IntroductionThe stressful pre-operative period exerts a profound impact on psychological, physiological and immunological outcomes. Oncological surgeries, in particular, elicit significantly higher stress responses than most other surgeries. Managing these responses through psychological interventions may improve long-term outcomes. The purpose of the current research was to review studies that have explored pre-operative psychological interventions in cancer patients in order to map the types of current interventions and provide an initial assessment of whether these interventions improved psychological, physiological, and/or immunological indices as (...) well as long-term cancer outcomes.MethodsA systematic literature search for studies that included pre-operative psychological interventions in oncology patients was conducted, using the databases PubMed and Web of Science. Inclusion criteria included studies pertaining to oncological surgery in adults, study designs that included a clearly defined pre-operative psychological intervention and control group.ResultsWe found 44 studies, each using one of the following interventions: psychoeducation, cognitive interventions, relaxation techniques, integrated approaches. All the studies reported improved immediate post-operative psychological, physiological, and/or immunological outcomes. Only a few studies addressed long-term cancer outcomes, and only one reported improved survival.ConclusionsResearch on pre-operative interventions with cancer patients is missing systematic methods. Studies provide varying results, which makes it difficult to compare them and reach reliable conclusions. There is considerable heterogeneity in the literature regarding the specific intervention used, the timing of intervention, the characteristics of the patients studied and the outcome measures. In order to improve research in this field, including the measurement of long-term outcomes, we suggest some steps that should be taken in further research. (shrink)

In early 2020, the COVID-19 pandemic forced a large portion of the world into quarantine, leading to an extensive period of stress making it necessary to explore regulatory techniques that are effective at stimulating long-lasting positive emotion. Previous research has demonstrated that anticipating positive events produces increases in positive emotion during discrete stressors. We hypothesized that state and trait positive anticipation during the COVID-19 pandemic would be associated with increased positive emotions. We assessed how often participants thought about a future (...) positive/negative/neutral event, activity, or goal through a daily reconstruction method that represented a “day in the life” of people in the United States during the early stages of the COVID-19 pandemic. The results of multi-level modeling and mediational analyses demonstrated that higher optimism, one form of trait positive anticipation, was related to higher state positive anticipation, which was in turn related to higher positive emotions during the current episode, which persisted to the next episode. In addition, both optimism and state positive anticipation were related to adaptive responses to the pandemic. These findings suggest that anticipation of future emotional experiences and hopefulness for the future can be a powerful predictor of positive emotions during global pandemics and perhaps other similar chronic stressors. (shrink)

We present an experiment designed to investigate three different mechanisms to achieve impartiality in distributive justice. We consider a first-person procedure, inspired by the Rawlsian veil of ignorance, and two third-party procedures, an involved spectator and a detached observer. First-person veiled stakeholders and involved spectators are affected by an initially unfair distribution that, in the stakeholders’ case, is to be redressed. We find substantial differences in the redressing task. Detached observers propose significantly fairer redistributions than veiled stakeholders or involved spectators. (...) Risk preferences partly explain why veiled stakeholders propose less egalitarian redistributions. Surprisingly, involved spectators, who are informed about their position in society, tend to favour stakeholders holding the same position as they do after the initial distribution. (shrink)

In a recent paper, Barry Loewer attempts to defend Humeanism about laws of nature from a charge that Humean laws are not adequately explanatory. Central to his defense is a distinction between metaphysical and scientific explanations: even if Humeans cannot offer further metaphysical explanations of particular features of their “mosaic,” that does not preclude them from offering scientific explanations of these features. According to Marc Lange, however, Loewer’s distinction is of no avail. Defending a transitivity principle linking scientific explanantia to (...) their metaphysical grounds, Lange argues that a charge of explanatory inadequacy resurfaces once this intuitive principle is in place. This paper surveys, on behalf of the Humean, three strategies for responding to Lange’s criticism. The ready availability of these strategies suggests that Lange’s argument may not bolster anti-Humean convictions, since the argument rests on premises that those not antecedently sharing these convictions may well reject. The three strategies also correspond to three interesting ways of thinking about relations of grounding linking Humean laws and their instances, all of which are consistent with theses of Humean supervenience, and some of which have been heretofore overlooked. (shrink)

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Senior service colleges provide professional education to prepare military and government civilians for public service at the senior levels of strategy and policy. Inclusive in the program of study...

