Over 50% of the world population will develop a psychiatric disorder in their lifetime.1 In the realm of psychiatric treatment, two primary modalities have been established: pharmacotherapy and psychotherapy. Yet, pharmacological interventions often take precedence as the initial treatment choice despite their comparable outcomes, severe side effects and disputed evidence of their efficacy. This preference for medication foregrounds a vital re-examination of what it means to be invasive in medical treatments, namely in psychiatric care. De Marco et al challenge the (...) standard account of invasiveness, presenting considerations that transcend the traditional criteria of physical intrusion.2 Through case studies centred on treatments for schizophrenia and depression, we aim to (1) reinforce De Marco et al ’s challenge to the standard account of invasiveness and (2) extend the dialogue to the moral imperative of redefining mental invasiveness. Our aims are to broaden the definition of mental invasiveness, aligning with De Marco et al ’s emphasis on context sensitivity, and to include the severity of side effects as a critical factor in this assessment. Redefining what is considered invasive in psychiatric treatment has profound implications for patient care and medical decision-making. Labelling treatments, namely medications, as invasive encourages both patients and healthcare providers to approach these options with a heightened level of scrutiny and care. This is …. (shrink)

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included (...) “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research programs (...) are embracing this populist rhetoric to encourage wider public participation. We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric. We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance. (shrink)

There is little doubt that Corporate Social Responsibility (CSR) is now a global concept and a prominent feature of international business, with its practice localised and differing across countries. Despite the growing body of research focussing on CSR in developing countries, there is dearth research on CSR institutionalisation in African countries. Drawing on institutional theory (IT), this article examines the focus and form of CSR practice of companies in Kenya. It is evident from our findings that the nature and orientation (...) of CSR differ across companies with operations only in Kenya and those headquartered abroad or with international operations. Significantly, firm-related drivers such as public relations and performance, as well as global institutional pressures explain the focus and form of CSR in Kenya. This article concludes that for the institutionalisation of CSR in Kenya, attention must be paid to conditions that stifle CSR uptake such as lack of government regulations, and the government's capacity and commitment to enforce regulation. The establishment of functional CSR institutions and a vibrant civil society that advance civil regulation ought to be encouraged. (shrink)

Online platforms like Instagram cover potentially distressing imagery with a sensitive-content screen (blurred imagery plus a content warning). Previous research suggests people typically choose to “uncover” and view screened content. In three studies, we investigated whether the presence of screens mitigates the negative emotional impact of viewing content. In Study 1, participants viewed positive and neutral images, and screens (with an option to view the negative images beneath) for a 5-minute period. In Study 2, half the participants saw a grey (...) mask in place of the typical sensitive-content screen. In addition, each image appeared for a fixed period (5 s) and participants had no option to uncover it. Study 3 was like Study 2 except half the participants saw negative images preceded by a sensitive-content screen and half saw negative images without screens. Overall, participants reported a significant increase in state anxiety and negative affect from pre-to post task when they were exposed to sensitive-content screens, whether or not they were also exposed to the negative imagery beneath. Our data suggest sensitive-content screens cause negative responses – state anxiety and negative affect – that do not translate to an emotional benefit when people view negative content. (shrink)

This chapter provides a historical account of the transformation of pregnancy through philosophical theory and legal practice. What has remained seemingly consistent across history, though, is the lack of rights a pregnant woman can enjoy. Whilst it may manifest differently across time and place, unfortunately misogynistic attitudes persist, and this is reflected in the continual degrading of the gestator (and gestation), which is reinforced by certain philosophical theorising and technological advancement. We thus urge caution in making philosophical claims about the (...) epistemic transformation in pregnancy, given the epistemic (and other) injustices already faced by pregnant people. We recognise that there are transformations that occur because of pregnancy, but we argue that there ought not be with respect to the pregnant person's autonomy, agency, and control over their bodies. Through an analysis of legal cases, we can see that the practice falls out of line with the theory regarding how pregnant people are treated. But perhaps it is both the theory and the practice that need to change so as to bring them in line. How we theorise about pregnancy is intertwined with our cultural views, our technological advancements, and our medical and legal practices, requiring multi-disciplinary study for a more holistic overview. In this chapter, we contribute to this endeavour by bringing some such strands together, regarding the transformation that pregnancy is, that pregnancy makes, and that pregnancy has had historically, in philosophy, and in legal practice. (shrink)

