Rosamond Rhodes calls for a reconceptualization of research ethics and a fundamental shift in attitude toward both research subjects and scientific investigators. She recognizes the limits of the e...

The report by Barbara Bierer and Mark Barnes highlights the complexities experienced by institutions that conduct Public Health Service‐funded research involving human subjects and that need to negotiate the requirements of two sets of federal regulations: 45 C.F.R. 46, covering protections for human research subjects, and 42 C.F.R. 93, the PHS policies on research misconduct. As the nation's single largest sponsor of biomedical and behavioral research, the National Institutes of Health seeks to exemplify and promote human research protections and the (...) highest level of scientific integrity, public accountability, and social responsibility in the conduct of science. The NIH is committed to protecting the rights and welfare of research participants and to upholding integrity standards for research supported with public funds. However, human subjects protections must always take priority. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

This paper considers ethical decision making by blending three streams of related research: cognitive moral development of the decision maker, rational choice theory and a subjective expected utility model. Ethical dilemmas can be defined as situations where moral certainty is compromised by rational cognition. In this paper, the authors assume that some people use a morality-first perspective and others a rationality-first perspective. Ethical scenarios were written and used to test hypotheses derived from this perspective. The instrument developed was shown to (...) be in need of further refinement. Results are discussed in terms of relationships between participant-characteristics variables overall and subscale responses to the ethical scenarios. (shrink)

The return of genetic research results after death in the pediatric setting comes with unique complexities. Researchers must determine which results and through which processes results are returned. This paper discusses the experience over 15 years in pediatric cancer genetics research of returning research results after the death of a child and proposes a preventive ethics approach to protocol development in order to improve the quality of return of results in pediatric genomic settings.

Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Althoughpatientsand by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are theleastlikely (...) to request them. At many healthcare organisations in the USA, ethics consultations are overwhelmingly requested by physicians and other clinicians. We believe it is vital that healthcare institutions bridge the knowledge gaps and power imbalances over access to ethics consultation services through augmented policies, procedures and infrastructure. With enhanced education and support, patients and families may use ethics consultation to elevate their voices and prioritise their unique characteristics and preferences in the delivery of their healthcare. Empowering patients and families to request ethics consultation can only strengthen the patient/family–clinician relationship, enhance the shared decision-making model of care and ultimately lead to improved patient-centred care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eucharistic Adoration:Veils for VisionEmmanuel Perrier O.P.Translated by Amy Christine DevaudTo the Virgin of the AnnunciationEucharistic adoration is an eminently personal form of prayer.1 Not in the sense that each one of us could fill this time spent in the presence of the Lord with what he or she wants; if this were to be the case, there would be no adoration at all, since it would simply be a (...) matter of meeting oneself and one's ideas about God. Eucharistic adoration is a personal prayer in the sense that the adorer welcomes in his soul the divine person of the eternal Son, through the vision of the human body united to the Son in the womb of the Virgin Mary, just as this body is offered by faith in the sacrament of the Eucharist. Therefore, what is crucial to this meeting is that prayer be guided by the truth of the Eucharistic mystery and not by the feelings of the adorer, even less by the introspection of himself while adoring. In presenting the theological foundations of Eucharistic adoration, the following pages have a threefold goal: to enlighten beginners about the very things which shape this prayer; to help those who are progressing in their adoration to align it to the vision of the Word who became flesh; and [End Page 397] to accompany and support those who are more advanced in putting into words what they are already experiencing.After having specified the foundations of Eucharistic adoration, we will address the themes that sustain it in the same order in which the soul welcomes the mystery of the Word become flesh. This is an order that can be followed as steps to take during a time of adoration. One will then take care to allow enough time for each step. But it may be more relevant to focus on a limited number of themes, or even on a single one. We will be careful to ensure that we do not neglect any of the themes presented throughout the various meditations for adoration.The Hope of VisionEucharistic adoration begins and is consumed in vision, in the gaze toward the Body of Christ in his sacrament. God has accustomed us to listen to him, ever since he began to speak to Abraham, to Moses, to David, through the prophets. The Law begins with this commandment: "Hear now, O Israel!" To hear the Word is to welcome it, to put it into practice, and in doing so, to let it bear fruit within us. But seeing God is quite different.In the days of Christ, the central part of the Temple in Jerusalem, one of the wonders of the world, had two rooms, one called the Holy Place and the other called the Holy of Holies. The entrance to each room was obstructed by a huge curtain (see Exod 26:31–32). The priests usually celebrated their services behind the curtain of the Holy Place. However, they did not enter the Holy of Holies, the dwelling place of God among men (see Exod 29:43–46), which sheltered, before its destruction (probably in 587 BC), the Ark of the Covenant containing the tables of the Law given at Sinai, as well as a relic of the manna, the bread that came down from heaven to feed the people of Israel during the Exodus (see Heb 9:4). Only once a year the High Priest would cross the veil of the Holy of Holies to stand in the presence of God and pronounce the Name above all names, in remembrance of God's encounters with Moses:Whenever Moses went out to the tent, all the people rose up, and every man stood at his tent door, and looked after Moses, until he had gone into the tent. When Moses entered the tent, the pillar of cloud would descend and stand at the door of to the tent, and the Lord would speak with Moses. And when all the people saw the pillar of cloud standing at the door of the tent, all the people would rise up and worship. … The Lord used to speak with Moses... (shrink)