Philosophers have recently argued, against a prevailing orthodoxy, that standards of knowledge partly depend on a subject’s interests; the more is at stake for the subject, the less she is in a position to know. This view, which is dubbed “Pragmatic Encroachment” has historical and conceptual connections to arguments in philosophy of science against the received model of science as value free. I bring the two debates together. I argue that Pragmatic Encroachment and the model of value-laden science reinforce each (...) other. Drawing on Douglas’ argument about the indispensability of value judgments in science, and psychological evidence about people’s inability to objectively reason about what they care about, I introduce a novel argument for Pragmatic Encroachment. (shrink)

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew inspiration (...) from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

It is commonly argued that values “fill the logical gap” of underdetermination of theory by evidence, namely, values affect our choice between two or more theories that fit the same evidence. The underdetermination model, however, does not exhaust the roles values play in evidential reasoning. I introduce WAVE – a novel account of the logical relations between values and evidence. WAVE states that values influence evidential reasoning by adjusting evidential weights. I argue that the weight-adjusting role of values is distinct (...) from their underdetermination gap-filling role. Values adjust weights in three ways. First, values affect our trust in the testimony of others. Second, values influence the evidential thresholds required for justified epistemic judgments. Third, values influence the relative weight of a certain type of evidence within a body of multimodal discordant evidence. WAVE explains, from an epistemic perspective, rather than psychological, how smokers, for example, can find the same evidence about the dangers of smoking less persuasive than non-smokers. WAVE allows for a wider effect of values on our accepted scientific theories and beliefs than the effect for which the underdetermination model allows alone; therefore, science studies scholars must consider WAVE in their research and analysis of evidential case studies. (shrink)

Accounting ethics failures have seized headlines and cost investors billions of dollars. Improvement of the ethical reasoning and behavior of accountants has become a key concern for the accounting profession and for higher education in accounting. Researchers have asked a number of questions, including what type of accounting ethics education intervention would be most effective for accounting students. Some researchers have proposed virtue ethics as an appropriate moral framework for accounting. This research tested whether Smithian virtue ethics training, based on (...) Adam Smith’s “The Theory of Moral Sentiments”, is effective in improving accounting student’s cognitive moral development. This research used a pre-test, treatment, post-test, quasi-experimental design utilizing the Defining Issues Test 2 instrument to measure students’ CMD. Analysis of DIT-2 gain scores did show a significant improvement in subjects’ personal interest scores and a significant improvement in an overall measure of CMD, the DIT N2 index, whereas their DIT-2 post-conventional scores did not improve significantly. This research supports the proposition that the concepts contained in Smithian virtue ethics can contribute to an effective accounting ethics education intervention. However, further research is required to determine what concepts should be included to improve accounting students’ post-conventional moral reasoning. (shrink)

The concept of minimal risk has been used to regulate and limit participation by adolescents in clinical trials. It can be understood as setting an absolute standard of what risks are considered minimal or it can be interpreted as relative to the actual risks faced by members of the host community for the trial. While commentators have almost universally opposed a relative interpretation of the environmental risks faced by potential adolescent trial participants, we argue that the ethical concerns against the (...) relative standard may not be as convincing as these commentators believe. Our aim is to present the case for a relative standard of environmental risk in order to open a debate on this subject. We conclude by discussing how a relative standard of environmental risk could be defended in the specific case of an HIV vaccine trial among adolescents in South Africa. (shrink)

Researchers are developing a fertility preservation technique?testicular tissue cryopreservation (TTCP)?for prepubescent boys who may become infertile as a result of their cancer treatment. Although this technique is still in development, some researchers are calling for its widespread use. They argue that if boys do not bank their tissue now, they will be unable to benefit from any therapies that might be developed in the future. There are, however, risks involved with increasing access to an investigational procedure. This article examines four (...) methods of expanding access to TTCP: (1) expansion of institutional review board (IRB)-approved research trials; (2) offering TTCP as an innovative procedure in hospitals; (3) offering TTCP as a standard practice in hospitals; and (4) commercialization of TTCP. The ethical and practical implications of each are evaluated through a comparison with umbilical cord blood banking (UCBB), a technology that has achieved widespread use based on similar claims of future benefit. (shrink)

Neuroscientific studies have shown that brain activity correlated with a decision to move can be observed before a person reports being consciously aware of having made that decision . Given that a later event cannot cause an earlier one , such results have been interpreted as evidence that decisions are made unconsciously . We argue that this interpretation depends upon an all-or-none view of consciousness, and we offer an alternative interpretation of the early decision-related brain activity based on models in (...) which conscious awareness of the decision to move develops gradually up to the level of a reporting criterion. Under this interpretation, the early brain activity reflects sub-criterion levels of awareness rather than complete absence of awareness and thus does not suggest that decisions are made unconsciously. (shrink)

Serena Olsaretti brings together new essays by leading moral and political philosophers on the nature of desert and justice, their relations with each other and with other values.

