Artificial intelligence has dramatically changed the way organizations communicate, understand, and interact with their potential consumers. In the context of this trend, the ethical considerations of advertising when applying AI should be the core question for marketers. This paper discusses six dominant algorithmic purchase decision pathways that align with ethical philosophies for online customers when buying a product/goods. The six ethical positions include: ethical egoism, deontology, relativist, utilitarianism, virtue ethics, and ethics of care. Furthermore, this paper launches an (...) “intelligent advertising” AI theme by examining its present and future as well as identifying the key phases of intelligent advertising. Several research questions are offered to guide future research on intelligent advertising to benefit ethical AI decision-making. Finally, several areas that can be widely applied to ethical intelligent advertising are suggested for future research. (shrink)

BackgroundWhether and how to disclose genomic findings obtained in the course of genomic clinical practice and medical research has been a controversial global bioethical issue over the past two decades. Although several recommendations and judgment tools for the disclosure of genomic findings have been proposed, none are sufficiently systematic or inclusive or even consistent with each other. In order to approach the disclosure/non-disclosure practice in an ethical manner, optimal and easy-to-use tools for supporting the judgment of physicians/researchers in genomic medicine (...) are necessary.MethodsThe bioethics literature on this topic was analyzed to parse and deconstruct the somewhat overlapping and therefore ill-defined key concepts of genomic findings, such as incidental, primary, secondary, and other findings. Based on the deconstruction and conceptual analyses of these findings, we then defined key parameters from which to identify the strength of duty to disclose (SDD) for a genomic finding. These analyses were then applied to develop a framework with the SDD matrix and systematic decision-making pathways for the disclosure of genomic findings.ResultsThe following six major parameters (axes), along with sub-axes, were identified: Axis 1 (settings and institutions where findings emerge); Axis 2 (presence or absence of intention and anticipatability in discovery); Axis 3 (maximal actionability at the time of discovery); Axis 4 (net medical importance); Axis 5 (expertise of treating physician/researcher); and Axis 6 (preferences of individual patients/research subjects for disclosure). For Axes 1 to 4, a colored SDD matrix for genomic findings was developed in which levels of obligation for disclosing a finding can be categorized. For Axes 5 and 6, systematic decision-making pathways were developed via the SDD matrix.ConclusionWe analyzed the SDD of genomic findings and developed subsequent systematic decision-making pathways of whether and how to disclose genomic findings to patients/research subjects and their relatives in an ethical manner. Our comprehensive framework may help physicians and researchers in genomic medicine make consistent ethical judgments regarding the disclosure of genomic findings. (shrink)

Pope Francis's has described his vision for a synodal Church, not simply as a once off programme of renewal, but as God's desire for the Church of the third millennium. As such, it aims to concretise the ecclesiology of the Second Vatican Council, making the Church today more manifestly one of communion, participation, and mission. It differs from previous synods and Councils in history in that it more directly invites and involves all the baptised in a direct process of listening (...) and discernment to the voice of the Holy Spirit. This paper aims to understand from a theological perspective how listening will work in a synodal Church, by exploring firstly what we mean by the ecclesiology of communion from the Council. Such an ecclesiology, manifesting the equal dignity of the faithful in Christ, will ground listening at the level of participation in God as well as acknowledging the gift of infallibility given to the whole Church. It means calling on the Holy Spirit to help discern how and where, the apostolic deposit of faith has been received by members of the body. It also explores what we mean by listening to the sensus fidei of the whole body and how the authority of laity and hierarchy operate both in united but distinct ways within a synodal process grounded in communion ecclesiology. Overall, such listening is to be done carefully for the sake of the Church's mission as the sacrament of salvation to the world. (shrink)

In response to calls for more research on how to prevent or detect fraud (ACAP, Final Report of the Advisory Committee on the Auditing Profession, United States Department of the Treasury, Washington, DC, 2008 ; AICPA, SAS No. 99: Consideration of Fraud in a Financial Statement Audit, New York, NY, 2002 ; Carcello et al., Working Paper, University of Tennessee, Bentley University and Kennesaw State University, 2008 ; Wells, Journal of Accountancy, 2004 ), we develop a framework that identifies three (...) psychological pathways to fraud, supported by multiple theories relating to moral intuition and disengagement, rationalization, and the role played by negative affect. The purpose of developing the framework is twofold: (1) to draw attention to important yet under-researched aspects of ethical decision-making, and (2) to increase our understanding of the psychology of committing fraud. Our framework builds on the existing fraud triangle (PCAOB, Consideration of fraud in a financial statement audit. AU Section 316, www.pcaobus.org , 2005 ) which is used by auditors to assess fraud risk. The fraud triangle is composed of three factors that, together, predict the likelihood of fraud within an organization: opportunity, incentive/pressure, and attitude/rationalization. We find that, when faced with the opportunity and incentive/pressure, there are three psychological pathways to fraud nestled within attitude/rationalization: (1) lack of awareness, (2) intuition coupled with rationalization, and (3) reasoning. These distinctions are important for fraud prevention because each of these paths is driven by a different psychological mechanism. This framework is useful in a number of ways. First, it identifies certain insidious situational factors in which individuals commit fraud without recognizing it. Second, it extends our knowledge of rationalization by theorizing that individuals use rationalization to avoid or reduce the negative affect that accompanies performing an unethical behavior. Negative affect is important because individuals wish to avoid it. Third, it identifies several other methods fraudsters use to reduce negative affect, each of which could serve as potential “psychological red flags” and helps predict future fraudulent behavior. Finally, our framework can be used as a theoretical foundation to explore several interventions designed to prevent fraud. (shrink)