This study investigates: the changes in three major health-related factors—physical activity, non-physical-activity health behavior, and depressive symptoms, and how changes in physical activity were associated with changes in one’s depressive symptoms among young adults, middle-aged adults, and older adults while controlling non-physical-activity health behavior and sociodemographic characteristics among young, middle-aged, and older adults before and after the COVID-19 outbreak lockdown in the United States. A total of 695 participants completed an online questionnaire via MTurk, and participants were asked to recall (...) their physical activity, depressive symptoms, and non-physical-activity health behavior status in January and May of 2020. The IPAQ-SF was used to evaluate individuals’ physical activity, while the CES-D-10 was used to assess depressive symptoms. Covariates included non-physical-activity health behavior and sociodemographic factors. A Bayesian significance testing of changes was used to examine significant changes in physical activity, non-physical-activity behavior, and depressive symptoms in each age group while Bayesian regression analysis was employed to examine how the changes in physical activity were associated with respondents’ depressive symptoms while controlling for individual NHB and sociodemographic characteristics. The results showed that the participants tended to maintain their physical activity levels after the lockdown despite significant increases in sitting time among young and older adults. Decreases in moderate physical activity frequency were associated with a higher level of depressive symptoms. Although young and middle-aged cohorts experienced fewer differences in depressive symptoms compared to their counterparts in the older group, we found no significant heterogeneity effects in the relationships of interest across all age groups. Considering different influences of physical activity on depressive symptoms depending on different levels of activity and ages, more randomized clinical trials with program-based intervention studies should be conducted with different physical activity programs for different age populations. (shrink)

In a healthcare setting, a multitude of ethical and moral challenges are often present when patients and families direct uncivil behavior toward clinicians and staff. These negative interactions may elicit strong social and emotional reactions among staff, other patients, and visitors; and they may impede the normal functioning of an institution. Ethics Committees and Clinical Ethics Consultation Services (CECSs) can meaningfully contribute to organizational efforts to effectively manage incivility through two distinct, yet inter-related channels. First, given their responsibility to promote (...) a humane, respectful, and professional climate, many CECSs and Ethics Committees may assist institutional leadership in evaluating and monitoring incivility policies and procedures. Second, when confronted with individual incidents of patient/family incivility, Ethics Consultants can and often do work with all stakeholders to address and mitigate potentially deleterious impacts. This manuscript presents an overview of the multifaceted ethical implications of incivility in the healthcare environment, discusses the inherent qualifications of Ethics Consultants for assisting in the management of incivility, and proposes specific mitigating actions within the purview of CECSs and Ethics Committees. We also invite healthcare organizations to harness the skills and reputation of their CECSs and Ethics Committees in confronting incivility through comprehensive policies, procedures, and training. (shrink)