Volume 20, Issue 7, July 2020, Page 112-114.

The corporate social responsibility literature recognizes that firms’ existing CSR reputation can serve as a safeguard from the impact of reputation-damaging events on a firm’s social legitimacy. However, the literature has yet to focus on the extent to which CSR activities can help mitigate such damage, post-event. This article examines how a firm’s social actions following a product recall facilitate the recovery of its diminished social legitimacy. We test our predictions using a sample of 197 product recalls involving 168 publicly (...) traded corporations from 1999 to 2009 and demonstrate that the speed of the CSR response, the frequency of CSR activities, and the intensity of CSR activities have a significant effect on firm recovery following crisis. The effects were most pronounced in instances where the magnitude of the recall was most severe. The visibility of the recall has a limited impact on post-event recovery. We discuss our contributions to research on strategic CSR and recovery. (shrink)

A special report of The Hastings Center and the Association of American Medical Colleges addressed the ethical oversight of learning health systems, which seek to combine high‐quality patient care with routine data collection aimed at improving patient outcomes. The report contained two position papers, authored by a number of distinguished bioethicists, and several commentaries. The position papers urged two changes. First, they urged a rethinking of our approach to the regulation of human subjects research, so as to make it easier (...) in the future for learning health systems to function well. Second, they argued that the rethinking required dispensing with a strict distinction between research and therapy, which has been a major tenet of bioethics since the Belmont Report, which explicated basic ethical principles governing human subjects research. We fully support the objectives of the authors, and we agree that the learning health system is an important advance that serves patients well. Unnecessary regulatory burden ought not impede this progress. We disagree, however, that the best way to bring about these needed changes in the regulatory environment is to reject the basic distinction between research and treatment. Unfortunately, we find the arguments in favor of that strategy to be, in places, reminiscent of what we take to be basic conceptual errors that hampered the ethical understanding of human subjects research prior to adoption of the Belmont Report. To see why one need not reject the research‐treatment distinction in order to promote learning health systems, we first investigate in some detail the arguments offered for eliminating the distinction. We next turn to an issue not addressed by those authors, namely, the relationship between the physician or investigator and the patient or subject, to illustrate why the distinction is important and what is lost if it is jettisoned. (shrink)

The rotating spot method of timing subjective events involves the subject’s watching a rotating spot on a computer and reporting the position of the spot at the instant when the subjective event of interest occurs. We conducted an experiment to investigate factors that may impact on the results produced by this method, using the subject’s perception of when they made a simple finger movement as the subjective event to be timed. Seven aspects of the rotating spot method were investigated, using (...) a factorial experiment. Four of these aspects altered the physical characteristics of the computer generated spot or clock face and the remaining three altered the instructions given to the participant. We found compelling evidence that one factor, whether the subject was instructed to report the instant when the finger movement was initiated or the instant when it was completed, resulted in a systematic shift in the response. Evidence that three other factors affect the observed variability in the response was also found. In addition, we observed that there are substantial systematic differences in the responses made by different subjects. We discuss the implications of our findings and make recommendations about the optimal way of conducting future experiments using the rotating spot method. Our overall conclusion is that our results strongly validate the rotating spot method of timing at least the studied variety of subjective event. (shrink)

We argue that there is an interesting modal analogue of temporal persistence, namely modal persistence, and an interesting modal analogue of time travel, namely modal travel. We explicate each of these notions and then argue that there are plausible conditions under which some ordinary objects modally persist. We go on to consider whether it is plausible that any modally persistent objects also modally travel.

