along with the underlying question of whether it is possible to give an accurate account (...) of clinical ethics consultants’ experience as experienced by ethics consultants. Before the challenge of submitting one’s accounts or case reports for review and evaluation from others, there is an underlying challenge of understanding and evaluating our own accounts. To highlight this crucial and deeply challenging dimension of actual clinical ethics practice, we present an account of a complex consultation, explicitly constructed to engage the reader in the unfolding experience of the consultant by emphasizing the multiple perspectives unfolding within the consultant’s experience. Written in script format, the three perspectives presented—prototypical clinically descriptive account; didactically reflective and self-evidentiary account often seen in journal presentations; highly self-critical reflective account emphasizing uncertainties inherent to clinical ethics practice—reflect different manners for responding to the ways actual clinical involvement in ethics consultation practice accentuates and refocuses the question of how to understand and evaluate our own work, as well as that of our colleagues. (shrink)

Since the concept of the living wills emerged nearly 50 years ago, there have been practical challenges in translating the concept of an advance directive into documents that are clinically useful across various healthcare settings and among different patient populations and cultures. Especially, challenging has been the reliance in most ADs on pre-selected “choices” about specific interventions which either revolve around broad themes or whether or not to utilize particular interventions, both of which about most laypersons know little and, more (...) importantly, lacking context, prove to be of limited meaningfulness. Moreover, whether by foundational frame, decade-long misunderstanding in medicine and bioethics, or different societal customs, these ADs present decision-making responsibility for initiating, continuing, or withdrawing medical interventions as a patient responsibility—creating a burden for which most patients are unprepared—and hence reducing healthcare providers’ responsibility to mere technical application or customer service. At our institution, significant efforts have focused on embracing the unique and complementary responsibilities of patients and physicians for enabling appropriate plans of care. This includes re-structuring our AD form to more accurately represent patient’s values as the frame within which physicians are responsible for determining appropriate care. Rather than specifying interventions, the AD makes patients responsible for specifying what matters to them as well as what they value in terms of function, interaction, and level of acceptable burden, thus providing clear goals for clinicians to pursue—or when goals are not reachable by available medical interventions, to acknowledge and allow for logical shifts to what may be achieved, including, in end of life contexts, care focused on respect and dignity. (shrink)

In this review, we describe some of the central philosophical issues facing origins-of-life research and provide a targeted history of the developments that have led to the multidisciplinary field of origins-of-life studies. We outline these issues and developments to guide researchers and students from all fields. With respect to philosophy, we provide brief summaries of debates with respect to (1) definitions (or theories) of life, what life is and how research should be conducted in the absence of an accepted theory (...) of life, (2) the distinctions between synthetic, historical, and universal projects in origins-of-life studies, issues with strategies for inferring the origins of life, such as (3) the nature of the first living entities (the “bottom up” approach) and (4) how to infer the nature of the last universal common ancestor (the “top down” approach), and (5) the status of origins of life as a science. Each of these debates influences the others. Although there are clusters of researchers that agree on some answers to these issues, each of these debates is still open. With respect to history, we outline several independent paths that have led to some of the approaches now prevalent in origins-of-life studies. These include one path from early views of life through the scientific revolutions brought about by Linnaeus (von Linn.), Wöhler, Miller, and others. In this approach, new theories, tools, and evidence guide new thoughts about the nature of life and its origin.We also describe another family of paths motivated by a” circularity” approach to life, which is guided by such thinkers as Maturana & Varela, Gánti, Rosen, and others. These views echo ideas developed by Kant and Aristotle, though they do so using modern science in ways that produce exciting avenues of investigation. By exploring the history of these ideas, we can see how many of the issues that currently interest us have been guided by the contexts in which the ideas were developed. The disciplinary backgrounds of each of these scholars has influenced the questions they sought to answer, the experiments they envisioned, and the kinds of data they collected. We conclude by encouraging scientists and scholars in the humanities and social sciences to explore ways in which they can interact to provide a deeper understanding of the conceptual assumptions, structure, and history of origins-of-life research. This may be useful to help frame future research agendas and bring awareness to the multifaceted issues facing this challenging scientific question. (shrink)

In this book of essays, he argues that morality cannot be defined solely by rational and universal principles; instead, a major place must be found for changing and conflicting ideals, values peculiar to specific times and cultures.

