When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

Our understanding of the neurochemical bases of human love and attachment, as well as of the genetic, epigenetic, hormonal, and experiential factors that conspire to shape an individual's sexual orientation, is increasing exponentially. This research raises the vexing possibility that we may one day be equipped to modify such variables directly, allowing for the creation of “high-tech” conversion therapies or other suspect interventions. In this article, we discuss the ethics surrounding such a possibility, and call for the development of legal (...) and procedural safeguards for protecting vulnerable children from the application of such technology. We also consider the more difficult case of voluntary, adult “conversion” and argue that in rare cases, such attempts might be permissible under strict conditions. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Volume 20, Issue 8, August 2020, Page 72-75.

The moral enhancement (or bioenhancement) debate seems stuck in a dilemma. On the one hand, the more radical proposals, while certainly novel and interesting, seem unlikely to be feasible in practice, or if technically feasible then most likely imprudent. But on the other hand, the more sensible proposals – sensible in the sense of being both practically achievable and more plausibly ethically justifiable – can be rather hard to distinguish from both traditional forms of moral enhancement, such as non-drug-mediated social (...) or moral education, and non-moral forms of bioenhancement, such as smart-drug style cognitive enhancement. In this essay, I argue that bioethicists have paid insufficient attention to an alternative form of moral bioenhancement – or at least a likely candidate – that falls somewhere between these two extremes, namely the (appropriately qualified) use of certain psychedelic drugs. (shrink)

There is an ongoing public debate about sex, gender and identity that is often quite heated. This is an edited transcript of an informal lecture I recorded in 2019 to serve as a friendly guide to these complex issues. It represents my best attempt, not to score political points for any particular side, but to give an introductory map of the territory so that you can think for yourself, investigate further, and reach your own conclusions about such controversial questions as (...) ‘What does mean to be a man or a woman?’. (shrink)

How shall we decide for others who cannot decide for themselves? And who—or what, in the case of artificial intelligence — should make the decision? The present issue of the journal tackles several interrelated topics, many of them having to do with surrogate decision making. For example, the feature article by Jardas et al 1 explores the potential use of artificial intelligence to predict incapacitated patients’ likely treatment preferences based on their sociodemographic characteristics, raising questions about the means by which (...) we come to decide for others. And a clinical ethics round table led by Wilkinson and Pillay2 examines the case of a premature baby on life support whose primary surrogate is herself incapacitated. Together, these examples force us to think more deeply about the meaning and significance of taken-for-granted concepts: respect for autonomy, substituted judgement, best interests. We’ll consider the baby first and then turn to AI. “Baby T” is a critically ill newborn delivered prematurely by emergency caesarean section. The mother had entered into a surrogacy arrangement with a same-sex male couple, the intended parents, who were to take over the baby’s care after birth—just as soon as a formal parental order could be obtained through the court. Until then, the birth mother, who had used her own eggs to conceive Baby T along with sperm from an unidentified donor, would have legal and ethical responsibility to decide about the baby’s care. Unfortunately, she too was in critical condition, having fallen unconscious prior to delivery due to a sudden brain haemorrhage. She remained unconscious, and thus incapacitated, during a crucial period in which time-sensitive decisions about Baby T’s care needed to be made, including whether to continue life support. Given the mother’s incapacity, who should …. (shrink)

