The federal government is funding a sea change in health care by investing in interventions targeting social determinants of health, which are significant contributors to illness and health inequity. This funding power has encouraged states, professional and accreditation organizations, health care entities, and providers to focus heavily on social determinants. We examine how this shift in focus affects clinical practice in the fields of oncology and emergency medicine, and highlight potential areas of reform.

Experimental research is commonly held up as the paradigm of "good" science. Although experiment plays many roles in science, its classical role is testing hypotheses in controlled laboratory settings. Historical science is sometimes held to be inferior on the grounds that its hypothesis cannot be tested by controlled laboratory experiments. Using contemporary examples from diverse scientific disciplines, this paper explores differences in practice between historical and experimental research vis-à-vis the testing of hypotheses. It rejects the claim that historical research is (...) epistemically inferior. For as I argue, scientists engage in two very different patterns of evidential reasoning and, although there is overlap, one pattern predominates in historical research and the other pattern predominates in classical experimental research. I show that these different patterns of reasoning are grounded in an objective and remarkably pervasive time asymmetry of nature. (shrink)

In her 2004 book Carol Gould addresses the fundamental issue of democratizing globalization, that is to say of finding ways to open transnational institutions and communities to democratic participation by those widely affected by their decisions. The book develops a framework for expanding participation in crossborder decisions, arguing for a broader understanding of human rights and introducing a new role for the ideas of care and solidarity at a distance. Reinterpreting the idea of universality to accommodate a multiplicity of (...) cultural perspectives, the author takes up a number of applied issues, including the persistence of racism, cultural rights, women's human rights, the democratic management of firms, the use of the Internet to enhance political participation, and the importance of empathy and genuine democracy in understanding terrorism and responding to it. Accessibly written with a minimum of technical jargon this is a major contribution to political philosophy. (shrink)

In just a few years, the book became an underground classic. Neither Man Nor Beast takes Adams' thought one step further.

The concept of solidarity has recently come to prominence in the healthcare literature, addressing the motivation for taking seriously the shared vulnerabilities and medical needs of compatriots and for acting to help them meet these needs. In a recent book, Prainsack and Buyx take solidarity as a commitment to bear costs to assist others regarded as similar, with implications for governing health databases, personalized medicine, and organ donation. More broadly, solidarity has been understood normatively to call for ‘standing with’ or (...) assisting fellow community members and possibly also distant others in regard to their needs, whether for its own sake or in order to realize the demands of justice. I argue here that the understanding of solidarity in the existing bioethics literature is unduly restricted by not sufficiently theorizing the notion of structural (or systemic) injustice and its import for understanding solidarity. Extending traditional conceptions of labor and social movement solidarity, I contrast unitary solidarity within a given group with ‘networking solidarities’ across groups. I analyze the meaning of structural injustice and its significance for solidarity, including countering institutionally entrenched inequalities and economic exploitation. I then apply this broadened conception to healthcare, discussing structural problems with the U.S. insurance system and the solidarity movements addressing its deficiencies. I analyze some natural disasters and global health challenges that were aggravated by structural injustices, along with the solidarity movements they engendered. Finally, I revisit the questions of governing health databases and of personalized medicine with the enlarged conception of solidarity in view. (shrink)

In the technical literature of computer science, the concept of an effective procedure is closely associated with the notion of an instruction that precisely specifies an action. Turing machine instructions are held up as providing paragons of instructions that "precisely describe" or "well define" the actions they prescribe. Numerical algorithms and computer programs are judged effective just insofar as they are thought to be translatable into Turing machine programs. Nontechnical procedures (e.g., recipes, methods) are summarily dismissed as ineffective on the (...) grounds that their instructions lack the requisite precision. But despite the pivotal role played by the notion of a precisely specified instruction in classifying procedures as effective and ineffective, little attention has been paid to the manner in which instructions "precisely specify" the actions they prescribe. It is the purpose of this paper to remedy this defect. The results are startling. The reputed exemplary precision of Turing machine instructions turns out to be a myth. Indeed, the most precise specifications of action are provided not by the procedures of theoretical computer science and mathematics (algorithms) but rather by the nontechnical procedures of everyday life. I close with a discussion of some of the rumifications of these conclusions for understanding and designing concrete computers and their programming languages. (shrink)

Describes what the author sees as a suppression of the feminine in Western culture, technology, and philosophy and opens a feminist postmodern space from which fresh differences may emerge. This title explores underdeveloped themes in American and Canadian feminism. It offers a deconstruction of the phallocentric dichotomies of nature and culture.

