Three major trends in American health policy are intersecting in a fascinating way. First, managed care has grown to become the most dominant form of health-care delivery, leading to reductions in health-care costs as insurers are able to influence health-care providers with financial incentives. Second, the present growth of managed care has slowed, almost to a standstill, largely on account of consumers questioning what effects these financial incentives are having on the care of patients — questioning that has been expressed (...) in particular through lawsuits against managed care companies.Third, we are experiencing a renewed interest in the existence of medical error and how it may be reduced as a result of the Institute of Medicine’s report, To Err Is Human: Building a Safer Health System. The most important aspect of this renaissance in error reduction has been its emphasis on health care as a system that can be made better through system-oriented change. The most frustrating aspect is that the IOM did not endorse change in malpractice liability, which consistently puts the impetus for reducing medical error on the individual provider rather than the system as a whole. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

It is an observed fact that human populations differ in genetic composition. Some of the inherited diversity is due to combined effects of many genes. Although it would be interesting to know the magnitude and nature of the genetic contribution to some characters under polygenic control, such as intelligence or physique, environmental effects may be so great that no genetic analysis is possible—as Thoday has pointed out earlier in this symposium. With other polygenic characters, such as skin colour, the genetic (...) component is more obvious but still difficult to analyse precisely. The number of genes involved, their frequency and dominance have not been established. This is one of the reasons why selective effects on such characters are not readily measured, although they probably exist. (shrink)

Background Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. Research aim The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). Research design The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the (...) consequences of broken trust. Participants Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. Ethical considerations The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. Findings Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. Discussion Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. Conclusion Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted. (shrink)

In this unique volume, some of today's most eminent political philosophers examine the thought of John Rawls, focusing in particular on his most recent work. These original essays explore diverse issues, including the problem of pluralism, the relationship between constitutive commitment and liberal institutions, just treatment of dissident minorities, the constitutional implications of liberalism, international relations, and the structure of international law. The first comprehensive study of Rawls's recent work, The Idea of Political Liberalism will be indispensable for political philosophers (...) and theorists interested in contemporary political thought. (shrink)

_Just Doctoring_ draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way (...) to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems—from informed consent to care rationing and the repercussions of the HIV epidemic—and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century. (shrink)

Horizontal gene transfer (HGT) is a major mechanism responsible for the spread of antibiotic resistance. Conversely, it is often assumed that antibiotics promote HGT. Careful dissection of the literature, however, suggests a lack of conclusive evidence supporting this notion in general. This is largely due to the lack of well‐defined quantitative experiments to address this question in an unambiguous manner. In this review, we discuss the extent to which HGT is responsible for the spread of antibiotic resistance and examine what (...) is known about the effect of antibiotics on the HGT dynamics. We focus on conjugation, which is the dominant mode of HGT responsible for spreading antibiotic resistance on the global scale. Our analysis reveals a need to design experiments to quantify HGT in such a way to facilitate rigorous data interpretation. Such measurements are critical for developing novel strategies to combat resistance spread through HGT. -/- . (shrink)

Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

Pickering & Garrod's (P&G's) call to study language processing in dialogue context is an appealing one. Their interactive alignment model is ambitious, aiming to explain the converging behavior of dialogue partners via both intra- and interpersonal priming. However, they ignore the flexible, partner-specific processing demonstrated by some recent dialogue studies. We discuss implications of these data.

Training in the responsible conduct of research (RCR) is required for many research trainees nationwide, but little is known about its effectiveness. For a preliminary assessment of the effectiveness of a short-term course in RCR, medical students participating in an NIH-funded summer research program at the University of California, San Diego (UCSD) were surveyed using an instrument developed through focus group discussions. In the summer of 2003, surveys were administered before and after a short-term RCR course, as well as to (...) alumni of the courses given in the summers of 2002 and 2001. Survey responses were analyzed in the areas of knowledge, ethical decision-making skills, attitudes about responsible conduct of research, and frequency of discussions about RCR outside of class. The only statistically significant improvement associated with the course was an increase in knowledge, while there was a non-significant tendency toward improvements in ethical decision-making skills and attitudes about the importance of RCR training. The nominal impact of a short-term training course should not be surprising, but it does raise the possibility that other options for delivering information only, such as an Internet-based tutorial, might be considered as comparable alternatives when longer courses are not possible. (shrink)