The insulin/insulin‐like growth factor‐1 (IGF‐1) signaling (IIS) pathway is a pivotal genetic program regulating cell growth, tissue development, metabolic physiology, and longevity of multicellular organisms. IIS integrates a fine‐tuned cascade of signaling events induced by insulin/IGF‐1, which is precisely controlled by post‐translational modifications. The ubiquitin/proteasome‐system (UPS) influences the functionality of IIS through inducible ubiquitylation pathways that regulate internalization of the insulin/IGF‐1 receptor, the stability of downstream insulin/IGF‐1 signaling targets, and activity of nuclear receptors for control of gene expression. An (...) age‐related decline in UPS activity is often associated with an impairment of IIS, contributing to pathologies such as cancer, diabetes, cardiovascular, and neurodegenerative disorders. Recent findings identified a key role of diverse ubiquitin modifications in insulin signaling decisions, which governs dynamic adaption upon environmental and physiological changes. In this review, we discuss the mutual crosstalk between ubiquitin and insulin signaling pathways in the context of cellular and organismal homeostasis. (shrink)

Given the potential dangers of unethical decisions in the workplace, it has become increasingly important for managers to hire, and promote into leadership positions, those who are morally inclined. Behavioral ethics research has contributed to this effort by examining an array of individual difference variables that play a role in morality. However, past research has focused mostly on direct causal effects and not so much on the processes through which different factors, especially those that are morality based, decrease unethical choices. (...) The purpose of the current research is to examine the process, which includes both subconscious and conscious decision pathways, through which moral attentiveness curbs unethical decision making at the individual level. The findings of a study employing about 200 participants and a cheating task reveal that both accurate ethical prototypes and moral awareness of the situation decreased unethical decisions, and moral attentiveness was found to be positively related to both of these constructs. In addition, having accurate ethical prototypes was found to be a partial mediator between perceptual moral attentiveness and less cheating, while moral awareness was found to be a partial mediator between reflective moral attentiveness and less cheating. The theoretical and practical implications of these findings are discussed. (shrink)

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the (...) application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. (shrink)

Recent years have witnessed an enormous increase in behavioral and neuroimaging studies of numerical cognition. Particular interest has been devoted toward unraveling properties of the representational medium on which numbers are thought to be represented. We have argued that a correct inference concerning these properties requires distinguishing between different input modalities and different decision/output structures. To back up this claim, we have trained computational models with either symbolic or nonsymbolic input and with different task requirements, and showed that this (...) allowed for an integration of the existing data in a consistent manner. In later studies, predictions from the models were derived and tested with behavioral and neuroimaging methods. Here we present an integrative review of this work. (shrink)

Adults who are incapacitated and alone, having no surrogates, may be known as “unbefriended.” Decision-making for these particularly vulnerable patients is a common and vexing concern for healthcare providers and hospital ethics committees. When all other avenues for resolving the need for surrogate decision-making fail, patients who are incapacitated and alone may be referred for “public guardianship” or guardianship of last resort. While an appropriate mechanism in theory, these programs are often under-staffed and under-funded, laying the consequences of (...) inadequacies on the healthcare system and the patient him or herself. We describe a qualitative study of professionals spanning clinical, court, and agency settings about the mechanisms for resolving surrogate consent for these patients and problems therein within the state of Massachusetts. Interviews found that all participants encountered adults who are incapacitated and without surrogates. Four approaches for addressing surrogate needs were: work to restore capacity; find previously unknown surrogates; work with agencies to obtain surrogates; and access the guardianship system. The use of guardianship was associated with procedural challenges and ethical concerns including delays in care, short term gains for long term costs, inabilities to meet a patient’s values and preferences, conflicts of interest, and ethical discomfort among interviewees. Findings are discussed in the context of resources to restore capacity, identify previously unknown surrogates, and establish improved surrogate mechanisms for this vulnerable population. (shrink)

The Notch proteins play a vital role in cell fate decisions in both invertebrate and vertebrate development. Careful analysis of this role has led to a model of signalling downstream of these receptors, via the CSL (CBF1, Suppressor of Hairless, Lag-1) family of transcription factors. There have been suggestions, however, that Notch can signal through other pathways. In the current paper, Ramain et al.1 provide compelling evidence for Notch signalling through a CSL-independent pathway and they demonstrate that the cytoplasmic (...) protein, Deltex, is required for this signal. In addition, they show that Wnt signalling may regulate this Deltex-dependent signal. (shrink)