Machine generated contents note: -- Chapter 1. A Short View of Ignorance -- Chapter 2. Finding Out -- Chapter 3. Limits, Uncertainty, Impossibility, and Other Minor Problems -- Chapter 4. Unpredicting -- Chapter 5. The Quality of Ignorance -- Chapter 6. Ignorance in Action: Case Histories -- Chapter 7. Ignorance beyond the Lab.

This book examines the concept of post-truth and the impact it is having on contemporary life, bringing out both its philosophical and political dimensions. Post-truth is contextualised within the philosophical discourse of truth, with particular reference to theories of scepticism and relativism, to explore whether it can take advantage of these to claim any intellectual credibility. Sim argues that post-truth cannot be defended on either sceptical or relativistic grounds – even those provided by recent iconoclastic philosophical movements such as poststructuralism (...) and postmodernism. The affinity between post-truth and conspiracy theory is emphasised, and the extent to which post-truth plays a role in religious doctrine is also considered. Post-truth is seen to constitute a threat to liberal democratic ideals and our Enlightenment heritage, raising the question of whether we are moving into a post-liberal age where the far right would hold power. To prevent this, post-truth urgently needs to be countered. (shrink)

We argue that the physics of complex materials and self-organizing processes should be made central to the biology of form. Rather than being encoded in genes, form emerges when cells and certain of their molecules mobilize physical forces, effects, and processes in a multicellular context. What is inherited from one generation to the next are not genetic programs for constructing organisms, but generative mechanisms of morphogenesis and pattern formation and the initial and boundary conditions for reproducing the specific traits of (...) a taxon. There is no inherent antagonism between this “physicalist” perspective and genetics, since physics acts on matter, and gene products are essential material components of living systems whose variability affects the systems’ parameters. We make this notion concrete by summarizing the concept of “dynamical patterning modules” (DPMs; Newman and Bhat, Phys Biol 5:1–14, 2008; Int J Dev Biol 53:693–705, 2009), an explicit physico-genetic framework for the origin and evolution of multicellular form in animals, as well as (when differences in interaction toolkit genes and applicable physical processes are taken into account) in multicellular plants (Hernández-Hernández et al., Int J Dev Biol 56:661–674, 2012). DPMs provide the missing link between development and evolution by revealing how genes acting in concert with physics can generate and transform morphology in a heritable fashion. (shrink)

First published in 2005. Routledge is an imprint of Taylor & Francis, an informa company.

In his article ‘The case against ethics review in the social sciences’, Schrag asserts that the social sciences should not be subject to ethical review. He recounts a number of examples where ethical review has seemingly failed. He further suggests some alternative models for dealing with ethical review in the social sciences. Finally, he concludes, and we concur, that there is a lack of empirical evidence as to the benefit of research ethics review.

When it was published in 1980, the Diagnostic and Statistical Manual of Mental Disorders, third edition - universally known as DSM-III - embodied a new method for identifying psychiatric illness. The manual's authors and their supporters claimed that DSM-III's development was guided by scientific principles and evidence and that its innovative approach to diagnosis greatly ameliorated the problem of the unreliability of psychiatric diagnoses. In this paper we challenge the conventional wisdom about the research data used to support this claim. (...) Specifically, we argue that the rhetoric of science, more than the scientific data, was used convincingly by the developers of DSM-III to promote their new manual. We offer a re-analysis of the data gathered in the original DSM-III field trials in light of the interpretations that had been offered earlier for the reliability studies of others. We demonstrate how the standards for interpreting reliability were dramatically shifted over time in a direction that made it easier to claim success with DSM-III when, in fact, the data were equivocal. (shrink)

Securitizing Islam examines the impact of 9/11 on the lives and perceptions of individuals, focusing on the ways in which identities in Britain have been affected in relation to Islam. 'Securitization' describes the processes by which a particular group or issue comes to be seen as a threat, and thus subject to the perceptions and actions which go with national security. Croft applies this idea to the way in which the attitudes of individuals to their security and to Islam and (...) Muslims have been transformed, affecting the everyday lives of both Muslims and non-Muslims. He argues that Muslims have come to be seen as the 'Other', outside the contemporary conception of Britishness. Reworking securitisation theory and drawing in the sociology of ontological security studies, Securitizing Islam produces a theoretically innovative framework for understanding a contemporary phenomenon that affects the everyday lives of millions. (shrink)

This is the first book to take a comprehensive look at white collar criminal offenses from the perspective of moral and legal theory. Focussing on the way in which key white collar crimes such as fraud, perjury, false statements, obstruction of justice, bribery, extortion, blackmail, insider trading, tax evasion, and regulatory and intellectual property offenses are shaped and informed by a range of familiar, but nevertheless powerful, moral norms.