The assumption that all life on Earth today shares the same basic molecular architecture and biochemistry is part of the paradigm of modern biology. This paper argues that there is little theoretical or empirical support for this widely held assumption. Scientists know that life could have been at least modestly different at the molecular level and it is clear that alternative molecular building blocks for life were available on the early Earth. If the emergence of life is, like other natural (...) phenomena, highly probable given the right chemical and physical conditions then it seems likely that the early Earth hosted multiple origins of life, some of which produced chemical variations on life as we know it. While these points are often conceded, it is nevertheless maintained that any primitive alternatives to familiar life would have been eliminated long ago, either amalgamated into a single form of life through lateral gene transfer (LGT) or alternatively out-competed by our putatively more evolutionarily robust form of life. Besides, the argument continues, if such life forms still existed, we surely would have encountered telling signs of them by now. These arguments do not hold up well under close scrutiny. They reflect a host of assumptions that are grounded in our experience with large multicellular organisms and, most importantly, do not apply to microbial forms of life, which cannot be easily studied without the aid of sophisticated technologies. Significantly, the most powerful molecular biology techniques available—polymerase chain reaction (PCR) amplification of rRNA genes augmented by metagenomic analysis—could not detect such microbes if they existed. Given the profound philosophical and scientific importance that such a discovery would represent, a dedicated search for ‘shadow microbes’ (heretofore unrecognized ‘alien’ forms of terran microbial life) seems in order. The best place to start such a search is with puzzling (anomalous) phenomena, such as desert varnish, that resist classification as ‘biological’ or ‘nonbiological’. Ó 2007 Elsevier Ltd.. (shrink)

The stability of each of the theories of separably closed fields is proved, in the manner of Shelah's proof of the corresponding result for differentially closed fields. These are at present the only known stable but not superstable theories of fields. We indicate in § 3 how each of the theories of separably closed fields can be associated with a model complete theory in the language of differential algebra. We assume familiarity with some basic facts about model completeness [4], stability (...) [7], separably closed fields [2] or [3], and (for § 3 only) differential fields [8]. (shrink)

This article argues that Thomas Pogge's important theory of global justice does not adequately appreciate the relation between interactional and institutional accounts of human rights, along with the important normative role of care and solidarity in the context of globalization. It also suggests that more attention needs to be given critically to the actions of global corporations and positively to introducing democratic accountability into the institutions of global governance. The article goes on to present an alternative approach to global justice (...) based on a more robust conception of human rights grounded in a conception of equal positive freedom, in which these rights are seen to apply beyond the coercive political institutions to which Pogge primarily confines them (e.g. to prohibiting domestic violence), and in which they can guide the development of economic, social and political forms to enable their fulfillment. (shrink)

This paper explores the conduct of performance appraisals of nurses in a New Zealand hospital, and how fairness is perceived in such appraisals. In the health sector, performance appraisals of medical staff play a key role in implementing clinical governance, which, in turn, is critical to containing health care costs and ensuring quality patient care. Effective appraisals depend on employees perceiving their own appraisals to be fair both in terms of procedure and interaction with their respective appraiser. We examine qualitative (...) data from interviews and focus groups, involving 22 nurses in a single department, to determine whether perceived injustices impact on the effective implementation of the appraisal system. Our results suggest that particular issues had been causing some sense of injustice, and most of these were procedural. Potential solutions focus on greater formalisation of the performance appraisal process, and more training for appraisers and appraisees. (shrink)