When faced with adverse circumstances, there may be a tendency for individuals, agencies, and governments to search for a target to assign blame. Our focus will be on the novel coronavirus outbreak, where racial groups, political parties, countries, and minorities have been blamed for spreading, producing or creating the virus. Blame—here defined as attributing causality, responsibility, intent, or foresight to someone/something for a fault or wrong—has already begun to damage modern society and medical practice in the context of the COVID-19 (...) outbreak. Evidence from past and current pandemics suggest that this tendency to seek blame affects international relations, promotes unwarranted devaluation of health professionals, and prompts a spike of racism and discrimination. By drawing on social and cognitive psychology theories, we provide a framework that helps to understand the effect of blame in pandemics, when people blame, whom they blame, and how blame detrimentally affects the COVID-19 response. Ultimately, we provide a path to inform health messaging to reduce blaming tendencies, based on social psychological principles for health communication. (shrink)

We describe the ongoing citations to biomedical articles affected by scientific misconduct, and characterize the papers that cite these affected articles. The citations to 102 articles named in official findings of scientific misconduct during the period of 1993 and 2001 were identified through the Institute for Scientific Information Web of Science database. Using a stratified random sampling strategy, we performed a content analysis of 603 of the 5,393 citing papers to identify indications of awareness that the cited articles affected by (...) scientific misconduct had validity issues, and to examine how the citing papers referred to the affected articles. Fewer than 5% of citing papers indicated any awareness that the cited article was retracted or named in a finding of misconduct. We also tested the hypothesis that affected articles would have fewer citations than a comparison sample; this was not supported. Most articles affected by misconduct were published in basic science journals, and we found little cause for concern that such articles may have affected clinical equipoise or clinical care. (shrink)

The purpose of this study was to identify and describe published research articles that were named in official findings of scientific misconduct and to investigate compliance with the administrative actions contained in these reports for corrections and retractions, as represented in PubMed. Between 1993 and 2001, 102 articles were named in either the NIH Guide for Grants and Contracts (“Findings of Scientific Misconduct”) or the U.S. Office of Research Integrity annual reports as needing retraction or correction. In 2002, 98 of (...) the 102 articles were indexed in PubMed. Eighty-five of these 98 articles had indexed corrections: 47 were retracted; 26 had an erratum; 12 had a correction described in the “comment” field. Thirteen had no correction, but 10 were linked to the NIH Guide “Findings of Scientific Misconduct”, leaving only 3 articles with no indication of any sort of problem. As of May 2005, there were 5,393 citations to the 102 articles, with a median of 26 citations per article (range 0–592). Researchers should be alert to “Comments” linked to the NIH Guide as these are open access, and the “Findings of Scientific Misconduct’ reports are often more informative than the statements about the retraction or correction found in the journals. (shrink)

El conocimiento histórico –entendido como un proceso metacognitivo de asimilación constructiva sobre el pasado para explicar fenómenos– comporta un análisis del impacto y la transcendencia de determinados acontecimientos y procesos históricos, en cuya comprensión y valoración influye el concepto de relevancia histórica. Desde esta perspectiva es necesario implementar propuestas de evaluación sólidas, vinculadas al desarrollo competencial. El objetivo de este estudio es diseñar una guía de caracterización de los instrumentos evaluativos –actividades y ejercicios– más utilizados por el profesorado de Historia, (...) con el fin de optimizar los procesos de evaluación de esta competencia mediante una serie de descriptores estructurales, competenciales y transferenciales. Estos indicadores de pertinencia pueden marcar el camino de aquellos docentes que deseen perfeccionar su manera de evaluar lo históricamente determinante. En conclusión, este innovador planteamiento supone un proceso de formación continua del profesorado que contribuye a la mejora de la calidad educativa. (shrink)