The question of what makes someone the same person through time and change has long been a preoccupation of philosophers. In recent years, the question of what makes ordinary or lay people judge that someone is—or isn’t—the same person has caught the interest of experimental psychologists. These latter, empirically oriented researchers have sought to understand the cognitive processes and eliciting factors that shape ordinary people’s judgments about personal identity and the self. Still more recently, practitioners within an emerging discipline, experimental (...) philosophical bioethics or “bioxphi”—the focus of this chapter—have adopted a similar aim and employed similar methodologies, but with two distinctive features: (a) a special concern for enhanced ecological validity in the examples and populations studied; and (b) an interest in contributing to substantive normative debates within the wider field of bioethics. Our aim in this chapter is to sample illustrative work on personal identity in bioxphi, explore how it relates to studies in psychology covering similar terrain, and draw out the implications of this work for matters of bioethical concern. In pursuing these issues, we highlight recent work in bioxphi that includes the perceived validity of advance directives following neurodegeneration, the right of psychologically altered study participants to withdraw from research, how drug addiction may cause one to be regarded by others as “a completely different person,” the effect of deep-brain stimulation on perceptions of the self, and the potential influence of moral enhancement interventions on intuitive impressions of a person’s character. (shrink)

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the _diminishment_ of a capacity or function, under the right set of circumstances, could plausibly contribute (...) to an individual's overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a _welfarist_ conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing. (shrink)

The WHO, American Academy of Pediatrics and other Western medical bodies currently maintain that all medically unnecessary female genital cutting of minors is categorically a human rights violation, while either tolerating or actively endorsing medically unnecessary male genital cutting of minors, especially in the form of penile circumcision. Given that some forms of female genital cutting, such as ritual pricking or nicking of the clitoral hood, are less severe than penile circumcision, yet are often performed within the same families for (...) similar reasons, it may seem that there is an unjust double standard. Against this view, it is sometimes claimed that while female genital cutting has ‘no health benefits’, male genital cutting has at least some. Is that really the case? And if it is the case, can it justify the disparate treatment of children with different sex characteristics when it comes to protecting their genital integrity? I argue that, even if one accepts the health claims that are sometimes raised in this context, they cannot justify such disparate treatment. Rather, children of all sexes and genders have an equal right to bodily autonomy. This includes the right to decide whether their own ‘private’ anatomy should be exposed to surgical risk, much less permanently altered, for reasons they themselves endorse when they are sufficiently mature. (shrink)

Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. We (...) also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)

By nature we are all addicted to love... meaning we want it, seek it and have a hard time not thinking about it. We need attachment to survive and we instinctively seek connection, especially romantic connection. [But] there is nothing dysfunctional about wanting love.Throughout the ages, love has been rendered as an excruciating passion. Ovid was the first to proclaim: “I can’t live with or without you”—a locution made famous to modern ears by the Irish band U2. Contemporary film expresses (...) a similar sentiment: as Jake Gyllenhaal’s character famously says in Brokeback Mountain, “I wish I knew how to quit you.” And everyday speech, too, is rife with such expressions as “I need you” and “I’m addicted to you.”... (shrink)

If you grade enough papers, you will find some consistent pitfalls, especially in the writing of students who are coming to philosophy for the first time. I wrote up the following tips a couple of years ago when I was a teaching assistant for an introductory philosophy class at Yale led by Daniel Greco called ‘Problems in Philosophy’. The tips were intended, then, for college students, many of them right out of high school, and most of whom had never written (...) a philosophy paper before. So the focus is on clarity and mastering the basics. With that in mind, I hope you will find these tips helpful for teaching or writing in philosophy. (shrink)

The ‘born this way’ movement for sexual orientation minority rights is premised on the view that sexual orientation is something that can neither be chosen nor changed. Indeed, current sexual orientation change efforts appear to be both harmful and ineffective. But what if ‘high-tech conversion therapies’ are invented in the future that are effective at changing sexual orientation? The conceptual basis for the movement would collapse. In this chapter, we argue that the threat of HCT should be taken seriously, motivating (...) a change in tactics for proponents of sexual orientation minority rights. We also discuss some of the practical-ethical and public-policy issues surrounding HCT, in case the technology is one day developed. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after (...) becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

In this chapter, we introduce the notion of “moral neuroenhancement,” offering a novel definition as well as spelling out three conditions under which we expect that such neuroenhancement would be most likely to be permissible (or even desirable). Furthermore, we draw a distinction between first-order moral capacities, which we suggest are less promising targets for neurointervention, and second-order moral capacities, which we suggest are more promising. We conclude by discussing concerns that moral neuroenhancement might restrict freedom or otherwise “misfire,” and (...) argue that these concerns are not as damning as they may seem at first. (shrink)