Adults who are incapacitated and alone, having no surrogates, may be known as “unbefriended.” Decision-making for these particularly vulnerable patients is a common and vexing concern for healthcare providers and hospital ethics committees. When all other avenues for resolving the need for surrogate decision-making fail, patients who are incapacitated and alone may be referred for “public guardianship” or guardianship of last resort. While an appropriate mechanism in theory, these programs are often under-staffed and under-funded, laying the consequences of (...) inadequacies on the healthcare system and the patient him or herself. We describe a qualitative study of professionals spanning clinical, court, and agency settings about the mechanisms for resolving surrogate consent for these patients and problems therein within the state of Massachusetts. Interviews found that all participants encountered adults who are incapacitated and without surrogates. Four approaches for addressing surrogate needs were: work to restore capacity; find previously unknown surrogates; work with agencies to obtain surrogates; and access the guardianship system. The use of guardianship was associated with procedural challenges and ethical concerns including delays in care, short term gains for long term costs, inabilities to meet a patient’s values and preferences, conflicts of interest, and ethical discomfort among interviewees. Findings are discussed in the context of resources to restore capacity, identify previously unknown surrogates, and establish improved surrogate mechanisms for this vulnerable population. (shrink)

The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for (...) the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication, and ethical decision-making, without the added demand to end the Liverpool Care Pathway would have resulted in a genuine advance in end of life care. (shrink)

Advances in perinatology have permitted the survival of fragile neonates. Quality of life has been considered a key element in medical decision-making. In this review we analyse the role of Q...

In this article we aim to provide insights about the challenges stakeholders in Portugal and across the globe may face throughout the Coronavirus Disease 2019 pandemic to reorganize coach training programs and suggest strategies to help coaches learn. Such reflection may help stakeholders across socio-cultural contexts consider the consequences of the changes made to coach training programs, the rationale for these decisions and the need to acknowledge existent challenges such as lower course completion rates, pressures to deliver the curriculum and (...) dilemmatic decisions about course format. Furthermore, we also suggest pathways for stakeholders to develop strategies that consider contextual variables and contribute to meaningful learning. Based on the Portuguese context, several issues are discussed. (shrink)

From a cultural-historical perspective, the impairments of a child with a condition like cerebral palsy have biological origins, but the disability evolves from the mismatch between the child and his/her social conditions for development. One example of this dialectical production of disability can be seen in the challenge of the 21st-century welfare state: How to provide economically feasible health and educational services anchored in evidence-based methods and practices. Standardized social service pathways for children with CP illustrates an attempt to (...) address this challenge and moderate the mismatch by acting in the intersection between impairment and society. The aim of the article is to analyze challenges in the practice of connecting research and practice-based knowledge with societal practices in order to diminish the disability of the child. A multidisciplinary group assembled by the Danish National Board of Social Services engaged in a practice of developing a guideline for a social service pathway. Agendas and minutes from their series of meetings provide insight in how the work evolved through conflictual discussions. Rather than a neutral transformation of knowledge into practice, the practice revealed itself as a value-laden process in which the needs of the child and family were at times decentred and the focus shifted to how social services could be realised in complex, structured social practices. While the group managed to overcome several conflicts and agree of a social service pathway, a socio-economic analysis was unable to argue for the comprehensive social service pathway as an economic sound choice for municipal decision-makers. The conflict between the welfare ideology and economic feasibility remains unresolved and can be expected to limit the extent that impairments can be remedied and the mismatch decreased. Overcoming or diminishing the mismatch might never become economic worthwhile. As the political pendulum oscillates between welfare and economic concerns, the experience of disability will likewise diminish or expand. (shrink)

BackgroundCaregivers may play a fundamental role in the clinical pathway of cancer patients. They provide emotional, informational, and functional support as well as practical assistance, and they might help mediate the interaction and communication with the oncologists when care options are discussed, or decisions are made. Little is known about the impact of dyadic dynamics on patient-doctor communication, patient's satisfaction, or adherence to the therapies. This study protocol aims to evaluate the efficacy of a psychological support intervention on patients-caregivers relationship (...) and their alignment in the treatment decision-making process and estimate related improvement in patient' compliance/adherence to treatments.MethodsA total of 102 patients-caregivers' dyads will be involved, among breast and prostate cancer patients. The study entails a pre- post- evaluation through psychological questionnaires, with a randomization of participants in two conditions, the experimental one in which subjects participate in a psychological support consultation, and the control one, where dyads do not receive any intervention. A follow up after 6 months from the enrollment is planned.DiscussionA positive impact of the psychological support intervention on patients' anxiety, depression, distress, and perceived social support is expected. Such improvements can directly affect patients' satisfaction and adherence to treatments. Data gathered from this study may inform health care providers, policy makers, and public health managers about the importance of caregiver's involvement in the cancer care pathway, and the best way to manage it. A further impact is to develop a specific intervention protocol to support caregivers' involvement in cancer care pathway, improve patient's wellbeing, the interaction with physicians and the compliance with the cancer treatment. (shrink)

While we know that career interruptions shape men’s and women’s professional trajectories, we know less about how job loss may matter for this process. Drawing on interviews with unemployed, college-educated men and women in professional occupations, I show that while both men and women interpret their job loss as due to impersonal “business” decisions, women additionally attribute their job loss as arising from employers’ “personal” decisions. Men’s job loss shapes their subsequent preferred professional pathways, but never in a way (...) that diminishes the importance of their participation in the labor force. For some women in this study, job loss becomes a moment to reflect on their professional pathways, often pulling them back from paid work. This study identifies job loss as an event that, on top of gendered workplace experiences and caregiving obligations, may curtail some women’s participation in paid work. (shrink)