Over the past decade, public discussion has focused on the ethics of issuing Do‐Not‐Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more common treatment/nontreatment decisions (...) in the critical care setting. (shrink)

Proposed changes to the Common Rule are proffered to save almost 7,000 reviews annually and consequently vast amounts of investigator and IRB-member time. However, the proposed changes have been subject to criticism. While some have lauded the changes as being imperfect, but nevertheless as improvements, others have contended that ‘neither the scientific community nor the public can be confident that improved practices will emerge from the regulatory changes mandated by the NPRM.’ In the present article, I discuss an important aspect (...) that has been overlooked: the question of whether benefits will emerge is demonstrably empirical, yet data upon which to draw conclusions are conspicuous by their absence. This is thrown into sharp relief when we consider the current environment in which health research is increasingly focused on providing evidence of need or benefit, where there is greater emphasis on evidence-based practice, and when we have the nascent field of implementation science. (shrink)

On 26 August 1974, Michel Foucault completed work on Discipline and Punish, and on that very same day began writing the first volume of The History of Sexuality. A little under ten years later, on 25 June 1984, shortly after the second and third volumes were published, he was dead. This decade is one of the most fascinating of his career. It begins with the initiation of the sexuality project, and ends with its enforced and premature closure. Yet in 1974 (...) he had something very different in mind for The History of Sexuality than the way things were left in 1984. Foucault originally planned a thematically organised series of six volumes, but wrote little of what he promised and published none of them. Instead over the course of the next decade he took his work in very different directions, studying, lecturing and writing about historical periods stretching back to antiquity. This book offers a detailed intellectual history of both the abandoned thematic project and the more properly historical version left incomplete at his death. It draws on all Foucault’s writings in this period, his courses at the Collège de France and lectures elsewhere, as well as material archived in France and California to provide a comprehensive overview and synthetic account of Foucault’s last decade. (shrink)

Newborn screening is the programme through which newborn babies are screened for a variety of conditions shortly after birth. Programmes such as this are individually oriented but resemble traditional public health programmes because they are targeted at large groups of the population and they are offered as preventive interventions to a population considered healthy. As such, an ethical tension exists between the goals of promoting the high uptake of supposedly ‘effective’ population-oriented programmes and the goal of promoting genuinely informed decision-making. (...) There is, however, a lack of understanding with regard to how parents experience the tension between promoting uptake and facilitating informed choice. This paper addresses this issue, and data are presented to show how aspects of the timing, presentation of information and procedural routinisation of newborn screening serves to impact on the decisions made by parents. (shrink)

Background More than one in 10 of all prisoners in England and Wales are Foreign Nationals. This article discusses whether the research applications to one London prison are aimed at understanding a prisoner population characterised by significant multinational and multilingual complexity. Methods We studied all accessible documents relating to research undertaken at a women's prison between 2005 and 2009 to assess the involvement of Foreign National prisoners and women with limited English. The source of information was prison research applications and (...) protocols. We also looked at available final research reports and journal articles. Results Two key findings emerged from this study. First, studies at this prison frequently excluded Foreign National prisoners and women with limited English. Second, Foreign National prisoners were often clustered as a homogeneous category in the research reports reviewed. This is despite their diverse cultural backgrounds, their variable immigration status and their differing competence in English, all of which affect their lives. Conclusions The failure to include and/or identify social subgroups of the population can undermine the value of research, including, in the case of the study prison, funded health research. This can compromise associated needs assessments and service delivery, particularly important in already disadvantaged populations; this may encourage and/or perpetuate a range of health inequalities. There is a pressing need to examine cultural exclusion in other health and criminal justice settings, to assess the ways in which—and the extent to which—such exclusion may compromise the merit of proposed and completed health and social research. (shrink)