BackgroundThe Public Health Service Increased Risk designation identified organ donors at increased risk of transmitting hepatitis B, hepatitis C, and human immunodeficiency virus. Despite clear data demonstrating a low absolute risk of disease transmission from these donors, patients are hesitant to consent to receiving organs from these donors. We hypothesize that patients who consent to receiving offers from these donors have decreased time to transplant and decreased waitlist mortality.MethodsWe performed a single-center retrospective review of all-comers waitlisted for liver transplant from (...) 2013 to 2019. The three competing risk events (transplant, death, and removal from transplant list) were analyzed. 1603 patients were included, of which 1244 (77.6%) consented to offers from increased risk donors.ResultsCompared to those who did not consent, those who did had 2.3 times the rate of transplant (SHR 2.29, 95% CI 1.88–2.79, p < 0.0001), with a median time to transplant of 11 months versus 14 months (p < 0.0001), as well as a 44% decrease in the rate of death on the waitlist (SHR 0.56, 95% CI 0.42–0.74, p < 0.0001). All findings remained significant after controlling for the recipient age, race, gender, blood type, and MELD. Of those who did not consent, 63/359 (17.5%) received a transplant, all of which were from standard criteria donors, and of those who did consent, 615/1244 (49.4%) received a transplant, of which 183/615 (29.8%) were from increased risk donors.ConclusionsThe findings of decreased rates of transplantation and increased risk of death on the waiting list by patients who were unwilling to accept risks of viral transmission of 1/300–1/1000 in the worst case scenarios suggests that this consent process may be harmful especially when involving “trigger” words such as HIV. The rigor of the consent process for the use of these organs was recently changed but a broader discussion about informed consent in similar situations is important. (shrink)

The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) developed a Bioethics Ambassador Program (BAP); a yearlong educational program to assist clinical and non-clinical staff develop the skills to identify and address common burgeoning ethical issues that can arise during the provision of care to patients with cancer. The goal was to provide greater awareness of the role and services of Ethics, particularly at the institution’s geographically-diverse outpatient care centers and to better-instill a culture of preventative ethics. This article (...) discusses the design and implementation of the first two years of the program and analyzes its strengths, weaknesses, and impact on MSK. (shrink)

The identity of lesbian-mother combines a marginalized identity with one of the most revered mainstream identities. With data collected through exploratory in-depth interviews from nine lesbian-mothers, the authors use symbolic interaction framework to explore the strategies that lesbian birth mothers and comothers employ to gain acceptance for their marginal-mainstream identities in their family networks. Respondents experienced varying levels of resistance from their social networks, with comothers being especially vulnerable due to their lack of both biological and legal substantiation. The authors (...) explore the process of identity negotiation in three realms of everyday experience: in relationships with extended families, in relations within the nuclear family, and in lesbian relationships that have ended. (shrink)

Institutional Review Boards have expressed concern that research into sensitive topics such as mental disorder will cause participants undue distress. This study investigated the emotional responses of 5,220 Australians to a survey on mental-health-related discrimination. Participants were interviewed about their mental health and experiences of discrimination across 10 life domains and then the emotional impacts of the survey. Results suggested that a minority experienced a negative reaction in contrast to 88% reporting positive experiences. A mental health problem was associated with (...) both negative and positive reactions. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Psychologists' emerging interest in spirituality and religion as well as the relevance of each phenomenon to issues of psychological importance requires an understanding of the fundamental characteristics of each construct. On the basis of both historical considerations and a limited but growing empirical literature, we caution against viewing spirituality and religiousness as incompatible and suggest that the common tendency to polarize the terms simply as individual vs. institutional or ′good′ vs. ′bad′ is not fruitful for future research. Also cautioning against (...) the use of restrictive, narrow definitions or overly broad definitions that can rob either construct of its distinctive characteristics, we propose a set of criteria that recognizes the constructs' conceptual similarities and dissimilarities. Rather than trying to force new and likely unsuccessful definitions, we offer these criteria as benchmarks for judging the value of existing definitions. (shrink)

A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

In cognitive science, there is a tacit norm that phenomena such as cultural variation or synaesthesia are worthy examples of cognitive diversity that contribute to a better understanding of cognition, but that other forms of cognitive diversity (e.g., autism, attention deficit hyperactivity disorder/ADHD, and dyslexia) are primarily interesting only as examples of deficit, dysfunction, or impairment. This status quo is dehumanizing and holds back much-needed research. In contrast, the neurodiversity paradigm argues that such experiences are not necessarily deficits but rather (...) are natural reflections of biodiversity. Here, we propose that neurodiversity is an important topic for future research in cognitive science. We discuss why cognitive science has thus far failed to engage with neurodiversity, why this gap presents both ethical and scientific challenges for the field, and, crucially, why cognitive science will produce better theories of human cognition if the field engages with neurodiversity in the same way that it values other forms of cognitive diversity. Doing so will not only empower marginalized researchers but will also present an opportunity for cognitive science to benefit from the unique contributions of neurodivergent researchers and communities. (shrink)