What to do with the missing shade of blue (MSB)? Some have argued that Hume's famous thought experiment undermines his central doctrine – the ‘copy principle’ – such that he should have revised his whole theory in light of it. Others contend that the MSB is not a true or actual counterexample to the copy principle, but merely an apparent or conceivable one, so that he had no such obligation to revise. In this essay, I argue that even if the (...) MSB is a true counterexample, Hume would not have been obligated to revise his theory, given methodological resources he makes available to himself elsewhere in his work and his overarching empiricist aims. And I offer a new suggestion for why he might have included and even highlighted the MSB in his writings despite its being so very vexing and peculiar. (shrink)

This volume provides an analysis of divine aseity in Karl Barth's thought and appreciates the vital role that this doctrine can play in contemporary theology. Brian D. Asbill begins by setting the general theological context, first through a broad sketch of the development of Barth's understanding of the relationship between the life of God pro nobis (pronobeity) and a se (aseity), and secondly through the examination of the basic theological convictions that guide his approach to the divine being in (...) Church Dogmatics II/1. The second section, 'The Love and Freedom of God', turns to the dialectical pairings which guide Barth's accounts of the divine reality in his earliest dogmatic cycle (The Göttingen Dogmatics §§16-7) as well as in his most mature treatment (Church Dogmatics §§28-31). Particular attention is given to how these themes arise from revelation and relate to one another. In the final section, 'The Aseity of God', Asbill identifies this doctrine's basic features and primary functions. Divine aseity is characterized as the self-demonstration and self-movement of God's life, a trinitarian and entirely unique reality, a primarily positive and dynamic concept, and the manner and readiness of God's love for creatures. Divine aseity is said to indicate God's lordship in the act of self-binding, God's uniqueness in the act of self-revelation, and God's sufficiency in the act of self-giving. (shrink)

Much of modern ethics is built around the idea that we should respect one another’s autonomy. Here, “we” are typically imagined to be adult human beings of sound mind, where the soundness of our mind is measured against what we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack (...) of consent makes sex wrong.1 Consent, in turn, is analysed in terms of autonomous decision-making: a “yes” or “no” that reflects the free and informed will of our idealised, sound-minded adult. Whether such models provide adequate normative guidance for ethical, much less good, sex between neurotypical human adults is an open question.2 3 When it comes to the ethics of sexual activity between humans and non-humans—robots, say—or between humans who don’t fit the rational stereotype, we hardly know where to begin.4–7 It is therefore heartening to see a number of papers in this issue tackling the difficult question how to respectfully facilitate or respond to the needs, desires, and decisions of people with different kinds or degrees of autonomy.8 For example, Sumytra Menon and colleagues9 explicitly discuss the notion of “borderline capacity” and argue, in the medical domain, for shared and supportive decision-making practices to “foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being.” Touching on a similar theme, Zahra Ladan 10 asks how we should conceive of liberty in the case of persons with certain inborn physical or mental limitations. Might it sometimes be necessary to …. (shrink)

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of (...) ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making.In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