How should judges decide which linguistic canons to apply in interpreting statutes? One important answer looks to the inside of the legislative process: Follow the rules that lawmakers contemplate. A different answer, based on the “ordinary meaning” doctrine, looks to the outside: Follow the rules that would guide an ordinary person’s understanding of the legal text. Empirical scholars have studied statutory interpretation from the inside—revealing what rules drafters follow—but never from the outside. We offer a novel framework for empirically testing (...) interpretive canons “from the outside,” recruiting 4,500 people from the United States, as well as a sample of U.S. law students, to evaluate hypothetical scenarios that correspond to each canon’s triggering conditions. -/- The empirical findings provide crucial evidence about which traditional canons “ordinary meaning” actually supports, and they carry several further implications. First, interpretive canons are not a closed set. We discovered new canons that are not yet reflected as legal canons, including one we term the “non-binary gender canon” and another the “quantifier domain restriction canon.” Second, the results support a new understanding of the ordinary meaning doctrine itself, as one focused on the ordinary interpretation of rules, as opposed to the traditional focus on “ordinary language” generally. Third, many of the canons reflect that ordinary people interpret rules with an intuitive anti-literalism. This anti-literalism finding challenges textualist assumptions about ordinary meaning, as well as offering a theme for researching other currently unrecognized canons. Most broadly, we hope the Essay initiates a new research program in empirical legal interpretation. If ordinary meaning is relevant to legal interpretation, interpreters should look to evidence of how ordinary people actually understand legal rules. We see our experiments as a first step in that new direction. (shrink)

Emotional stimuli (e.g. words, images) are often remembered better than neutral stimuli. However, little is known about how memory is affected by an environmentally induced emotional state (without any overtly emotional occurrences) – the focus of this study. Participants were randomly assigned to discovery (n = 305) and replication (n = 306) subsamples and viewed a desktop virtual environment before rating their emotions and completing objective (i.e. item, temporal-order, duration) and subjective (e.g. vividness, sensory detail, coherence) memory measures. In both (...) samples, a Partial Least Squares Correlation analysis showed that an emotional state characterised by high negative emotion (i.e. threat, fear, anxiety) and arousal was reliably associated with better memory in both objective (i.e. item) and subjective (i.e. vividness and sensory detail) domains. No reliable associations were observed for any temporal memory measures (objective or subjective). Thus, an environmentally induced state of negative emotion corresponds with enhanced memory for indices of episodic memory pertaining to “what” happened, but not necessarily “when” it happened. (shrink)

In early 2020, in-person data collection dramatically slowed or was completely halted across the world as many labs were forced to close due to the COVID-19 pandemic. Developmental researchers who assess looking time were forced to re-think their methods of data collection. While a variety of remote or online platforms are available for gathering behavioral data outside of the typical lab setting, few are specifically designed for collecting and processing looking time data in infants and young children. To address these (...) challenges, our lab developed several novel approaches for continuing data collection and coding for a remotely administered audiovisual looking time protocol. First, we detail a comprehensive approach for successfully administering the Multisensory Attention Assessment Protocol, developed by our lab to assess multisensory attention skills. The MAAP is administered from a distance by using Zoom, Gorilla Experiment Builder, an internet connection, and a home computer. This new data collection approach has the advantage that participants can be tested in their homes. We discuss challenges and successes in implementing our approach for remote testing and data collection during an ongoing longitudinal project. Second, we detail an approach for estimating gaze direction and duration collected remotely from webcam recordings using a post processing toolkit and demonstrate its effectiveness and precision. However, because OpenFace derives gaze estimates without translating them to an external frame of reference, we developed a machine learning approach to overcome this limitation. Thus, third, we trained a ML algorithm [] to classify gaze estimates from OpenFace with respect to areas of interest on the participant's screen. We then demonstrate reliability between this approach and traditional coding approaches. The combination of OpenFace and ML will provide a method to automate the coding of looking time for data collected remotely. Finally, we outline a series of best practices for developmental researchers conducting remote data collection for looking time studies. (shrink)

We challenge Johnson et al.'s assumption that people reduce unclear situations to a single narrative explanation and that such reduction would be adaptive for decision-making under radical uncertainty. Instead, we argue that people imagine and maintain multiple narrative possibilities throughout the decision-making process and that this process provides cognitive flexibility and adaptive benefits within the proposed model.