History and Systems of Psychology provides an engaging introduction to the rich story of psychology's past. Retaining the clarity and accessibility praised by readers of earlier editions, this classic textbook provides a chronological history of psychology from the pre-Socratic Greeks to contemporary systems, research, and applications. The new edition also features expanded coverage of Eastern as well as Western traditions, influential women in psychology, professional psychology in clinical, educational, and social settings, and new directions in twenty-first century psychology as a (...) cognitive and a positive science. Assuming little prerequisite knowledge, the authors discuss the people, places, and concepts that have shaped psychology's story, and show that we remain fascinated by the same enduring questions that confronted our ancestors - namely, our wonder at our subjectivity and consciousness of self. The seventh edition is fully supported by robust pedagogical features, instructor resources, and a companion website to aid student learning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Everyday Utopia: What 2,000 Years of Wild Experiments Can Teach Us About the Good Life by Kristen R. GhodseeMark A. AllisonKristen R. Ghodsee. Everyday Utopia: What 2,000 Years of Wild Experiments Can Teach Us About the Good Life. New York: Simon & Schuster, 2023. 352 pp., hardcover, $29.99. ISBN 9781982190217.Kristen R. Ghodsee has written a wide-ranging, highly readable, and commendably radical vindication of utopian thought and experimentation. Everyday (...) Utopia is aimed at the educated lay reader—itself, perhaps, a utopian projection—rather than specialists. Nevertheless, all but the most erudite and cosmopolitan of scholars will encounter unfamiliar and compelling utopiana within its pages. While her earlier book, Why Women Have Better Sex Under Socialism: And Other Arguments for Economic Independence (2018), concentrated on "state-sponsored solutions" to the deprivations of capitalism and patriarchy, the present volume sets its sights squarely on the private sphere, and utopian visions "for rearranging our domestic lives" (17).Ghodsee situates this turn to the domestic in two contexts. The first is the COVID-19 pandemic, which revealed the frangibility of the international commitment to gender equality. "Women around the globe woke up and realized that decades of feminism had done little to reverse the social expectation that mothers, sisters, wives, and daughters should provide care for young children, elderly parents, and sick relatives, as well as perform the emotional labors that hold families together in times of crisis," she laments (xii). Everyday Utopia's second context is the spate of recent works of "popular neo-utopianism," including Rutger Bregman's Utopia for Realists (2017), Aaron Bastani's Fully Automated Luxury Communism (2019), and Peter Diamandis and Steven Kotler's Abundance: The Future is Better Than You Think (2012) (14). What Ghodsee finds wanting in this discourse is its myopic focus on the public sphere, and its unspoken presupposition that our private and domestic lives have no such need of utopian renovation. But it is just this presupposition [End Page 285] that the COVID-19 lockdown discredited, although many other indicators (runaway housing and childcare costs, the environmental crisis, the epidemic of loneliness) already suggested as much. Ghodsee rightly insists that "where we reside, how we raise and educate our children, our personal relationship to things, and the quality of our connections to friends, families, and partners impact us as much as tax policies, the price of energy, or the way we organize formal employment" (14). As utopian thinkers from Plato forward have understood, moreover, it is short-sighted to suppose that sweeping economic and political transformations are possible without a concomitant rethinking of the "intimate worlds" that subtend these public domains (15).Accordingly, Everyday Utopia devotes its succeeding chapters to examining alternatives to the dominant institutions of the contemporary private sphere, including the single-family household, the monogamous couple paradigm of childrearing and mating, and the institution of private property. In each case, Ghodsee plumbs the past and limns the present to highlight utopian alternatives to contemporary norms. Among this book's greatest strengths is its consistently international range of examples and admirably sustained commitment to feature "experiments that have received relatively less attention" in the extant literature (xv).Take, for example, the chapter on communal alternatives to single-family homes. Ghodsee includes many of the usual (and eminently worthy) suspects: Buddhist and Christian cenobite monasteries, Fourierist phalansteries, Israeli kibbutzim, and the Corbusier-inspired "microdistricts" of the former Eastern bloc (47). But we also learn of less canonical phenomena, such as the Neolithic proto-city of Çatalhöyük, "one of the first major settlements in the world," where as many as eight thousand people lived in an essentially contiguous structure, in highly egalitarian and likely non-consanguineous households (32). Or consider the Beguine nuns, a lay order founded in 1190 that survived, albeit in attenuated form, into the twentieth century. The Beguine lived communally in urban areas, enjoying liberties unthinkable not only to their cloistered counterparts, but to virtually all their female contemporaries: they brewed beer, made lace, taught school—and traversed the streets unchaperoned. The chapter concludes with a discussion of contemporary cohousing. In Denmark, roughly one percent of the population was living in co... (shrink)

