This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from (...) the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine. (shrink)

Modelling contagious diseases needs to include a mechanistic knowledge about contacts between hosts and pathogens as specific as possible, e.g., by incorporating in the model information about social networks through which the disease spreads. The unknown part concerning the contact mechanism can be modelled using a stochastic approach. For that purpose, we revisit SIR models by introducing first a microscopic stochastic version of the contacts between individuals of different populations (namely Susceptible, Infective and Recovering), then by adding a random perturbation (...) in the vicinity of the endemic fixed point of the SIR model and eventually by introducing the definition of various types of random social networks. We propose as example of application to contagious diseases the HIV, and we show that a micro-simulation of individual based modelling (IBM) type can reproduce the current stable incidence of the HIV epidemic in a population of HIV-positive men having sex with men (MSM). (shrink)

This paper puts forward an ontology that is indebted to QBism, Kant, Bohr, Schrödinger, the philosophy of the Upanishads, and the evolutionary philosophy of Sri Aurobindo. Central to it is that reality is relative to consciousness or experience. Instead of a single mind-independent reality, there are different poises of consciousness, including a consciousness to which “we are all really only various aspects of the One”. This ontology helps clear up unresolved issues in the philosophy of science, such as arise from (...) the reification of quantum states or from disregard of the universal context of science, which is human experience. It further helps clear up unresolved issues in the philosophy of mind, in particular the problem of intentionality and the dilemma posed by the mutual inclusion of self and world. (shrink)

A comprehensive and timely examination of the history and current status of immigrants and refugees--their stories, the events that led to their movement, and the place of these movements in contemporary history and politics. Immigration and Asylum: From 1900 to the Present is an accessible and up-to-date introduction to the key concepts, terms, personalities, and real-world issues associated with the surge of immigration from the beginning of the 20th century to the present. It focuses on the United States, but is (...) also the first encyclopedic work on the subject that reflects a truly global perspective. With contributions from the world's foremost authorities on the subject, Immigration and Asylum offers nearly 200 entries organized around four themes: immigration and asylum; the major migrating groups around the world; expulsions and other forced population movements; and the politics of migration. In addition to basic entries, the work includes in-depth essays on important trends, events, and current conditions. There is no better resource for exploring just how profoundly the voluntary and forced movement of asylum seekers and refugees has transformed the world--and what that transformation means to us today. Nearly 200 A-Z entries on immigration and asylum around the world 150+ contributors, including leading immigration scholars from around the globe such as Nathan Glazer, Saskia Sassen, Ari Zolberg, James Hollifield, Desmond King, and Stephen Castles A separate volume of primary source documents, including legislation, treaties, speeches, and United Nations documents A chronology of major movements of migrants and asylum seekers. (shrink)

There is a standard story told about the rise and fall of ordinary language philosophy: it was a widespread, if not dominant, approach to philosophy in Great Britain in the aftermath of World War II up until the early 1960s, but with the development of systematic approaches to the study of language—formal semantic theories on one hand and Gricean pragmatics on the other—ordinary language philosophy more or less disappeared. In this paper we present quantitative evidence to evaluate the standard story (...) of the rise and fall of ordinary language philosophy, building on the topic model of over 30,000 philosophy articles in Weatherson (2022). Using a combination of qualitative judgment and a topic-model-based measurement of similarity between individual articles, we find evidence that supports the first part of the standard story, according to which ordinary language philosophy arises in the 1940s, peaks between the early 1950s and the late 1960s, and then rapidly declines. But we argue that there is also evidence of a "new wave" of ordinary language philosophy in the early 21st century that defies the second part of the standard story. (shrink)

Existing research on the formation of employee ethical climate perceptions focuses mainly on organization characteristics as antecedents, and although other constructs have been considered, these constructs have typically been studied in isolation. Thus, our understanding of the context in which ethical climate perceptions develop is incomplete. To address this limitation, we build upon the work of Rupp to develop and test a multi-experience model of ethical climate which links aspects of the corporate social responsibility, ethics, justice, and trust literatures and (...) helps to explain how employees’ ethical climate perceptions form. We argue that in forming ethical climate perceptions, employees consider the actions or characteristics of a complex web of actors. Specifically, we propose that employees look outward at how communities are impacted by their organization’s actions, upward to make inferences about the ethicality of leaders in their organizations, and inward at their own propensity to trust others as they form their perceptions. Using a multiple-wave field study conducted at a privately held US corporation, we find substantial evidence in support of our model. (shrink)

Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed ‘malignant’ are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is offered to (...) patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored. (shrink)

Restrictions on research on therapeutic cloning are questionable as they inhibit the development of a technique which holds promise for succesful application of pluripotent stem cells in clinical treatment of severe diseases. It is argued in this article that the ethical concerns are less problematic using therapeutic cloning compared with using fertilised eggs as the source for stem cells. The moral status of an enucleated egg cell transplanted with a somatic cell nucleus is found to be more clearly not equivalent (...) to that of a human being. Based on ethical considerations alone, research into therapeutic cloning should be encouraged in order to develop therapeutic applications of stem cells. (shrink)

We investigate claims about the frequency of "know" made by philosophers. Our investigation has several overlapping aims. First, we aim to show what is required to confirm or disconfirm philosophers’ claims about the comparative frequency of different uses of philosophically interesting expressions. Second, we aim to show how using linguistic corpora as tools for investigating meaning is a productive methodology, in the sense that it yields discoveries about the use of language that philosophers would have overlooked if they remained in (...) their "armchairs of an afternoon", to use J.L. Austin’s phrase. Third, we discuss facts about the meaning of "know" that so far have been ignored in philosophy, with the aim of reorienting discussions of the relevance of ordinary language for philosophical theorizing. (shrink)

(2000). Full transcript of inaugural AARST Science Policy Forum, New York Hilton, Friday 20 November 1998, 7?9 pm. Social Epistemology: Vol. 14, No. 2-3, pp. 131-180.

The paper discusses ten philosophical problems in deontic logic: how to formally represent norms, when a set of norms may be termed ‘coherent’, how to deal with normative conflicts, how contraryto-duty obligations can be appropriately modeled, how dyadic deontic operators may be redefined to relate to sets of norms instead of preference relations between possible worlds, how various concepts of permission can be accommodated, how meaning postulates and counts-as conditionals can be taken into account, and how sets of norms may (...) be revised and merged. The problems are discussed from the viewpoint of input/output logic as developed by van der Torre & Makinson. We argue that norms, not ideality, should take the central position in deontic semantics, and that a semantics that represents norms, as input/output logic does, provides helpful tools for analyzing, clarifying and solving the problems of deontic logic. (shrink)

This article presents the new German law on advance directives from 1 September 2009. The history of the parliamentary process of this law is described, the present regulations are explained, their relevance for medical practice discussed and shortcomings are identified. Finally, the new law is compared with other regulations in the international context. Previously established legal practice in Germany has now become largely confirmed by the new law: An advanced directive must be respected in any decision concerning medical treatment, regardless (...) of the stage of the illness. It can be informally revoked at any time, even with limited decision-making capacity. Nobody may be obliged to issue a directive in any way. Advance directives do not need notarisation or routine updating after certain time intervals. Provided that the patient, who is no longer mentally competent, has issued a lasting power of attorney, or provided that the patient has been appointed a healthcare proxy by the courts, this authorised surrogate must assert the patient's will. The role of the guardianship court is clarified: it only needs to be involved in cases of disagreement as to the patient's will. The new German law thus combines more legal certainty with a liberal emphasis on patient autonomy and flexible, adaptable regulations. (shrink)

The early coronavirus disease 2019 (COVID‐19) outbreak inflicted vulnerability on individuals and societies on a completely different scale than we have seen previously. The pandemic developed rapidly from 1 day to the next, and both society and individuals were put to the test. Older people's experiences of the early outbreak were no exception. Using an abductive analytical approach, the study explores the individual experiences of vulnerability as described by older people hospitalised with COVID–19 in the early outbreak. In these older (...) people, we found that the societal context and the individual experiences of vulnerability were inextricable linked. The study demonstrates that despite significant individual stress, informants displayed an interesting ability to also view their situation to reorient their perspective. The experience of vulnerability is both conditional and individual, which imposes a degree of unpredictability that neither they nor others were able to negotiate. The article discusses the phenomenon of unpredictability in light of a modern society with regard to how individuals and society may encounter unexpected events in the future where the potential to reorient will be vital. (shrink)