El artículo empieza con un recorrido por las ideas republicanas del 1848 francés en torno a la fraternidad como idea fundamental para combatir el individualismo e instaurar un nuevo orden social. No obstante, el ideal de fraternidad es rápidamente ignorado por el pensamiento político contemporáneo, contrariamente a o que ocurre con los dos otros dos términos de la divisa revolucionaria: la libertad y la igualdad. La autora se plantea si conviene recuperar el concepto de fraternidad y en qué sentido. ¿Es (...) una virtud en el sentido aristotélico? Pese a que hay filósofos contrarios a esa idea, se defiende la tesis de que es difícil que sin fraternidad pueda hacerse justicia y que, en consecuencia, la fraternidad no puede ser vista sino como una virtud o una obligación moral imprescindible como base de la cooperación social. (shrink)

MUC1 and MUC4 are the two membrane mucins that have been best characterized. Although they have superficially similar structures and have both been shown to provide steric protection of epithelial surfaces, recent studies have also implicated them in cellular signaling. They act by substantially different mechanisms, MUC4 as a receptor ligand and MUC1 as a docking protein for signaling molecules. MUC4 is a novel intramembrane ligand for the receptor tyrosine kinase ErbB2/HER2/Neu, triggering a specific phosphorylation of the ErbB2 in the (...) absence of other ErbB ligands and potentiating phosphorylation and signaling through the ErbB2/ErbB3 heterodimeric receptor complex formed in the presence of neuregulin. In contrast, MUC1 has a highly conserved cytoplasmic tail, which binds β‐catenin, a key component of adherens junctions and a regulator of transcription, in a process that is tightly regulated by MUC1 phosphorylation. The specific localization of these membrane mucins to the apical surfaces of epithelial cells suggests that their signaling functions may be important as sensor mechanisms in response to invasion or damage of epithelia. BioEssays 25:66–71, 2003. © 2002 Wiley Periodicals, Inc. (shrink)

Freud tracked the psyche along the paths of sleep, following the “royal road” of dreams. For the ancient Greeks, too, the psyche was revealed in sleep, not through the semiotics of dreams but through the peculiar state of being we occupy while asleep. As a “borderland between living and not living”, sleep offered unique access to the psukhē, that element within the self unassimilable to waking consciousness. This paper examines how Greek philosophers theorized the sleep state and the somnolent psukhē, (...) focusing on Heraclitus, Plato, and Aristotle. Each of the three attempts to reclaim sleep for waking life and to join the sleeping soul to the philosophical self. But that attempt never fully succeeds. Instead sleep consistently emerges as a philosophical blindspot, a state that—unlike dreams—cannot be spoken by philosophy's logos nor fully illuminated by philosophical analysis. (shrink)

This paper explores the effects of incidental guilt on Socially Responsible Investment (SRI) decisions of retail investors. Do investors who feel guilty invest more in SRIs to clear their conscience? Are guilty investors willing to sacrifice returns to restore their moral selves? Using survey data from an online quasi-experiment among a sample of US retail investors, we find that individuals who experience incidental guilt are willing to invest more in SRI funds than those in a neutral state. We show that (...) this effect, albeit moderate in magnitude, cannot be explained solely by differences in retail investors’ moral reasoning, attitudes towards social responsibility, risk tolerance and demographic factors. When presented with a trade-off between sustainability, risk and return characteristics of the funds, guilty investors are more willing to sacrifice returns for greater sustainability than non-guilty participants. Our research provides new evidence of the effect that incidental guilt has on the sustainable investing decisions of retail investors. (shrink)