The American Institute of Certified Public Accountants (AICPA) is responsible for the Code of Professional Conduct that governs the actions of CPAs. In 1988, the Code was revised by the AICPA, but a number of issues still remain unresolved or confounded by the new Code. These issues are examined in light of the profession''s stated commitment to the public good, a commitment that is discussed at length in the new Code.Specifically, this paper reviews the following issues: (1) client confidentiality and (...) whistleblowing, (2) limited liability, and (3) auditor independence. We argue that, in each of these areas, the AICPA promotes a position that is potentially harmful to the public good. (shrink)

_Just Doctoring_ draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way (...) to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems—from informed consent to care rationing and the repercussions of the HIV epidemic—and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century. (shrink)

We examine how the shift to remote work altered responsibilities for domestic labor among partnered couples and single parents. The study draws on data from a nationally representative survey of 2,200 US adults, including 478 partnered parents and 151 single parents, in April 2020. The closing of schools and child care centers significantly increased demands on working parents in the United States, and in many circumstances reinforced an unequal domestic division of labor.

Spatial localization, often demarcated by food miles, has emerged as the dominant theme in movements for more socially just and environmentally benign alternative food systems, especially in industrialized countries such as the United States. We analyze how an emphasis on spatial localization, combined with the difficulty of defining and measuring adequate indicators for alternative food systems, can challenge efforts by food system researchers, environmental writers, the engaged public, and advocacy groups wanting to contribute to alternative food systems, and facilitates exploitation (...) by the mainstream players using “localwash” to maintain the status quo. New indicators are urgently needed because research shows that spatial localization in general and minimized food miles in particular are not adequate or even required for most of the goals of alternative food systems. Creating indicators to operationalize goals for alternative, local food systems requires asking the right questions to make sure indicators are not misleading us: What are the goals of alternative food systems? What actions and policies will most effectively achieve those goals? What is the potential of reducing food miles as an action and a policy for achieving goals? What are the best indicators for measuring progress toward goals? We discuss how these questions can be answered for a wide range of alternative food system goals via four categories according to the role of food miles reduction as an action and policy in promoting them: necessary and sufficient, necessary but not sufficient, potentially important, and potentially supportive. (shrink)

Christians, Allison, Benoît-Guay, Nicolas.

This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of Autism Spectrum Disorder.1 However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis, which is widely taken to be far-and-away the best “treatment”2 for ASD, manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but they (...) often exacerbate them. Warnings of the perils of ABA are not original to us—autism advocates have been ringing this... (shrink)

This book constitutes one of the most important contributions to recent Kant scholarship. In it, one of the pre-eminent interpreters of Kant, Henry Allison, offers a comprehensive, systematic, and philosophically astute account of all aspects of Kant's views on aesthetics. The first part of the book analyses Kant's conception of reflective judgment and its connections with both empirical knowledge and judgments of taste. The second and third parts treat two questions that Allison insists must be kept distinct: the (...) normativity of pure judgments of taste, and the moral and systematic significance of taste. The fourth part considers two important topics often neglected in the study of Kant's aesthetics: his conceptions of fine art, and the sublime. (shrink)