In the past 20 years, Latinas have begun to outperform Latinos in high school completion and college enrollment, tracking the overall “gender reversal” in college attainment that favors women. Few studies have examined what factors contribute to Latinas’ increasing educational success. This article focuses on gender differences in college-going behavior among a cohort of 50 Latino/a college aspirants in the San Francisco East Bay Area. Through 136 longitudinal interviews, I examine trends in Latinos/as’ postsecondary pathways and life course decisions (...) over a two-year period. Findings suggest evidence for gendered familism, in which gender and racial/ethnic beliefs intersect to differentially shape Latinos/as’ attitudes, behaviors, and college choices. Gendered familism encouraged Latinas to seek a four-year degree as a means of earning independence, while Latinos expressed a sense of automatic autonomy that was not as strongly tied to educational outcomes. (shrink)

Societies have always used their heritage to remain resilient and to express their cultural identities. Today, all the still-available experiences accrued by human societies over time and across space are, in principle, essential in coping with the twenty-first century grand challenges of humanity. Artificial intelligence and machine learning algorithms can assist the next generation of historians, heritage stakeholders, and decision-makers in decoding unstructured knowledge and wisdom embedded in selected cultural artefacts and social rituals, encoding data in machine-readable systems, aggregating (...) information according to the user’s needs in real time, and simulating the consequences of either erasing, neglecting, putting in latency, or preserving and sharing specific human experiences. What our global society needs is a multilingual and transcultural approach to decode-encode the treasure of human experience and transmit it to the next generation of world citizens. This approach can be the pathway to work on a new science of heritage, its ethics, and empathy. (shrink)

Global food security challenges demand an understanding of farmers’ gendered practices and perspectives. This research draws on data from a quantitative survey and qualitative methods to explore gender differences related to farmers’ practices, perceptions, and knowledge of pesticides and other pest management practices in tomato growing regions of Ghana and Mali. A pathways approach based on participatory mapping integrates findings and reveals gender differences in labor and knowledge at different stages of tomato production. Farmers in both countries are heavily (...) reliant on pesticides, but there are also differences in pest management knowledge and practices between them. In Mali, farmers are more familiar with Integrated Pest Management practices, but less aware of potential health risks of pesticides and more likely to engage in dangerous agro-chemical practices. In both countries, women are significantly less aware of pesticide dangers and IPM techniques than men and exposed to pesticides though a variety of pathways. We argue that the gender division of labor and differences in access to resources, information, and power between the two sites leads to gendered pesticide exposure pathways that are often unseen by the biological scientists who tend to focus on the field. Gender inequalities in knowledge and unsafe practices were particularly apparent in Mali compared to Ghana, possibly due to the lower literacy rates and decision making power of women and their narrower range of involvement in tomato production. The article concludes with gender sensitive recommendations to improve IPM research methods, trainings, and technology diffusion. (shrink)

Research studies have identified various different mechanisms in the effects of nature engagement on well-being and mental health. However, rarely are multiple pathways examined in the same study and little use has been made of first-hand, experiential accounts through interviews. Therefore, a semi-structured interview was conducted with seven female students who identified the role of nature engagement in their well-being and mental health. After applying thematic analysis, 11 themes were extracted from the data set, which were: “enjoying the different (...) sensory input,” “calm nature facilitates a calm mood,” “enhancing decision making and forming action plans,” “enhancing efficiency and productivity,” “alleviating pressure from society's expectations regarding education,” “formation of community relations,” “nature puts things into perspective,” “liking the contrast from the urban environment,” “feel freedom,” “coping mechanism,” and “anxious if prevented or restricted.” The results indicate complementary mechanisms for how nature-related activities benefit mental health and well-being that may occupy different levels of experience within a hierarchical framework informed by perceptual control theory. (shrink)

Most minor children are eligible for Social Security survivors benefits if a wage-earning parent dies, but eligibility of children not in utero at the time of death is more nuanced. The purpose of this study was to examine attitudes concerning access to Social Security survivors benefits in the context of posthumous reproduction. A probability sample of 540 Florida households responded to a multiple-segment factorial vignette designed to examine the effects of state intestacy laws and five reproductive pathways – normative, (...) posthumous birth, cryopreserved embryo, cryopreserved gametes, and posthumous gamete retrieval – on attitudes toward eligibility for the Social Security survivors benefits. Broad support was found for the survivors benefits following normative and posthumous birth pathways, but attitudes were decidedly less favorable when the child was not in utero at the time of parental death. In addition, in stark contrast to the recent U.S. Supreme Court decision in Astrue v. Capato, the vast majority of respondents did not believe state intestacy laws should determine eligibility for Social Security survivors benefits. (shrink)