In the research ethics literature, there is strong disagreement about the ethical acceptability of placebo-controlled trials, particularly when a tested therapy aims to alleviate a condition for which standard treatment exists. Recently, this disagreement has given rise to debate over the moral appropriateness of the principle of clinical equipoise for medical research. Underlying these debates are two fundamentally different visions of the moral obligations that investigators owe their subjects.Some commentators and ethics documents claim that physicians, whether acting as care givers (...) or researchers, have the same duty of beneficence towards their patients and subjects: namely, that they must provide optimal medical care. In discussing placebo surgery in research on refractory Parkinson's disease, Peter Clark succinctly states this view: “The researcher has an ethical responsibility to act in the best interest of subjects.”. (shrink)

In The Healer's Power, Howard Brody placed the concept of power at the heart of medicine's moral discourse. Struck by the absence of “power” in the prevailing vocabulary of medical ethics, yet aware of peripheral allusions to power in the writings of some medical ethicists, he intuited the importance of power from the silence surrounding it. He formulated the problem of the healer's power and its responsible use as “the central ethical problem in medicine.” Through the prism of power he (...) refracted a wide range of ethical problems, from informed consent to truth-telling, from confidentiality to futility, from the physician's fantasies to the physician's virtues. At times this prism shed new light on old problems, enabling us to see from an unexpected angle the elements of which the problem was composed. At other times it exposed issues of ethical significance that had been neglected in the bioethics literature. (shrink)

Contributors to this volume demonstrate how the ethics of care factors into a variety of social policies and institutions, and can indeed be useful in thinking about a number of different social problems. Divided into two sections, the first looks at care as a model for an evaluative framework that rethinks social institutions, liberal society, and citizenship at a basic conceptual level. The second explores care values in the context of specific social practices or settings, as a framework that should (...) guide thinking. (shrink)

Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood disorders research. These include issues of consent and decision-making capacity, including (...) patients’ motivations for participating in research. We also address drug withdrawals, placebo controls, and the overall safety of research. Finally, we examine the extant literature for studies discussing potential indirect benefits of clinical trials research to participants. Taken together, the evidence suggests that clinical trials research incorporating drug withdrawals and placebo controls can be conducted safely and ethically, even in patients with severe or treatment-resistant mood disorders. In fact, given the dearth of effective treatment options for this population, it is our opinion that a moral imperative exists to extend the offer of research participation to severely ill or treatment-resistant groups. (shrink)

We are very grateful to the commentators for taking the time to respond to our little article, ‘What Makes Killing Wrong?’ They raise many points, so we cannot respond to them all, but we do want to head off a few misinterpretations.Our critics in this journal avoid one careless misinterpretation, but less informed readers have pressed this misinterpretation in popular venues, so we need to start by renouncing it. We do not deny that killing humans is morally wrong. To the (...) contrary, we argue that killing humans is almost always morally wrong, because killing humans is almost always disabling, and disabling is morally wrong. Here we do not disagree with common sense. We also do not deny that killing partially or even profoundly disabled humans is morally wrong. People who are disabled in some ways still retain many other valuable abilities. This should be obvious. To kill a person with some disabilities but many other valuable abilities is to disable that person, so that is morally wrong. Here again we do not disagree with common sense. The one and only surprising application of our theory is to humans who are alive but totally disabled. We argue that, apart from special circumstances, it is not morally wrong to kill live humans who are totally disabled, whereas many people think that it would be morally wrong to kill even in these extreme and unusual cases, because they assume that killing is morally wrong for reasons apart from disabling.What could those reasons be? DeGrazia mentions three possibilities. First, ‘the harm of killing —in those ordinary cases in …. (shrink)

In the ancient world, precious stones (valuable stones and hard substances excluding gold, silver and copper) were distinguished in terms of appearance (beauty, colour), function (durability) and cost (rarity). As a result, there is considerable difficulty in determining how to correlate the inventory of lexical terms referring to precious stones in the ancient Near East with modern mineralogical identifications. In this article, the etymology and identification of precious stones in the Bible are revisited using editorial theory and complexity thinking. The (...) starting point for lexicographical identification is the breastpiece of the high priest (Ex 28:17–20; 39:10–14) with its 12 precious stones and the translation of the Hebrew terms in the Septuagint. In the light of the considerable writings in the Hellenistic world on precious stones, especially Pliny’s Naturalis Historia and Theophrastus’ On Stones, the Septuagint provides the key for the etymology and identification of the precious stones in both the Old Testament and the New Testament. Contribution: The Septuagint translation of the precious stones in the high priest’s breastpiece is the Rosetta Stone for the identification all of the precious stones in the Hebrew Bible and New Testament. The subsequent translations of the terms indicate changes or substitutions of referents and their meanings. (shrink)