Although a good deal has been written about Kant's conception of free will in recent years, there has been no serious attempt to examine in detail the development of his views on the topic. This book endeavours to remedy the situation by tracing Kant's thoughts on free will from his earliest discussions of it in the 1750s through to his last accounts in the 1790s. This developmental approach is of interest for at least two reasons. First, it shows that the (...) path that led Kant to view freedom as a transcendental power that is both radically distinct from and compatible with the causality of nature was a winding one. Second, it indicates that, despite the variety of views of free will that Kant held at various times, the concept occupied a central place in his thought, because it was the point of union between his theoretical and practical philosophy. (shrink)

Many opponents of BIG programs believe that receiving guaranteed subsistence income would act as a strong disincentive to work. In contrast, various areas of empirical research in psychology suggest that a BIG would not lead to meaningful reductions in work. To test these competing predictions, a comprehensive review of BIG outcome studies reporting data on adult labor responses was conducted. The results indicate that 93 % of reported outcomes support the prediction of no meaningful work reductions when the criterion for (...) support is set at less than a 5 % decrease in either average hours worked per week or the rate of labor participation. Overall, these results indicate that adult labor responses would show no substantial impact following a BIG intervention. (shrink)

The development of genomic technologies has seemed almost magical. Excitement about it, both in medicine and among the public, stems from the belief that genomic techniques will illuminate the causes of health and disease, will lead to effective interventions for both rare and common genetic conditions, and will inform reproductive decision‐making. Novel diagnostic tools, however, are often deployed before targeted therapies are developed, tested, or available and before their psychosocial implications are explored. Newer technologies such as prenatal whole exome screening (...) are seen as offering “decisional autonomy” to expectant parents, although such technologies identify information about genetic sequencing that may not have clear meaning. The “therapeutic gap” between the ability to conduct genetic sequencing and the ability to fully understand what the test results mean, much less what treatments to offer, leaves families with complex and unclear information they cannot act upon with confidence during pregnancy. In this essay, we will consider the psychosocial and ethical implications of such assumptions—and of the uncertain information produced by these technologies—for individuals and families and for societal aspects such as medical service usage and demographic inequities. (shrink)

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

This study is an analysis of surrogate-focused ethics consultations in the Intensive Care Unit (ICU) and the general wards (Ward) of a large community hospital in Northern California. We identified the major themes of surrogate-focused ethics consultations to better understand the root cause of surrogate conflicts, and identified the similarities and differences between surrogate-based conflicts in the two settings. Consults requested because the surrogate had desires that conflicted with the physicians medical opinion of ‘best interest’, or cases involving surrogates not (...) upholding a patient’s known values reflected the root cause of the majority of surrogate conflicts (72.7% ICU, 83.3% Ward). (shrink)

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

the standard reading of plato's Republic is that justice is predicated of the ideal city and of the philosophers, and that all other constitutions, both psychic and political, that are mentioned in the course of the dialogue are in some way or another defective and unjust. A non-standard reading appears to be gaining traction, however. Unorthodox Plato commentators such as Silverman, Jonas, Nakazawa, Braun, and Rowe argue that the ideal city—lovingly named 'Kallipolis'—is not just, that it is merely an improvement (...) upon, but not a complete cure for, the Luxurious City that is described immediately before it.1 If we want to gaze upon a just city, these unorthodox commentators propose, look no farther than the City of... (shrink)

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207–42 836 young adults aged 18–29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least (...) 18.5 serious adverse events from mRNA vaccines, including 1.5–4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430–4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates. (shrink)

Parfit argues that survival, Not identity, Is the important thing in cases of personal resurrection, Fission, Etc. I argue that parfit's and dennett's well known cases--And fantasies about cloning and telecloning--Suggest a distinction between type and token persons, Memories, Intentions, Etc. Parfit is wrong, I suggest, To think survival more determinate than identity; with quine I hold that there is no objective matter to be right or wrong about.