This paper advocates for the inclusion of patient perspectives in the diagnosis and treatment of eating disorders (EDs) for ethical, epistemological, and pragmatic reasons. We build upon the ideas of a recent editorial published in this journal. Using EDs as their example, the authors argue against dominant DSM-oriented approaches in favor of an increased focus on understanding patients’ subjective experiences. We argue that their analysis stops too soon for the development of practical—and actionable—insights into how to effect the integration of (...) first-person and third-person accounts of EDs. Methods Contextual analysis was used to make the case for patient perspectives. (shrink)

This study examined academic and instructional effects of history fair participation on English Language Learners (ELLs). The exhibition preparation process included inquiry-based pedagogy to increase bilingual students’ social studies knowledge. The Bilingual History Fair required recent immigrant, 4th–12th grade students to explore community and immigration through oral history research projects. The mixed-methods data collection process involved a survey of 37 teacher participants, two teacher focus group interviews, and pre- and post-data collected from 149 student participants. Student involvement in the history (...) project expanded student learning and understanding of historical concepts. Through this initiative, teachers validated the students’ languages, cultures, and life experiences of their families. The student-to-teacher interactions and the employed targeted instructional strategies were “key methods to moving ELLs toward a stage of historical thinking that will have a measurable impact on student progress in the social studies” ( Salinas, Franquiz, & Guberman 2006, p. 207 ). The findings demonstrate that “teaching social studies that matters to ELLs is an achievable goal” ( Cruz & Thornton, 2009, p. 274 ). The process enhanced the self-concept and efficacy of the students and their sense of place in their schools and communities. (shrink)

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small-N study to explore the associations between stress and psychological symptoms (...) during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms, as well as stressful life experiences prior to-versus during the pandemic. Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers’ experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers’ mental health. (shrink)

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics in the Twenty-First Century: Why We Should Pay Attention to Eighteenth-Century Medical EthicsLaurence B. McCullough (bio)Those of us who work in the field of bioethics tend to think that, because the word “bioethics” is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724–1773) did bioethics just as we do it, at least two centuries (...) before we thought to do it (Gregory 1772). He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume’s moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory’s accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.Gregory’s “Problem List”Gregory wrote his medical ethics as a response to the then current state of medicine in Britain. We now follow Gregory in our writing of bioethics and clinical ethics in response to the problems of our time. A great deal that we now take for granted did not then exist. 1There was not, as there is now, any uniform pathway into medicine. Nor did there exist universal licensure. The Royal Colleges did attempt to assert, but failed to achieve, monopoly control of medical practice. The concepts of health and disease were themselves contested and therefore competed for their success in the market place. There was a marked oversupply of practitioners who competed fiercely—very fiercely indeed—in the medical market place for their concepts of health and disease, their treatments, and therefore their livelihoods. Patients had their own concepts of health and disease, engaged in “self-physicking” or self-care, and often traded physician’s prescriptions.Medicine exhibited little scientific discipline in its accounts of disease and in determining the efficacy of treatments, a fact that Gregory (1743) laments as a [End Page 329] medical student. There was no marked improvement when he began to give his medical ethics lectures nearly a quarter of a century later. Treatments failed as often, perhaps more often, than they succeeded in benefiting patients. The sick usually sought out the help of a physician after trying self-physicking.Physicians, Gregory taught, could not hope to control human biology, though they could aim to manage its processes well. When nature underresponds to disease the physician should assist her processes; when nature overresponds, the physician should tamp down nature’s responses, to lessen their “violence”—in both cases always attentive to the limits of medicine’s capacities in treating disease.Physicians attended the well-to-do sick at home, and the sick person summoned and dismissed physicians, surgeons, or apothecaries at will. A physician therefore might find himself—no women had yet been admitted to the ranks of university-trained physicians—summoned before, after, or simultaneously with a competitor, with his concepts and diagnosis and treatment put to the acid test. In this setting, there existed only a patient-physician relationship, not a physician-patient relationship.Physicians left off the care of dying patients, a practice that was made a matter of duty by Friederich Hoffmann (1749). One would suffer punishing economic consequences if one had a high mortality rate. Better, then, to label the patient incurable, withdraw, and turn matters over to clergy. Gregory attacks this practice as intellectual fraud and calls for the physician to continue to attend the dying. Indeed, he says, “It is as much the business of a physician to alleviate pain, and to smooth the avenues of death, when unavoidable, as to cure diseases” (Gregory 1772, p. 35). He does not explicitly address what we now call physician-assisted suicide; neither does he condemn it, and he is quick to condemn some things—e.g., sexual abuse of female patients or “sporting” with patients in the Royal Infirmary by using experiments as the first line of treatment.The Royal Infirmary was established to care for the deserving, working poor, who received free care... (shrink)