Is one of the roles of theory in biology answering the question “What is life?” This is true of theory in many other fields of science. So why should not it be the case for biology? Yet efforts to identify unifying concepts and principles of life have been disappointing, leading some (pluralists) to conclude that life is not a natural kind. In this essay I argue that such judgments are premature. Life as we know it on Earth today represents a (...) single example and moreover there is positive evidence that it may be unrepresentative of life considered generally. Furthermore, as I discuss, the prototype for theorizing about life has traditionally been based on multicellular plants and animals. Yet biologists have discovered that the latter represent a rare, exotic, and fairly recent form of Earth life. By far the oldest, toughest, most extensive, and diverse form of life on our planet is unicellular, prokaryotic microbes, and there are reasons to suppose that this is almost certainly true elsewhere in the universe as well. If there are explanatorily and predictively powerful, biologically distinctive principles for life that can be gleaned from our insular example of life it is more likely that they will be found among the microbes. I discuss some provocative ways in which unicellular microbes differ from multicellular eukaryotes and argue that some of them just might provide us with key insights into the nature of life. (shrink)

This article examines the current use of Jesus language in a convenience sample of twenty-five mission statements from Roman Catholic hospitals and health care systems in the United States. Only twelve statements specifically use the words “Jesus” or “Christ” in their mission statements. The author advocates the use of explicit Jesus language and modeling. While the witness of Jesus in the Gospel healing narratives is not the only corrective to current abuses in the health care delivery system, it is foundational (...) to the integrity of Roman Catholic health care identity and mission. An analysis of Gospel healing narratives is used to illustrate the prophetic dimension of Jesus' wisdom, word, and witness. (shrink)

The first book of NE is organised on the model of investigating definitions described in the second Book of the Posterior Analytics, although, of course, with some adaptation due to the subject matter. It first establishes if the object exists and looks for the meaning of the terms used in common language to indicate it, next considers some necessary qualities of the object and then concludes with a definition of the object. We find there a dialectical syllogism of definition, and (...) not the procedure in three steps described in NE VII 1, sometimes called 'the method of ethics'. In fact, the method described in NE VII 1 does not apply to the first book of the NE. Its relevance for the NE has been somehow exaggerated. (shrink)

For feminists, working in/with the ‘posts’ is, always has been, and must be, a collective and collaborative endeavour. Increasingly, post-inquiry involves taking seriously multiplicities of humans, nonhumans, more-than-and-other-than-humans, multispecies and natureculture entities, including viral, microbial, elemental and atmospheric relationalities. The individual papers in this Special Issue, this editorial, and the Special Issue as a whole attest to this imperative pull to the collective-collaborative in seeking to explore the entangled relations of/between feminisms and the ‘posts’. As a collaborative-collective multiplicity, the Special (...) Issue interrogates what these entangled relations offer for reconfiguring gender and education research, theory, pedagogic practice, activism and praxis. (shrink)

Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines (...) the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people. (shrink)

Two years ago, the US National Academy of Sciences and the National Academy of Medicine released a report drafted by an international committee regarding the use of gene editing in humans. Once a tedious and expensive process, gene editing has now become more accessible and cheaper using the new CRISPR technology, making the issue of its use more urgent and pressing. The committee cites general support for somatic nonheritable gene editing to correct for a serious disease already present in a (...) human being, but more controversial is germline gene editing for heritable conditions. Performing gene editing that affects an individual's descendants is at present tightly controlled in the US, but around the... (shrink)

It is generally assumed that group agency must be a social phenomenon because it involves interactions among many human beings. This assumption overlooks the real metaphysical nature of agency, which is both normative and voluntarist. Construed as a normative phenomenon, individual agency arises wherever there is a point of view from which deliberation and action proceed in accord with the requirements that define individual rationality. Such a point of view is never a metaphysical given, but is always a product of (...) rational activities that aim to satisfy the requirements that define individual rationality. When such a deliberative point of view is forged within a whole human life, there is a single agent of human size. But such points of view can also be forged within parts of human lives so as to constitute multiple agents within them; and they can also be achieved within groups of human lives so as to constitute group agents that literally deliberate and act as one. If such a group agent were a social phenomenon, then its agency would simultaneously be the agency of many even as it was also the agency of one. In that case, its deliberations and actions would have to proceed from many separate deliberative points of view, at the same time that they also proceeded from a single deliberative point of view. A correct account of rational agency shows that this is not necessarily so, and indeed, not typically so. Moreover, if it were so much as possible for this to be so, it would require special conditions of the sort that Rousseau identified in his account of the general will. But this special case is not a good model on which to understand the cases of group agency that are most often discussed in the philosophical literature. They are more appropriately viewed as cases in which the condition of individual agency is realized at the level of a group, than as cases of social agency per se. (shrink)