Making good decisions in extremely complex and difficult processes and situations has always been both a key task as well as a challenge in the clinic and has led to a large amount of clinical, legal and ethical routines, protocols and reflections in order to guarantee fair, participatory and up-to-date pathways for clinical decision-making. Nevertheless, the complexity of processes and physical phenomena, time as well as economic constraints and not least further endeavours as well as achievements in medicine (...) and healthcare continuously raise the need to evaluate and to improve clinical decision-making. This article scrutinises if and how clinical decision-making processes are challenged by the rise of so-called artificial intelligence-driven decision support systems (AI-DSS). In a first step, this article analyses how the rise of AI-DSS will affect and transform the modes of interaction between different agents in the clinic. In a second step, we point out how these changing modes of interaction also imply shifts in the conditions of trustworthiness, epistemic challenges regarding transparency, the underlying normative concepts of agency and its embedding into concrete contexts of deployment and, finally, the consequences for (possible) ascriptions of responsibility. Third, we draw first conclusions for further steps regarding a ‘meaningful human control’ of clinical AI-DSS. (shrink)

This paper looks at how local livelihoods and to a certain extent their transitions are embedded in, and in thrall to, power relations at higher levels. Placing the shaping of livelihood pathways within the context of top-down hydropower planning, it shows how the latter predetermines farm households’ current farming strategies and future livelihood pathways. Taking two villages along the Mekong River, both of which are to be impacted by the planned Pak Beng hydropower dam in Pak Beng district, (...) Oudomxay province, the paper illustrates how the pathways that rural livelihoods are taking in northern Laos are being shaped by decisions and processes embedded in national and regional exigencies. We argue that top-down approaches in hydropower planning, as manifested in the current institutional vacuum to formally deal with resettlement and compensation issues at the village level result in village authorities’ and potentially affected villagers’ inability to strategically convey and negotiate their views and concerns. Moreover, we reveal how it is the specter of change which drives livelihood adaptation, not change itself, thus illustrating how the defined compensation rules and procedures shape farm households’ farming strategies and future livelihood pathways even prior to the construction of the hydropower dam. (shrink)

This book explores ways in which educational leaders can apply the wisdom of the Tao in their day-to-day work in schools. It offers an alternative to the standard ways of western thinking to give the leader more possibilities when confronting a situation. We tend to value immediate and decisive action, winning, directing, and getting one’s way. Taoist Lessons for Educational Leaders offers another way of approaching the workplace. We can also value waiting and reflection before acting, seeing all participants as (...) winners or at least no one as a loser, following as a form of leadership, and giving away some victories, as beneficial to the governance of a school. There is more than one way to “win” and more than one way assert one’s authority, as illustrated by this book. (shrink)

Non-Invasive Prenatal Testing is a technology which provides information about fetal genetic characteristics very early in pregnancy by examining fetal DNA obtained from a sample of maternal blood. NIPT is a morally complex technology that has advanced quickly to market with a strong push from industry developers, leaving many areas of uncertainty still to be resolved, and creating a strong need for health policy that reflects women’s social and ethical values. We approach the need for ethical policy-making by studying the (...) use of NIPT and emerging policy in the province of Ontario, Canada. Using an adapted version of constructivist grounded theory, we conducted interviews with 38 women who have had personal experiences with NIPT. We used an iterative process of data collection and analysis and a staged coding strategy to conduct a descriptive analysis of ethics issues identified implicitly and explicitly by women who have been affected by this technology. The findings of this paper focus on current ethical issues for women seeking NIPT, including place in the prenatal pathway, health care provider counselling about the test, industry influence on the diffusion of NIPT, consequences of availability of test results. Other issues gain relevance in the context of future policy decisions regarding NIPT, including funding of NIPT and principles that may govern the expansion of the scope of NIPT. These findings are not an exhaustive list of all the potential ethical issues related to NIPT, but rather a representation of the issues which concern women who have personal experience with this test. Women who have had personal experience with NIPT have concerns and priorities which sometimes contrast dramatically with the theoretical ethics literature. These findings suggest the importance of engaging patients in ethical deliberation about morally complex technologies, and point to the need for more deliberative patient engagement work in this area. (shrink)

The Pathways Commission calls on accounting educators to develop students’ skills in ethical judgment and decision making, but there is uncertainty about how best to accomplish this task. We test if participation in Volunteer Income Tax Assistance programs is positively associated with students’ ethical judgment and decision making. Using a questionnaire administered to students participating in VITA and students not participating in VITA at seven universities, we form multiple measures of students’ ethical judgment and students’ ethical (...) class='Hi'>decision making. Regression analyses reveal that VITA participation is positively and significantly associated with ethical judgment and, in certain cases, is also positively and significantly associated with ethical decision making, even after controlling for other determinants including completion of ethics courses. We conclude that VITA programs can be effective educational interventions to promote ethical development in students. Our study adds to the growing literature on positive student outcomes associated with VITA participation, provides empirical evidence to support the tenets of situated learning and service-learning theories, and contributes to the development of effective ethics education. (shrink)