Existing research has examined if undergraduate factors influence chemistry and physics, or physical science, doctoral degree entry and whether variables during PhD programs associate with graduation. Yet research on the transition from bachelor’s degree to doctoral degree entry (i.e., PhD entry in less than 6 months, attainment of a master’s degree prior to doctoral degree entry, or working in a science-related job for more than a year prior to doctoral degree entry) on PhD degree graduation remains scarce. Our study examines (...) the transition from bachelor’s to doctoral degrees to see if experiences therein associate with female PhD graduation, after doctoral degree enrollment. Our logistic regression analysis, of female chemistry and physics doctorates (n = 867), indicated that attainment of a master’s degree did not change the likelihood of graduation, when compared to direct entry into physical science doctoral programs. Meanwhile working in a science-related job for a year or more is associated with a significantly lower likelihood of physical science doctoral graduation when compared to women who entered directly into PhD programs or received a master’s degree prior to enrollment. (shrink)

The project we highlight in this article stems from our philosophical work on moral disagreements that appear to be—and sometimes are—intractable. Deliberative democratic theorists tout the merits of dialogue as an effective way to bridge differences of values and opinion, ideally resulting in agreement, or perhaps more often resulting in greater mutual understanding. Could dialogue mitigate disagreements about a controversial education policy such as affirmative action? Could it foster greater understanding? We conceived of a project that would simultaneously fulfill two (...) goals that we had as philosophers, education researchers, and aspiring public intellectuals. First, it would allow us to use philosophy in research, grounding our mixed methods research in a philosophically informed framework. The tools and analytic techniques that are particular to philosophers felt uniquely suited for an empirical study concerning political theory. Second, we aimed to use philosophy in the community. We were able to put our own expertise in philosophy and race-conscious education policy to good use by purposefully creating opportunities for diverse community members in our larger metropolitan area to engage in dialogue and deliberation with each other over the issue of affirmative action. (shrink)

BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)

Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73–99% in New Zealand and 72–94% in Australia depending on the scenario) the percentage who would not (...) discuss expensive unfunded drugs was substantially lower in New Zealand (6.4–11.1%) than it was in Australia (28–41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians' decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.1 (2001) 23-47 [Access article in PDF] Suárez' Doctrine of Eternal Truths Amy D. Karofsky 1. Introduction The primary aim of this paper is to offer an interpretation of Suárez' doctrine of eternal truths as found in Metaphysical Disputation XXXI, chapter XII, sections 38-47. There, following the typical scholastic style, Suárez considers and rejects several theories before developing his own. Because it is (...) somewhat difficult to determine what view Suárez ultimately adopts, interpretations of this passage tend to vary. For example, Norman Wells suggests that the necessity and eternality of essential propositions is grounded in the intellect of the divine being. 1 Armand Maurer and John P. Doyle maintain that eternal truths are not grounded in the being of God, but rather in the real being of the essences themselves. 2 I will argue that none of these interpretations adequately expresses Suárez' project, for Suárez wants a solution to the problem of eternal truths that does not depend upon the will of the divine being and one that avoids any ontological commitment to unactualized, possible essences. 3 2. Explanation of the Problem of Eternal Truths Suárez begins the thirty-first disputation with a proof of the identity of essence and existence in finite creatures. The key premise in his argument is the claim that, lacking existence, an unactualized essence is not a being, but absolutely [End Page 23] nothing. 4 By 'being' Suárez means existing being, or a being that is created by God. 5 Unlike the essence of God, the essence of a creature is dependent for its being on the efficient causality of God. Prior to the creative act of God, then, the essence of a creature is not an existing being, hence not a being at all; the unactualized, possible essence is a non-being or nothing.From the claim that a nonexistent essence is absolutely nothing, the following problem arises:... si, ablata existentia, perit essentia, ergo propositiones illae in quibus praedicata essentialia de re praedicantur, non sunt necessariae, neque perpetuae veritatis... 6An essential proposition of the form "X is f" is a proposition in which an essential property f is attributed to an object X. If there are no X's in existence, then there is nothing of which f can be predicated. It would seem, then, that the proposition, "X is f" must be false. One might maintain, however, that even though there are no X's in existence, there is an essence (of) X that has the property f. And in this way, "X is f" remains true, even if there are no X's in existence.However, if one holds, as Suárez does, that the unactualized essence is absolutely nothing, then this solution will not work. For if there are no X's in existence, and if a nonexistent essence is absolutely nothing, then there is nothing of which the essential attribute can be predicated. Thus it appears that any proposition that purports to attribute a property to a nonexistent object must be false and so clearly it can be neither necessarily nor eternally true. Therefore, because Suárez believes that an unactualized essence is absolutely nothing, he seems to be committed to the claim that essential propositions are neither necessarily, nor eternally, true. I will refer to this problem as the Problem of Eternal Truths.Another way to illustrate the Problem of Eternal Truths is to see that there are two seemingly inconsistent propositions: AN: An unactualized, possible essence is absolutely nothing, and NE: True essential propositions are necessarily and eternally true. [End Page 24]Given that a proposition in which a property is attributed to an unactualized essence is false, if Suárez wants to assert the truth of AN, it would appear that he must deny the truth of NE, and, in so doing, reject the possibility of any science of creatures that deals only with necessary truths.Suárez considers three different solutions to this problem: (What I will call) the Aristotelian Solution, the Divine... (shrink)

Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of (...) a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives. (shrink)

Albert Jonsen in The Birth of Bioethics notes that his career in bioethics began with a phone call to him from soon-to-be colleagues at the University of California at San Francisco Medical Center. Bioethics didn't begin with a bang but as an accident in the root sense—something that happened, not by necessity, but rather by chance. Indeed, the opening chapters of Jonsen's book chronicle a series of accidents that helped to create the field of bioethics. Principal among these was the (...) fact that physicians and biomedical scientists who became puzzled about the moral dimensions of their work and began to think about these puzzles sought help in doing so from moral theologians and philosophers. These physicians and scientists, for the most part, were university people. They thought broadly, not just deeply, about their work, but they just as well could have defined themselves by their academic discipline and departments and not reached beyond these familiar and comfortable intellectual confines to the “culture” of the humanities disciplines and departments. The theologians and philosophers whom these physicians and scientists sought out were also university people who also happened to have generous views of the intellectual life in their disciplines—atypical of the time, especially in philosophy. If C. P. Snow had been altogether right and if ungenerous self-understanding of their work by physicians, scientists, philosophers, and theologians had prevailed, bioethics might not have happened at all. (shrink)

Law, Ethics and the Biopolitical explores the idea that legal authority is no longer related to national sovereignty, but to the 'moral' attempt to nurture life. The book argues that whilst the relationship between law and ethics has long been a central concern in legal studies, it is now the relationship between law and life that is becoming crucial. The waning legitimacy of conventional conceptions of sovereignty is signalled the renewal of a version of natural law, evident in discourses of (...) human rights, that de-emphasises the role of a divine law-giver in favour of an Aristotelian conception of the natural purpose of life and the 'common good'. Synthesising elements of legal scholarship on sovereignty, theories of biopolitics and biopower, as well as recent developments in the domains of ethics, Amy Swiffen examines the invocation of 'life' as a foundation for legal authority. The book documents the connection between law, life and contemporary forms of biopolitical power by critically analysing the fundamental principles of the bioethical paradigm. Unique in its critical and cross-disciplinary approach, Law, Ethics and the Biopolitical will be of interest to students and teachers in the areas of law and society, law and literature, critical legal studies, social theory, bioethics, psychoanalysis, and biopolitics."--P. [iv] of cover. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses in what (...) came to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)