Male circumcision—partial or total removal of the penile prepuce—has been proposed as a public health measure in Sub-Saharan Africa, based on the results of three randomized control trials showing a relative risk reduction of approximately 60 per cent for voluntary, adult male circumcision against female-to-male human immunodeficiency virus transmission in that context. More recently, long-time advocates of infant male circumcision have argued that these findings justify involuntary circumcision of babies and children in dissimilar public health environments, such as the USA, (...) Australasia and Europe. In this article, we take a close look at the necessary ethical and empirical steps that would be needed to bridge the gap between the African RCTs and responsible public health policy in developed countries. In the course of doing so, we discuss some of the main disagreements about the moral permissibility of performing a nontherapeutic surgery on a child to benefit potential future sexual partners of his. In this context, we raise concerns not only about weaknesses in the available evidence concerning such claims of benefit, but also about a child’s moral interest in future autonomy and the preservation of his bodily integrity. We conclude that circumcision of minors in developed countries on public health grounds is much harder to justify than proponents of the surgery suggest. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Consistently Pro-Life: The Ethics of Bloodshed in Ancient Christianity by Rob Arner, and: Christ at the Checkpoint: Theology in the Service of Justice and Peace ed. by Paul Alexander, and: Becoming Nonviolent Peacemakers: A Virtue Ethic for Catholic Social Teaching and US Policy by Eli Sarasan McCarthyBrian D. BerryReview of Consistently Pro-Life: The Ethics of Bloodshed in Ancient Christianity ROB ARNER Eugene, OR: Pickwick, 2010. 136 pp. $15.56Review (...) of Christ at the Checkpoint: Theology in the Service of Justice and Peace EDITED BY PAUL ALEXANDER Eugene, OR: Pickwick, 2012. 182 pp. $19.80Review of Becoming Nonviolent Peacemakers: A Virtue Ethic for Catholic Social Teaching and US Policy ELI SARASAN MCCARTHY Eugene, OR: Pickwick, 2012. 259 pp. $27.00In Consistently Pro-Life, Rob Arner (who teaches at Chestnut Hill College in Philadelphia) makes the case that Christians should not kill other human beings—regardless of the circumstances. Taking as his point of departure the vigilante killing of abortion doctor George Tiller in Wichita, Kansas, in 2009, he argues not only that abortion is always morally impermissible but so also is [End Page 217] the murder of abortion doctors and the use of the death penalty to punish those who murder them. In addition, he turns to the early church fathers to contend that, prior to Constantine, “without exception, the church strongly condemned the taking of human life in any form whatsoever”—thus rejecting abortion and infanticide, the blood sport of the Roman games, suicide, and killing in war (120). This was because the New Testament witness to Jesus and his death on the cross required early Christians to view “the means as just as important, if not more important, than the ends” (xiii).Arner supplements this deontological argument for Christian pacifism, which he learned from John Howard Yoder, with a brief consideration of the virtue of patience cultivated in the early churches, reflecting the influence of Stanley Hauerwas on his thought. This “cardinal virtue” connoting “longsuffering, forbearance, patient endurance”—as found in Jesus’s teaching in the Sermon on the Mount (Mt 5:38–48)—enabled early Christians to practice non-violent resistance “deferring personal revenge in favor of God’s vindicating justice” (98). If Christians were to adopt this same consistently pro-life ethic today, argues Arner, it would “lead to greater healing and peace in our blood-soaked world” (121). The book closes with three appendices—one of which is a chart of terminology that dehumanizes vulnerable victims, including unborn human beings. Unfortunately, the book does not have an index.Christ at the Checkpoint, edited by Paul Alexander (professor of Christian ethics and public policy at the Palmer Theological Seminary of Eastern University), includes thirteen plenary addresses delivered at a conference on the Arab-Israeli conflict organized by Palestinian Evangelical Christians at Bethlehem Bible College in March 2010. Almost all of the contributors to this volume—including biblical scholars, theologians, ethicists, pastors, activists, and others—criticize the ideology of Christian Zionism and its support of a theology of dispensationalism that, in their view, distorts the scriptures and fosters violence rather than reconciliation between the Israelis and the Palestinians. In his own presentation titled “What Can Pentecostals and Charismatics Do for Peace with Justice in Israel and Palestine?,” Alexander—who describes himself as a former “one-sided” Christian Zionist who later discovered the writings of Yoder and Hauerwas—appeals to Jesus’s teaching in the Sermon on the Mount and urges Pentecostals to create church communities “that cultivate persons of character and conviction, who through habits, practices, and action live out the core of our faith” (69). Along with being faithful to the “greater challenges” of love, mercy, compassion, and forgiveness, he argues that they should publicly declare that Jesus does not want Israel to continue the occupation of Palestine, and they should engage in the “easier tasks” of promoting human rights, lending support to United Nations Resolutions, and working toward a two-state solution (72). “The time has come in human history,” writes Alexander, “for Pentecostals to speak and act prophetically regarding this present injustice … [End Page 218] and to use every nonviolent weapon in our arsenal—stories, preaching... (shrink)