Based on extensive questionnaire data, this paper focuses on parents’ views about children’s right to decide about participation in research. The data originates from 4000 families participating in a longitudinal prospective screening as 1997. Although current regulations and recommendations underline that children should have influence over their participation, many parents in this study disagree. Most (66%) were positive providing information to the child about relevant aspects of the study. However, responding parents were split about whether or not children should at (...) some point be allowed decisional authority when participating in research: 41.6% of the parents reported being against or unsure. Those who responded positively believed that children should be allowed to decide about blood-sampling procedures (70%), but to a less extent about participation (48.5%), analyses of samples (19.7%) and biological bank storage (15.4%). That as many as possible should remain in the study, and that children do not have the competence to understand the consequences for research was strongly stressed by respondents who do not think children should have a right to decide. When asked what interests they consider most important in paediatric research, child autonomy and decision-making was ranked lowest. We discuss the implications of these findings. (shrink)

When the Oxyrhynchus Papyri of Sophocles' 'ІΧνενταí gave the forms κννηγ[Έ]σω, 1. 44 in Fragmenta Tragica Papyracea, and ΈκκννηγΈσαι, 1. 75, it restored to light a verb which is not acknowledged in the Lexicons, but which had remained, though almost unnoticed, in Phrynichus, Soph. Propar. in Bekker's Anecdota I. p. 48, and Theognostus' Canons in Cramer's Anecdota Oxoniensia II. p. 143. The form could not come from κννηγετΕîν, nor from the Hellenistic verb κννηγεîν, and attention was first drawn to these (...) two authorities by P. Maas in Berl. Philol. Wochenschr. 1912, p. 1075, and by J. Stahl in Rhein. Mus. Vol. LXVIII. p. 307. I owe these references to Mr. Stuart Jones. (shrink)

“La Poésie Comme Exercice Spirituel” first appeared in a 1942 issue of Revue Fontaine edited by Jacques and Raissa Maritain and was subsequently republished in Wah’s 1948 text Poésie, Pensée, Perception, published by Calmann-Lévy. The following is a translation of the Fontaine version. I have noted all of the variations from the latter version in the notes. As I emphasize in my commentary, the piece is a notable display of Wahl’s eclectic range of influences. Most importantly, it shows the extent (...) to which his interest in radical empiricism and process metaphysics informs his creative approach to the intersection of poetics and metaphysics. These interests are not explicitly named in the essay, and yet their influence is pervasive. The essay also includes several moments of substantial resonance with the work of Gilles Deleuze, as noted in the commentary. (shrink)

Due to the potential ethical and psychological implications of screening, and especially inregard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM).The primary (...) aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1–6).We found that the majority of respondents felt calm in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring theethical criteria of autonomy and respect, were emphasised by our respondents. We believe theissues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards. (shrink)

When the Oxyrhynchus Papyri of Sophocles' 'ІΧνενταí gave the forms κννηγ[Έ]σω , 1. 44 in Fragmenta Tragica Papyracea, and ΈκκννηγΈσαι, 1. 75, it restored to light a verb which is not acknowledged in the Lexicons, but which had remained, though almost unnoticed, in Phrynichus, Soph. Propar. in Bekker's Anecdota I. p. 48, and Theognostus' Canons in Cramer's Anecdota Oxoniensia II. p. 143. The form could not come from κννηγετΕîν, nor from the Hellenistic verb κννηγεîν, and attention was first drawn to (...) these two authorities by P. Maas in Berl. Philol. Wochenschr. 1912, p. 1075, and by J. Stahl in Rhein. Mus. Vol. LXVIII. p. 307 . I owe these references to Mr. Stuart Jones. (shrink)

Technical, rigorous, and self-contained, this book will be useful for macroeconomists who seek to improve the robustness of decision-making processes.