Objective: To analyse the process of end of life decisions in a neurosurgical environment.Methods: All 113 neurosurgical patients, who were subject to so called end of life decisions within a one year period were prospectively enrolled in a computerised data bank. Decision pathways according to patient and physician related parameters were assessed.Results: Leading primary diagnoses of the patients were traumatic brain injury and intracranial haemorrhage. Forty-five patients had undergone an emergency neurosurgical operation prior to end of life (...) class='Hi'>decision, N = 69 were conservatively treated, which included intracranial pressure recording, or they were not offered neurosurgical care because of futile prognosis. N = 111 died after a median of two days. Two, in whom the end of life decisions were revised, survived. Clear decisions to terminate further treatment were made by a senior staff member on call being informed by the senior resident on call , difficult decisions on the basis of extensive round discussions , and very difficult decision by an interdisciplinary ethical consult . Decisions were further substantiated by electrophysiological examinations in N = 59.Conclusion: End of life decisions are to be considered standard situations for neurosurgeons. These decisions may reach a high rate of “positive” prediction, if substantiated by electrophysiological examinations as well as on the grounds of clinical experience and respect for the assumed will of the patient. The fact that patients may survive following revision of an end of life decision underlines the necessity for repeated reassessment of these decisions. Ethical training for neurosurgeons is to be encouraged. (shrink)

Several attempts have been made previously to provide a biological grounding for cognitive architectures by relating their components to the computations of specific brain circuits. Often, the architecture's action selection system is identified with the basal ganglia. However, this identification overlooks one of the most important features of the basal ganglia—the existence of a direct and an indirect pathway that compete against each other. This characteristic has important consequences in decision-making tasks, which are brought to light by Parkinson's disease (...) as well as genetic differences in dopamine receptors. This paper shows that a standard model of action selection in a cognitive architecture cannot replicate any of these findings, details an alternative solution that reconciles action selection in the architecture with the physiology of the basal ganglia, and extends the domain of application of cognitive architectures. The implication of this solution for other architectures and existing models are discussed. (shrink)

Vulval development in the Caenorhabditis elegans hermaphrodite represents a simple, genetically tractable system for studying how cell signaling events control cell fata decisions. Current models suggest that proper specification of vulval cell fates relies on the integration of multiple signaling systems, including one that involves a receptor tyrosine kinase (RTK)→Ras→mitogen activated protein kinase (MAPK) cascade and one that involves a LIN‐12/Notch family receptor. In this review, we first discuss how genetic strategies are being used to identify and analyze components that (...) control vulval cell fate decisions. We then describe the different signaling systems that have been elucidated and how they relate to one another. Finally, we highlight several recently characterized genes that encode positive regulators, negative regulators or potential targets of the RTK→Ras→MAPK cascade involved in vulval induction. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

Some recent trade decisions, such as the U.S.’s imposition of protectionist measures against China, have attracted fervent popular support as well as outrage. Critics of these trade policies argue that they fail to promote society’s own interests. This paper catalogues the different ways that trade decisions can hinder and facilitate a society’s pursuit of social justice. I adopt a simple description of trade liberalization: a society forgoes the use of certain policy options, in order to pursue greater economic productivity through (...) increased trade flows. Using this simple descriptive account, the paper identifies two pathways for a society’s trade policies to shape its pursuit of social justice. First, greater economic productivity improves a society’s capacities to realize justice, especially distributive justice. I will argue that the value of greater economic capacities depends upon the society’s existing capacities and its inclinations to pursue justice. When a society has greater capacities and fails to extend their benefits to its worse-off citizens, these citizens have more serious grounds for complaint. Second, a society forgoes certain policy options when it liberalizes trade, and some of these options may be instrumentally valuable or even necessary for the society’s pursuit of justice. I will argue that, under non-ideal conditions, it can be desirable for a society to limit its own policy space so it cannot feasibly select policies that are unjust. Certain protectionist policies have taken on the expressive meaning that some groups are inferior in social and moral status. (shrink)

Smallholder farmers in Rattanakmondol District, Battambang Province, Cambodia face challenges related to soil erosion, declining yields, climate change, and unsustainable tillage-based farming practices in their efforts to increase food production within maize-based systems. In 2010, research for development programs began introducing agricultural production systems based on conservation agriculture to smallholder farmers located in four communities within Rattanakmondol District as a pathway for addressing these issues. Understanding gendered practices and perspectives is integral to adapting CA technologies to the needs of local (...) communities. This research identifies how gender differences regarding farmers’ access to assets, practices, and engagement in intra-household negotiations could constrain or facilitate the dissemination of CA. Our mixed-methods approach includes focus group discussions, semi-structured interviews, famer field visits, and a household survey. Gender differences in access to key productive assets may affect men’s and women’s individual ability to adapt CA. Farmers perceive the practices and technologies of CA as labor-saving, with the potential to reduce men’s and women’s labor burden in land-preparation activities. However, when considered in relation to the full array of productive and reproductive livelihood activities, CA can disproportionately affect men’s and women’s labor. Decisions about agricultural livelihoods were not always made jointly, with socio-cultural norms and responsibilities structuring an individual’s ability to participate in intra-household negotiations. While gender differences in power relations affect intra-household decision-making, men and women household members collectively negotiate the transition to CA-based production systems. (shrink)