During vertebrate limb development, various genes of the Hox family, the products of which influence skeletal element identity, are expressed in specific spatiotemporal patterns in the limb bud mesenchyme. At the same time, the cells also exhibit ‘self‐organizing’ behavior – interacting with each other via extracellular matrix and cell‐cell adhesive molecules to form the arrays of mesenchymal condensations that lead to the cartilaginous skeletal primordia. A recent study by Yokouchi et al.(1) establishes a connection between these phenomena. They misexpressed the (...) product of the Hoxa‐13 gene in chick limb buds and demonstrated both skeletal pattern perturbations and changes in cell‐cell adhesivity in mesenchyme aberrantly expressing this protein. (shrink)

_Wittgenstein's Remarks on the Foundations of AI_ is a valuable contribution to the study of Wittgenstein's theories and his controversial attack on artifical intelligence, which successfully crosses a number of disciplines, including philosophy, psychology, logic, artificial intelligence and cognitive science, to provide a stimulating and searching analysis.

Foundations -- The normal and the pathological -- Philosophy of biology -- Physiology and the reflex -- Regulation and psychology -- Evolution and monstrosity -- Philosophy of history -- Writings on medicine -- Legacies.

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Imagination is extremely important for science, yet very little is known about how scientists actually use it. Are scientists taught to imagine? What do they value imagination for? How do social and disciplinary factors shape it? How is the labor of imagining distributed? These questions should be high priority for anyone who studies or practices science, and this paper argues that the best methods for addressing them are qualitative. I summarize a few preliminary findings derived from recent interview-based and observational (...) qualitative studies that I have performed. These finding include: (i) imagination is only valued for use in addressing maximally specific problems, and only when all else fails; (ii) younger scientists and scientists who are members of underrepresented groups express less positive views about imagination in general, and have less confidence in their own imaginations; (iii) while scientists seem to employ various epistemological frameworks to evaluate imaginings, overall they appear to be epistemic consequentialists about imagination, and this holds also for their evaluations of the tools they use to extend the power of their imaginations. I close by discussing the epistemic and ethical consequences of these findings, and then suggesting a few research avenues that could be explored next as we move forward in the study of scientific imagination. (shrink)

_Outlines a mystical theology and experience of the sacred founded on the absence of god._.

Descartes’s work as a philosopher was inspired by three dreams he had on November 10, 1619, and yet the philosophy that Descartes produced in response to this inspiration included an argument that all dreams are deceptive. This particular incongruity is indicative of a more general ambivalence and anxiety in Descartes’s thought concerning images, which creates a tension that is never fully resolved. In this essay I focus primarily on one side of that tension: the part of Descartes’s philosophy that is (...) distrustful of images. To do this I first reconstruct Descartes’s theory of images, drawing from several of his lesser-known writings on optics, and then I consider how that theory of images leads Descartes to conceptualize true vision as a matter of “insight” rather than “eyesight” and to argue that the blind actually see better than those with working eyes. In the final part of the essay I briefly consider some of the consequences of Descartes’s theory of vision and the suspicion of images that animates it. (shrink)

In Thus Spoke Zarathustra Nietzsche explores the nature of teaching and learning and concludes that a teacher can do more harm than good in a student's life if she allows her students to become her ‘disciples’. A disciple assigns too much authority to a teacher and thus loses the ability to think independently; this is what Zarathustra means when he warns his students, ‘Beware that you are not killed by a statue!’ In this article I argue that Zarathustra's solution to (...) this problem is to undermine his own authority by performing several different variations of the Liar's Paradox in parts 2 and 3 of Thus Spoke Zarathustra. (shrink)

I argue for an approach to Philosophical Fragments that allows it to be philosophical and fragmentary, and that pays particular attention to the fragments, or crumbs, that seem least important. One such overlooked crumb is the theory of merely human education in the book—education that does not enlist God as the teacher, where humans simply try to teach and learn from each other. I argue that Philosophical Fragments defends this theory of education with several reductio ad absurdum proofs that are (...) especially useful because they clarify why merely human education so often fails. Finally I apply the theory of merely human education in Philosophical Fragments to Kierkegaard’s authorship as a whole and argue that it gives us a paradigm for understanding all of Kierkegaard’s texts that is more fundamental than the distinction between direct and indirect communication. (shrink)