In behavioral ethics today, there is debate as to which theory of moral development is the best for understanding ethical decision making, thereby facilitating ethical behavior. This debate between behavioral ethicists has been profoundly influenced by the field of moral psychology. Unfortunately, in the course of this marriage between moral psychology and business ethics and subsequent internal debate, a simple but critical understanding of human being in the field of management has been obscured; i.e., that morality is not a secondary (...) phenomenon arising out of something else. Therefore, in this paper, we will argue that there is a need in behavioral ethics to shift our understanding away from the influence of contemporary moral psychology and back to management theorist Ghoshal’s :75–91, 2005) view of what it means to be human in which the moral is fundamental. To assist in this labor, we will build on the philosophical work of Emmanuel Levinas who sees ethics, regardless of the setting, as a metaphysical concern. What this means is that Levinas sees the essential moral character of human life and the reality of human agency as ontologically fundamental, or constitutive of human nature itself. In other words, the ethical is the “first cause” in regard to understanding the nature and action of the individual, including within organizations. Thus, morality in any sphere of human endeavor, including in business, is not merely epiphenomenal to some more fundamental reality. (shrink)

In this essay, I will argue that contemporary ecofeminist discourse, while potentially adequate to deal with the issue of animals, is now inadequate because it fails to give consistent conceptual place to the domination of animals as a significant aspect of the domination of nature. I will examine six answers ecofeminists could give for not including animals explicitly in ecofeminist analyses and show how a persistent patriarchal ideology regarding animals as instruments has kept the experience of animals from being fully (...) incorporated within ecofeminism.2. (shrink)

This paper discusses how Salvadoran companies practice corporate philanthropy in El Salvador, and what might motivate it. First, I briefly discuss three principal theories of corporate philanthropy, and explore some current trends in international corporate philanthropy to highlight some of the motives Salvadoran companies may have to participate in charitable activities. Then, I discuss the history of the Salvadoran private sector to help us understand philanthropic activity today. Next, I suggest that philanthropic acts by Salvadoran firms are driven by altruistic (...) and politically strategic motives, and reflect individualistic and paternalistic attitudes. In the discussion, I include examples of Salvadoran corporate philanthropy as it is practiced today, based on recent field research in El Salvador. (shrink)

Most normative advice to individuals about what they should do to help prevent climate change focuses on reductions in personal emissions. This is consistent with an accountancy model of morality, with perpetrators held responsible for the harms they individually cause. An alternative focus receiving less popular and philosophical attention, but with greater potential to achieve substantial mitigation outcomes, is citizen activism for systemic reforms. Rather than perpetration priority moral concern can be directed to bystanding. To more effectively guide action, reformist (...) ethics need to be informed by psychosociological research on motivation and societal transformation. (shrink)

Aging at work is a dynamic process. As individuals age, their motives, abilities and values change as suggested by life-span development theories (Kanfer & Ackerman, 2004; Lang & Carstensen, 2002). Their growth and extrinsic motives weaken while intrinsic motives increase (Kooij, De Lange, Jansen, Kanfer, & Dikkers, 2011), which may result in workers investing their resources in different areas accordingly. However, there is significant individual variability in aging trajectories (Hedge, Borman, & Lammlein, 2005). In addition, the changing nature of work, (...) the evolving job demands, as well as the available opportunities at work may no longer be suitable for older workers, increasing the likelihood of person-job misfit. The potential misfit may, in turn, impact how older workers perceive themselves on the job, which leads to conflicting work identities. With the traditional job redesign approach being a top-down process, it is often difficult for organizations to take individual needs and skills into consideration and tailor jobs for every employee (Berg, Dutton, & Wrzesniewski, 2010). Therefore, job crafting, being an individualized process initiated by employees themselves, can be a particularly valuable mechanism for older workers to realign and enhance their demands-abilities and needs-supplies fit. Through job crafting, employees can exert personal agency and make changes to the task, social and cognitive aspects of their jobs with the goal of improving their work experience (Wrzesniewski & Dutton, 2001). Building on the Life Span Theory of Control (Heckhausen & Schulz, 1995), we posit that job crafting, particularly cognitive crafting, will be of increasing value as employees age. Through reframing how they think of their job and choosing to emphasize job features that are personally meaningful, older workers can optimize their resources to proactively redesign their jobs and maintain congruent, positive work identities. (shrink)