Numerous societal issues, from climate change to pandemics, require public engagement with scientific research. Such engagement reveals challenges that can arise when experts communicate with laypeople. One of the most common frameworks for framing these communicative interactions is the deficit model of science communication, which holds that laypeople lack scientific knowledge and/or positive attitudes towards science, and that imparting knowledge will fill knowledge gaps, lead to desirable attitude/behavior changes, and increase trust in science. §1 introduces the deficit model in more (...) detail and shows that adhering to this model often fails to achieve its aims, which motivates the main question of this chapter: how can Ludwik Fleck’s theory of thinking collectives address the persistent problem of deficit approaches in science communication? I suggest that it can do so by exposing the deficit model’s implicit assumption of an expert-lay divide. Accordingly, §2 lays out Fleck’s theory and §3 contrasts it with contemporary debates about science communication. Following this descriptive work, §4 draws on Fleck’s ideas to make four concrete suggestions for further questioning the expert-lay divide. (shrink)

Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified—and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, (...) coherence-based approach to the evaluation of healthcare priority-setting. Drawing on Rawls, we argue that an institutional priority-setter’s claim to moral justification can be assessed, in part, based on the extent to which its many normative commitments are mutually supportive and free from dissonance; that is, on the ability to establish narrow reflective equilibrium across the normative content of a priority-setter’s policy and practice. While we do not suggest that the establishment of such equilibrium is sufficient for moral justification, we argue that failure to do so might—like the proverbial canary in the coalmine—act as a generalised warning that something is awry. We offer a theoretical argument in support of this view and briefly outline a practical method for systematically examining coherence across priority-setting policy and practice. (shrink)

In Building Better Beings, Vargas develops and defends a naturalistic account of responsibility, whereby responsible agents must possess a feasibly situated capacity to detect and respond to moral considerations. As a preliminary step, he also offers a substantive account of how we might justify our practices of holding responsible—viz., by appeal to their efficacy in fostering a ‘valuable form of agency’ across the community at large, a form of agency that precisely encompasses sensitivity to moral considerations. But how do these (...) accounts relate to one another? Though I find much that is appealing in Vargas’s general approach, I challenge his insistence that these accounts should be treated as ‘conceptually independent’, arguing that this generates an objectionable “justification gap”: on his analysis, someone could remain an appropriate target of our responsibility practices and yet fail to be a morally responsible agent. In closing, I offer a potential solution to this problem, though it means re-visioning how the account of moral responsibility is conceptually tied to the justification of our responsibility practices. (shrink)

Following the critically acclaimed _Zen at War_, Brian Victoria explores the intimate relationship between Japanese institutional Buddhism and militarism during the Second World War. Victoria reveals for the first time, through examination of the wartime writings of the Japanese military itself, that the Zen school's view of life and death was deliberately incorporated into the military's programme of 'spiritual education' in order to develop a fanatical military spirit in both soldiers and civilians. Furthermore, that D. T. Suzuki, the (...) most famous exponent of Zen in the West, is shown to have been a wartime proponent of this Zen-inspired viewpoint which enabled Japanese soldiers to leave for the battlefield already resigned to death. Victoria takes us onto the naval battlefield in the company of warrior-monk and Rinzai Zen Master Nakajima Genjô. We view the war in China through the eyes of a Buddhist military chaplain. The book also examines the relationship to Buddhism of Japan's seven Class-A war criminals who were hung by the Tokyo War Crimes Tribunal in 1948. A highly controversial study, this book will be of interest, first and foremost, to students of Zen as well as all those studying the history of this period, not to mention anyone concerned with the perennial question of the 'proper' relationship between religion and the state. (shrink)