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

Suppose that three patients each independently confront the same high-stakes treatment decision. Perhaps it is an option to terminate a high-risk pregnancy, or to accept a blood transfusion after a catastrophic hemorrhage. Suppose further that the three patients approach their choice in radically different ways. The divergence lies not in the choice made, but in the pathway followed in arriving at it. P1 is a classic analytical reasoner. She enumerates the potential costs and benefits of each option, reviews the (...) probabilities, and makes a decision on the basis of her analysis. P2 does none of that analytical work. She has a settled and robust prior... (shrink)

Financial and cost accounting information is processed by decision-makers guided by their particular need to support decisions. Recent technological advances impacting on information as well as organizations such as the European Community mandating financial reporting requirements for many countries is rapidly changing the landscape for decision making using accounting information. Hence, the importance of individuals'' decision making is more important than it was previously. These decisions are also influenced by individuals'' ethical beliefs. The Throughput Modeling approach to (...) cultural and ethical concerns provides a way of dealing with accounting information processed through various pathways by decision-makers. This modeling approach captures different philosophical perspectives from which to understand what is involved in "thinking scientifically." In the Throughput Modeling approach, pathways highlight the importance of how different philosophical perspectives may be used by individuals in arriving at a decision. This paper highlights key concepts involved in rethinking the basis of moral decision making in terms of an underlying process, rather than focusing on the application of principles or the development of a virtuous character. Examples are provided from both English and Spanish settings to help emphasize the importance of modeling ethical decision making globally. (shrink)

We believe that most bioethies committees as well as individual ethics consultants have major shortcomings in that they are unlikely to be open to serving the widest number of citizens who may need their services when facing bioethical dilemmas. The HDCC serves as a community resource, is open to all citizens, is free standing, and provides a wide variety of perspectives which can assist patients, their families, and healthcare providers to explore a range of values and options.The HDCC serves as (...) a model for communities that seek to establish a bioethics resource. Further, the HDCC model permits the further exploration of ways in which important healthcare issues can be faced. AHD believes, in keeping with its mission, that the creation of the HDCC can increase the public's awareness of and involvement in healthcare issues. As B. Jennings reminds us,The mission of community health decisions projects is to stimulate a well-informed conversation where many voices are heard and all reasonable perspectives given due consideration. They not only inform, but also enable responsible civic participation and thoughtful health care decisionmaking (6).The HDCC model can serve to bring discussions on bioethical dilemmas out of secrecy into safer, yet more open, community fora. (shrink)

Recent studies support a model in which the progeny of SOX9+ epithelial progenitors at the distal tip of lung branches undergo cell allocation and differentiation sequentially along the distal‐to‐proximal axis. Concomitant with the elongation and ramification of lung branches, the descendants of the distal SOX9+ progenitors are distributed proximally, express SOX2, and differentiate into cell types in the conducting airways. Amid subsequent sacculation, the distal SOX9+ progenitors generate alveolar epithelial cells to form alveoli. Sequential cell allocation and differentiation are integrated (...) with the branching process to generate a functional branching organ. This review focuses on the roles of SOX9+ cells as precursors for new branches, as the source of various cell types in the conducting airways, and as progenitors of the alveolar epithelium. All of these processes are controlled by multiple signaling pathways. Many mouse mutants with defective lung branching contain underlying defects in one or more steps of cell allocation and differentiation of SOX9+ progenitors. This model provides a framework to understand the molecular basis of lung phenotypes and to elucidate the molecular mechanisms of lung patterning. It builds a foundation on which comparing and contrasting the mechanisms employed by different branching organs in diverse species can be made. (shrink)

In this Open Peer Commentary, we draw on our clinical experience to argue that instrumental paternalism carves a pathway to competent refusal of medical intervention. Whether C successfully navigat...

Multi-level institutional designs with distributed power and authority arrangements among federal, state, regional, and local government agencies could lead to the emergence of differential patterns of socioeconomic and infrastructure development pathways in complex social–ecological systems. Both exogenous drivers and endogenous processes in social–ecological systems can lead to changes in the number of “basins of attraction,” changes in the positions of the basins within the state space, and changes in the positions of the thresholds between basins. In an effort to (...) advance the theory and practice of the governance of policy systems, this study addresses a narrower empirical question: how do intergovernmental institutional rules set by federal, state, and regional government agencies generate and sustain basins of attraction in funding infrastructure projects? A pattern-oriented, agent-based model (ABM) of an intergovernmental network has been developed to simulate real-world transportation policy implementation processes across the federal, the state of Vermont, regional, and local governments for prioritizing transportation projects. The ABM simulates baseline and alternative intergovernmental institutional rule structures and assesses their impacts on financial investment flows. The ABM was calibrated with data from multiple focus groups, individual interviews, and analysis of federal, state, and regional scale transportation projects and programs. The results from experimental simulations are presented to test system-wide effects of alternative multi-level institutional designs, in particular different power and authority arrangements between state and regional governments, on the emergence of roadway project prioritization patterns and funding allocations across regions and towns. (shrink)