Boundaries in the doctor–patient relationshipis an important concept to help healthprofessionals navigate the complex andsometimes difficult experience between patientand doctor where intimacy and power must bebalanced in the direction of benefitingpatients. This paper reviews the concept ofboundary violations and boundary crossings inthe doctor–patient relationship, cautions aboutcertain kinds of boundary dilemmas involvingdual relationships, gift giving practices,physical contact with patients, andself-disclosure. The paper closes with somerecommendations for preventing boundaryviolations.

Recent neuroscience research makes it clear that human biology is cultural biology - we develop and live our lives in socially constructed worlds that vary widely in their structure values, and institutions. This integrative volume brings together interdisciplinary perspectives from the human, social, and biological sciences to explore culture, mind, and brain interactions and their impact on personal and societal issues. Contributors provide a fresh look at emerging concepts, models, and applications of the co-constitution of culture, mind, and brain. Chapters (...) survey the latest theoretical and methodological insights alongside the challenges in this area, and describe how these new ideas are being applied in the sciences, humanities, arts, mental health, and everyday life. Readers will gain new appreciation of the ways in which our unique biology and cultural diversity shape behavior and experience, and our ongoing adaptation to a constantly changing world. (shrink)

Epistemologists, like other philosophers, sometimes try to convince us of the truth of their claims about the nature of knowledge by appeals to our epistemic intuitions. Sometimes intuitions are gathered and deployed against an epistemological theory: as, for example, when our intuitive judgement that the subject in a Gettier case fails to know what he justifiably and truly believes is used to undermine the view that knowledge is justified true belief. Othertimes intuitions are gathered and deployed in support of an (...) epistemological theory: as, for example, when the same intuition about the Gettier case is used to support the view that knowledge is true belief that could not easily have been wrong. In a more sophisticated way (which I shall describe in more detail), contextualists about knowledge have made appeal to epistemic intuitions a central part of the arguments they offer in support of their view. Appeals to intuition, then, are central to the current methodology of epistemology. (shrink)

The spacing effect is among the most widely replicated empirical phenomena in the learning sciences, and its relevance to education and training is readily apparent. Yet successful applications of spacing effect research to education and training is rare. Computational modeling can provide the crucial link between a century of accumulated experimental data on the spacing effect and the emerging interest in using that research to enable adaptive instruction. In this paper, we review relevant literature and identify 10 criteria for rigorously (...) evaluating computational models of the spacing effect. Five relate to evaluating the theoretic adequacy of a model, and five relate to evaluating its application potential. We use these criteria to evaluate a novel computational model of the spacing effect called the Predictive Performance Equation. Predictive Performance Equation combines elements of earlier models of learning and memory including the General Performance Equation, Adaptive Control of Thought—Rational, and the New Theory of Disuse, giving rise to a novel computational account of the spacing effect that performs favorably across the complete sets of theoretic and applied criteria. We implemented two other previously published computational models of the spacing effect and compare them to PPE using the theoretic and applied criteria as guides. (shrink)

When examining how emotions are evoked through music, the role of musical expectancy is often surprisingly under-credited. This mechanism, however, is most strongly tied to the actual structure of the music, and thus is important when considering how music elicits emotions. We briefly summarize Leonard Meyer's theoretical framework on musical expectancy and emotion and cite relevant research in the area.