Large language models (LLMs) such as ChatGPT or Google’s Bard have shown significant performance on a variety of text-based tasks, such as summarization, translation, and even the generation of new...

“Love hurts”—as the saying goes—and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could “cure” an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses—and misuses—of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

What makes conscious experience a difficult or confusing subject for science to deal with is its personal or individualistic character (that is to say the fact that a given experience is an experience apparently tied to a particular individual). It is in this respect very different from the other phenomena studied by science, where while the phenomena may be observed by a particular individual they are considered to be in principle independent of that individual. To say that an individual’s experience (...) is merely the functioning ofthat individual’s brain does not fully resolve the problem, since experiences are so very different in nature from brain processes. (shrink)

The History of Psychology course occupies an unusual but critical place in the psychology curriculum at most universities. As the field has become ever more specialized, with the various subdisciplines branching off, The History of Psychology is often the one course where the common roots of all of these areas are explored. Asking not only "What is psychology?" but also "What is science?" "Why is psychology a science?" and "How did it become one?" this book examines how the paradigm of (...) Psychology was built. Discussing key figures in history in the context of their time, it takes students on a carefully formulated, chronological journey through the build-up of psychology from ancient times to the present, and seeks to draw students into the way science is done, rather than merely presenting them with historical fact. Students will learn not only the "what," but the "why" of the history of psychology and will acquire the necessary background historical material to fully understand those concepts. Organized around a series of moments and cases--such as a shift from scholasticism to rationalism or empiricism, and a shift from idealism to materialism--the book seeks to portray psychology as an on-going, evolving process, rather than a theory.--page i. (shrink)

If there is a single thread running through this issue of the journal, it may be the complex interplay between the individual and the system of which they are apart, highlighting a need for systems thinking in medical ethics and public health.1 2 Such thinking raises at least three sorts of questions in this context: normative questions about the locus of moral responsibility for change when a system is unjust; practical questions about how to change systems in a way that (...) is morally appropriate without triggering unintended, potentially harmful side-effects; and epistemic questions about how to predict the multidimensional consequences of a proposed change or set of changes to an intricate social system such as healthcare.3 These questions crop up throughout the issue, as I will discuss, but my focus is the target article and linked commentaries on gender bias in the surgical profession. Hutchison conducted in-depth interviews with 46 Australian women surgeons and surgical trainees, taking care to avoid leading questions regarding gender bias or gendered mistreatment. Nevertheless, despite minimal prompting, at least four types of gender-related concerns were described by the surgeons,whether directly or indirectly: 1. structural bias in workplace factors, including insufficient parental leave for women, exclusion from men’s spaces where informal training may occur, and a dearth of senior female role models; 2. epistemic injustices including unfair doubting of women’s surgical competence or knowledge relative to men; 3. stereotyped expectations that women surgeons would or should shoulder the burden of medical carework, for example, by attending to patients’ emotional needs; and 4. objectification, both by colleagues and patients, including sexual innuendo, remarks about clothing, and even outright sexual assault. Each of these concerns is disturbing on its own, and yet they do not operate in isolation. Rather, they interact …. (shrink)