The National Institute for Health and Care Excellence (NICE) is the UK’s primary healthcare priority-setting body, responsible for advising the National Health Service in England on which technologies to fund and which to reject. Until recently, the normative approach underlying this advice was described in a 2008 document entitled ‘Social value judgements: Principles for the development of NICE guidance’ (SVJ). In January 2020, however, NICE replaced SVJ with a new articulation of its guiding principles. Given the significant evolution of NICE’s (...) methods between 2008 and 2020, this study examines whether this new document (‘Principles’) offers a transparent account of NICE’s current normative approach. It finds that it does not, deriving much of its content directly from SVJ and failing to fully acknowledge or explain how and why NICE’s approach has since changed. In particular, Principles is found to offer a largely procedural account of NICE decision-making, despite evidence of the increasing reliance of NICE’s methods on substantive decision-rules and ‘modifiers’ that cannot be justified in purely procedural terms. Thus, while Principles tells NICE’s stakeholders much about how the organisation goes about the process of decision-making, it tells them little about the substantive grounds on which its decisions are now based. It is therefore argued that Principles does not offer a transparent account of NICE’s normative approach (either alone, or alongside other documents) and that, given NICE’s reliance on transparency as a requirement of procedural justice, NICE does not in this respect satisfy its own specification of a just decision-maker. (shrink)

The need for research to advance scientific understanding must be balanced with ensuring the rights and wellbeing of participants are safeguarded, with some research topics posing more ethical quandaries for researchers than others. Moral injury is one such topic. Exposure to potentially morally injurious experiences can lead to significant distress, including post-traumatic stress disorder, depression, and selfinjury. In this article, we discuss how the rapid expansion of research in the field of moral injury could threaten the wellbeing, dignity and integrity (...) of participants. We also examine key guidance for carrying out ethically responsible research with participants’ rights to self-determination, confidentiality, non-maleficence and beneficence discussed in relation to the study of moral injury. We describe how investigations of moral injury are likely to pose several challenges for researchers including managing disclosures of potentially illegal acts, the risk of harm that repeated questioning about guilt and shame may pose to participant wellbeing in longitudinal studies, as well as the possible negative impact of exposure to vicarious trauma on researchers themselves. Finally, we offer several practical recommendations that researchers, research ethics committees and other regulatory bodies can take to protect participant rights, maximise the potential benefits of research outputs and ensure the field continues to expand in an ethically responsible way. (shrink)

Background As the UK’s main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE’s decisions. In this study we adopt a complementary approach, based on the proposition that (...) a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE’s formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified. Methods The study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance. Findings Much of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE’s formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE’s specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value. Conclusion At the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence. (shrink)

This book selectively examines a range of ideas and arguments drawn from the philosophical traditions of South and East Asia, focusing on those that are especially relevant to the philosophy of religion. The book introduces key debates about the self and the nature of reality that unite the otherwise highly diverse philosophies of Indian and Chinese Buddhism, Hinduism, and Jainism. The emphasis of the book is analytical rather than historical. Key issues are explained in a clear, precise, accessible manner, and (...) with a view to their relevance to contemporary philosophical debates. (shrink)

Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that “autonomy” is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because (...) it is unable to facilitate a relational approach to decision making in cases when the patient’s competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants’ understanding was the emergent concept of “relational knowing,” a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings. (shrink)

The commentaries in response to our feature paper1 are indicative of the varied perspectives that can be taken towards artificial amnion and placenta technology (AAPT) and more specifically its relationship with pregnancy (loss). Kennedy rightly argues that empirical research is essential for understanding the experiences of pregnancy loss and AAPT2 and our own advocacy of empirical research is evident in previous work.3–5 Kennedy also acknowledges the current impossibility of researching AAPT experiences since it has not yet been applied in clinical (...) settings. It is precisely for this reason that we draw on the reported experiences of neonatal intensive care (NICU) parents since they present the closest analogy which can be drawn with the technology.1 What we reject in Kennedy’s response, however, is the claim that the experiences of NICU parents have been ‘exploited’ by us.2 Studies documenting the experiences of NICU parents were drawn on to indicate that our considerations are more than mere speculation. As stated, the experiences of NICU parents, particularly the pregnant individual who experiences pregnancy loss, are the closest indication we have of how AAPT and what it entails may be experienced. To claim that this data is being exploited by us is to undermine the very purpose that such research is undertaken—to indicate how future care may be improved. It would be much more harmful to not use this information. While we believe that experiences of …. (shrink)