This article contributes to the debate about how regulatory science for agricultural technologies can be ‘opened up’ for a more diverse set of concerns and knowledges. The article focuses on the regulation of ‘socio-economic considerations’ for genetically modified organisms. While numerous countries have declared their intent to include these considerations in biotechnology decision-making, it is currently unclear both what counts as a socio-economic consideration and how such considerations should be assessed. This article provides greater clarity about how socio-economic considerations (...) can be included in regulations by drawing upon the experience of two countries whose efforts in this field are particularly advanced: Kenya and South Africa. Based on extensive fieldwork, this article identifies the contours of an emerging regulatory regime by presenting two practice-based models for including socio-economic considerations in biotechnology decision-making. Whereas Kenya has taken a bottom-up process prior to assessing the first technologies and strongly emphasises scientific expertise, South Africa has instead established regulatory standards in an ad hoc fashion on a case-to-case basis, with a less prominent role for scientific evidence. The discussion of the distinct characteristics and tensions of both models provides insight into two potential pathways for including socio-economic considerations in the regulation of agricultural technologies. (shrink)

The unified framework for addiction (UFA) formulated by Redish et al. is a tour de force. It uniquely predicts that there should be multiple addiction syndromes and pathways – a diversity that would reflect the complexity of the mammalian brain decision system. Here I explore some of the evolutionary and developmental ramifications of UFA and derive several new avenues for research.

A unique feature of flowering plants is their ability to produce organs continuously, for hundreds of years in some species, from actively growing tips called apical meristems. All plants possess at least one form of apical meristem, whose cells are functionally analogous to animal stem cells because they can generate specialized organs and tissues. The shoot apical meristem of angiosperm plants acts as a continuous source of pluripotent stem cells, whose descendents become incorporated into organ primordia and acquire different fates. (...) Recent studies are unveiling some of the molecular pathways that specify stem cell fate in the center of the shoot apical meristem, that confer organ founder cell fate on the periphery, and that connect meristem patterning elements with events at the cellular level. The results are providing important insights into the mechanisms through which shoot apical meristems integrate cell fate decisions with cellular proliferation and global regulation of growth and development. BioEssays 24:27–37, 2002. Published 2002 John Wiley & Sons, Inc. (shrink)

This study examines an important aspect of energy history and policy: the intertwinement of energy technologies with ideals. Ideals play an important role in energy visions and innovation pathways. Aspirations to realize technical, social, and political ideals indicate a long-term commitment in the design of energy systems, distinguishable from commitment to other abstract goals, such as values. This study offers an analytical scheme that could help to conceptualize these differences and their impact on energy policy. In the proposed model, (...) two spheres of interaction are highlighted: a material sphere in which values and technologies co-evolve, and an imaginary sphere in which ideals interact with idealized technologies. Furthermore, the relation between these two spheres can be understood in different ways. This study examines three cases that are illustrative of the different roles of ideals in the development of energy technologies and visions: (1) the evolution of safety in nuclear reactor design; (2) visions of atomic power in France; (3) the political idealization of a tidal power scheme in the Severn Estuary. Finally, the developed model implies more general insights for the development of sociotechnical systems. Amongst others, it shows why certain projects and technologies remain a political, but not a techno–economic option. (shrink)

Smallholder farmers in Rattanakmondol District, Battambang Province, Cambodia face challenges related to soil erosion, declining yields, climate change, and unsustainable tillage-based farming practices in their efforts to increase food production within maize-based systems. In 2010, research for development programs began introducing agricultural production systems based on conservation agriculture to smallholder farmers located in four communities within Rattanakmondol District as a pathway for addressing these issues. Understanding gendered practices and perspectives is integral to adapting CA technologies to the needs of local (...) communities. This research identifies how gender differences regarding farmers’ access to assets, practices, and engagement in intra-household negotiations could constrain or facilitate the dissemination of CA. Our mixed-methods approach includes focus group discussions, semi-structured interviews, famer field visits, and a household survey. Gender differences in access to key productive assets may affect men’s and women’s individual ability to adapt CA. Farmers perceive the practices and technologies of CA as labor-saving, with the potential to reduce men’s and women’s labor burden in land-preparation activities. However, when considered in relation to the full array of productive and reproductive livelihood activities, CA can disproportionately affect men’s and women’s labor. Decisions about agricultural livelihoods were not always made jointly, with socio-cultural norms and responsibilities structuring an individual’s ability to participate in intra-household negotiations. While gender differences in power relations affect intra-household decision-making, men and women household members collectively negotiate the transition to CA-based production systems. (shrink)

The precautionary principle may offer an appropriate framework for conducting in‐depth participatory technology assessment (PTA)‐type evaluations. It also holds considerable promise for responsible research and innovation (RRI). The precautionary principle is made up of several different elements and principles. This chapter considers these components, noting from the outset that they relate essentially to scientific evaluation. Probabilities are not particularly helpful in the context of the precautionary principle due to the levels of uncertainty with regard to knowledge of phenomena. In this (...) context, various forms of scenarios, narratives and unjustified inferences are particularly relevant. The chapter also considers more precise ways of identifying decision pathways in uncertain situations, where there is a risk of causing serious and/or irreversible damage, to use the terms given in various definitions of the precautionary principle. This decision can be made using: a utility‐based criterion, right‐based criteria, technology‐based criteria, and hybrid criteria. (shrink)