I would like to begin this essay by sharing an intuition. It is an intuition requiring much fuller development, but I see myself making a modest contribution to it here—and that is the prospect of integrating mimetic theory with Christian contemplative practice. Such integration would, I imagine, be the beginning of something very ancient and very new.I am aware of some promising developments in this direction,1 but my conviction is that its potential is barely tapped. It would probably be too (...) much to suggest that such integration could result in a distinctive "school" of spirituality, though that is not inconceivable. Perhaps a better analogy for what I envision can be found in the emerging field of Contemplative... (shrink)

Near the end of his speech, Timaeus outlines a theory of bodily health and disease which has seemed to many commentators loosely unified or even inconsistent . But this section is better unified than it has appeared, and gives us at least one important insight into the workings of physical causality in the Timaeus. I argue first that the apparent disorder in Timaeus’s theory of disease is likely a deliberate effect planned by the author. Second, the taxonomy of disease in (...) the passage consists of one genus subsuming two species. Third, in Timaeus’s theory, health lies between perfect stability and a chaos of all possible motions; this indicates a conception of health as the activation of the body's powers in the right way. A power is a property directed towards bringing about some change. Fourth, the activation of these powers can change depending on the location of their possessors. This last point shows that causation among the physical items in the Timaeus involves structures as well as pushes. (shrink)

Historically, empirical research in bioethics has drawn on methods developed within the social sciences, including qualitative interviews, focus groups, ethnographic studies, and opinion surveys, t...

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either good (...) or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

Surprisingly, Lepard finds the most hopeful source for a global ethic is based on the scriptures of the various world religions-the same belief systems that are ...

This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn to (...) the status of the genitals as ‘intimate’ anatomy—a status that is not fully erased by being in a medical context. In this editorial, we draw on the work of Talia Mae Bettcher on ‘intimate agency’ to explore why unconsented interventions into the genitalia may constitute a distinctive sort of personal violation compared to unconsented contact with various other parts of the human body. In their feature article, Marit van der Pijl and colleagues1 argue it is unethical for healthcare providers to perform unconsented episiotomies on persons in labour. In particular, they suggest that, outside of certain rare emergencies in which, for example, the person giving birth is incapacitated1 and the procedure cannot be delayed until consent becomes possible without introducing a significant risk of serious harm (call these ‘medically necessary’2 procedures), ‘presumed consent’ is the incorrect standard to apply. Instead, they stress that, especially when a proposed intervention involves a person’s genital, sexual or reproductive organs, the need to obtain their explicit consent in advance of proceeding must be honoured. As the authors note, the broader social significance of our genitalia—widely regarded as ‘private’ anatomy—is not erased by being in a medical context (see also 2–4). Boundaries must still be observed. Ethically, this ‘leaves a very small margin for error because invasion of these body parts …. (shrink)

The current study investigated the relationship of the Dark Triad with peer reporting, which occurs when an employee informs management that another coworker has engaged in counterproductive work behavior (CWB). We hypothesized that low organizational commitment would strengthen the negative relationships between each Dark Triad trait and peer reporting. Data from 281 employees suggested that low organizational commitment indeed strengthened the negative relationships between (a) narcissism and the base rate of peer reporting CWBs and (b) psychopathy and the base rate (...) of peer reporting CWBs. Our findings thus extended Dark Triad research to the topic of peer reporting. (shrink)

This paper presents two notes relating to Jason’s prayer to Apollo before the launch of the Argo in Apollonius’ Argonautica. In both cases, I examine what may be termed the “subtextual” facets of the passage: textual data that are significant—productive of meaningful interpretation—and yet hardly apparent on a surface-level reading of the poem. The first note concerns the changing total number of crewmembers aboard the Argo, an evolving figure which Apollonius encourages the reader to track as the narrative progresses. The (...) second proposes a new acrostic that “completes” the ΑΚΤΙΑ acrostic that Selina Stewart recently discovered in Jason’s prayer. In each case, I draw different conclusions from these subliminal data, which have ramifications for questions of gender and inclusivity in Jason’s crew and the role of the gods in the poem. Both readings, however, are a testament to the careful design and unity of purpose that runs through the epic. (shrink)