:In this article, we present an educational intervention that embeds ethics education within research laboratories. This structure is designed to assist students in addressing ethical challenges in a more informed way, and to improve the overall ethical culture of research environments. The project seeks to identify factors that students and researchers consider relevant to ethical conduct in science, technology, engineering, and math and to promote the cultivation of an ethical culture in experimental laboratories by integrating research stakeholders in a bottom-up (...) approach to developing context-specific, ethics-based guidelines. An important assumption behind this approach is that direct involvement in the process of developing laboratory specific ethical guidelines will positively influence researchers’ understanding of ethical research and practice issues, their handling of these issues, and the promotion of an ethical culture in the respective laboratory. The active involvement may increase the sense of ownership and integration of further discussion on these important topics. Based on the project experiences, the project team seeks to develop a module involving the bottom-up building of codes-of-ethics-based guidelines that can be used by a broad range of institutions and that will be distributed widely. (shrink)

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. The cases described were disturbing. They involved physicians engaged in excessive “enrollment activities” in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the (...) safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (shrink)

This handbook article reviews the situationist movements in psychology and philosophy, before turning to possible implications for issues about free will and moral responsibility. Particular attention is paid to possible threats to reasons-responsiveness and to agency.

Bernard Williams charges that the moral psychology built into R. M. Hare’s utilitarianism is incoherent in virtue of demanding a bifurcated kind of moral thinking that is possible only for agents who fail to reflect properly on their own practical decision making. I mount a qualified defence of Hare’s view by drawing on the account of the ‘reactive attitudes’ found in P. F. Strawson’s ‘Freedom and Resentment’. Against Williams, I argue that the ‘resilience’ of the reactive attitudes ensures that our (...) taking an instrumental view of our dispositions to experience guilt and compunction, as Hare calls for us to do while engaged in ‘critical’ moral thinking, will not prevent us from experiencing these feelings as people ordinarily do while we are thinking ‘intuitively’. I also consider the implications of my argument for consequentialism more generally and (briefly) Kantianism. (shrink)

This is a response paper to Daniel Russell's paper in the same volume. I raise some challenges to Russell's model of virtue acquisition which draws extensively on the CAPS model in psychology and on parallels between virtues and skills.

Conventionalism’ about personal-identity is an umbrella term for a cluster of views. All these views accept the core idea that conventions, or what are often known as person-directed practices, are crucially involved in the identity of persons over time, and that had those conventions or practices been different, the individuation and persistence conditions of persons would have been different.The purpose of this paper is not to argue for conventionalism broadly understood, nor for any particular version of conventionalism. That is a (...) task I, and others have undertaken elsewhere. Rather, since there is frequent confusion about conventionalism, I will first be concerned to clarify what it is that conventionalists really say about the identity of persons over time. Since there are a number of different views that broadly fall under the banner of conventionalism, it will be part of the task of this paper to disentangle these views and determine what they have in common and where they disagree. (shrink)

To speak of human rights in the twenty-first century is to speak of proportionality. Proportionality has been received into the constitutional doctrine of courts in continental Europe, the United Kingdom, Canada, New Zealand, Israel, South Africa, and the United States, as well as the jurisprudence of treaty-based legal systems such as the European Convention on Human Rights. Proportionality provides a common analytical framework for resolving the great moral and political questions confronting political communities. But behind the singular appeal to proportionality (...) lurks a range of different understandings. This volume brings together many of the world's leading constitutional theorists - proponents and critics of proportionality - to debate the merits of proportionality, the nature of rights, the practice of judicial review, and moral and legal reasoning. Their essays provide important new perspectives on this leading doctrine in human rights law. (shrink)

In this paper we describe the objectives of teaching medical ethics to undergraduates and the teaching methods used. We describe a workshop used in the University of Liverpool Department of Psychiatry, designed to enhance ethical sensitivity in psychiatry. The workshop reviews significant historical and current errors in the ethical practice of psychiatry and doctors' defence mechanisms against accepting responsibility for deficiencies in ethical practice. The workshop explores the student doctors' own group ethos in response to ethical dilemmas, and demonstrates how (...) the individual contributes to and is responsible for the group ethos through participation and also through nonparticipation. The student feedback about the workshop is reviewed. The Toronto Ethical Sensitivity Instrument was used to assess whether or not the workshop altered sensitivity. Compared to a control group the attenders' sensitivity was significantly increased (on Student's t-test p equals or is less than 0.002). (shrink)