Background Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons’ perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.Methods We surveyed IRB chairpersons leading U.S. boards registered (...) with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).Results Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.Conclusions Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets. (shrink)

The brief, practical texts in the Essentials of Qualitative Methods series introduce social science and psychology researchers to key approaches to capturing phenomena not easily measured quantitatively, offering exciting, nimble opportunities to gather in-depth qualitative data. In this book, Scott D. Churchill introduces readers to existential phenomenological research, an approach that seeks an in-depth, embodied understanding of subjective human existence that reflects a person's values, purposes, ideals, intentions, emotions, and relationships. This method helps researchers understand the lives and needs of (...) others by helping identify and set aside theoretical and ideological prejudgments. About the Essentials of Qualitative Methods book series: Even for experienced researchers, selecting and correctly applying the right method can be challenging. In this groundbreaking series, leading experts in qualitative methods provide clear, crisp, and comprehensive descriptions of their approach, including its methodological integrity, and its benefits and limitations. Each book includes numerous examples to enable readers to quickly and thoroughly grasp how to leverage these valuable methods. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

Being a patient and living a life -- Clinical space and traits of healing -- False starts and frequent failures -- Three journeys : A.'Ibuprofen and love', B. 'Staying tuned up', C. 'We all want the same things' -- Being a patient : the moral field -- Rethinking healthcare ethics : the patient's moral authority.

Much has been written about the importance of narrative in teaching ethics and humanities to medical students and residents, as well as the value of narratives in clinical care. Relatively little has been said about the essential role of narrative in bioethics consultations. For most consults, the interpretation of narratives is the central moral feature, and the ethics consultant is inevitably one of the narrators. In a recent consult in which I participated, at least three narratives were in play. The (...) medical record itself was a narrative, or really, a variety of narratives. A second distinct narrative was the story of why this case had come to be categorized as an ethical concern for the medical team. A third narrative was the tentative sketch running through my mind as a consultant‐partly factual, partly anticipatory and conjectural, inevitably personal‐about what was going on here. (shrink)

"This book maps the moral terrain in the grounded reality of human experience without relying on theories or systems of ethics as the primary orienting strategy. Moral awareness needs first to be appreciated for what it is before it is made to conform to theories or systems. And moral consciousness is not a steady or stable set of perceptions; as we change so do the moral challenges that most concern us"--.

A key takeaway from the recent volume Theistic Evolution: A Scientific, Philosophical, and Theological Critique is that no version of theistic evolution that adheres largely to consensus views in biology is a plausible option for orthodox Christians. In this paper we argue that this is false: contrary to the arguments in the volume, evolutionary theory, properly understood, is perfectly compatible with traditional Christian commitments. In addition, we argue that the lines between Intelligent Design and theistic evolution are not as sharp (...) as most scholars have assumed, such that many who self-identify as Intelligent Design adherents would also qualify as theistic evolutionists. (shrink)

This essay strives to bring together the institutional history of phenomenological psychology within the American academy from the middle of the 20th century to the current moment. Although phenomenological psychology has always been a dynamically international and interdisciplinary movement, the scope of this essay is limited to the different ways in which this new field expressed itself in certain psychology departments and educational institutions across the United States. After presenting this institutional history, and some individual contributors, a brief commentary is (...) offered. (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

In March 1996, the General Accounting Office issued the report Scientific Research: Continued Vigilance Critical to Protecting Human Subjects. It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always clear (...) to clinicians. Controversy exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

In a recent article in The Journal of Clinical Ethics, David Wendler argues that worries about the therapeutic misconception (TM) are not only misconceived, but detract from the larger agenda of a proper informed consent for subjects involved in clinical research. By contrast, we argue that Wendler mischaracterizes those who support TM research, and that his arguments are fragmentary, often illogical, and neglect a critical difference between clinical care and clinical research. A clear explanation about the chief aim of research (...) is, in fact, what gives the other elements in a consent process their meaning. We argue that informed consent must be both trial-specific and context-sensitive, and that concern about the TM is needed now more than ever. (shrink)

Money plays a powerful role in modern medicine, both in terms of how health services are organized and delivered and increasingly in how physicians understand themselves and their work. The phrase “the hegemony of money” is intended to capture that power.

Theological determinism is, at first glance, difficult to square with the typical Christian commitment to the appropriateness of divine blame. How, we may wonder, can it be appropriate for God to blame someone for something that was determined to occur by God in the first place? In this paper, I try to clarify this challenge to Christian theological determinism, arguing that its most cogent version includes specific commitments about what is involved when God blames wrongdoers. I then argue that these (...) commitments are not essential to divine blame, and that there are plausible alternative accounts of such blame that would not court similar challenges. I end with a case for the intelligibility of divine blame within theological determinism, in light of its possible similarity in relevant respects to certain instances of intelligible human blame. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 15-16, July 2011.

Many philosophers judge that typical agent-causal accounts of freedom improperly sacrifice the possibility of rational explanation of the action for the sake of securing control, while others judge that the reverse shortcoming plagues typical event causal accounts. (Of course, many philosophers make both these judgments.) After briefly rehearsing the reasons for these verdicts on the two traditional strategies, we undertake an extended examination of Randolph Clarke's recent attempt to meet the challenge by proposing an original, "integrated agent-causal" account of human (...) free action. We argue that Clarke's account fails. In a final section, we sketch a more promising route to integration. (shrink)

The ultimate challenge for psychology as a human science inheres in accessing the experience of the other. In general, the field of psychology has perpetuated the epistemological dualism of distinguishing between the realm accessible by external perception and the realm accessible by inner perception, and hence between the subjective and the objective , regarding the "first person" perspective as a legitimate means of access only to one's own private experience, while insisting that all others' experience must be observed from a (...) neutral "third person" perspective. By reflecting on his participant-observational encounters with the animal other of the Bonobo, the author attempts to demonstrate in this paper the possibility of a third approach between the antinomy of methodological subjectivism and methodological objectivism as a way out of the dilemmas posed by epistemological dualism. The alternative proposed is the "second person" framework of observation, which, by invoking empathic seeing as its means of accessing the private space of the other and creating the space of the "in between", allows for intersubjective engagement in an experiential gestalt consisting of "myself and the other", and offers the possibility of testing one's ‘own' experience of an intersubjective moment in dialogue with the other. In so far as it infers the focusing of consciousness on embodied experience and expression, and the synthesis of receptive and proprioceptive consciousness in "experiaction" , the "second person" perspective restores inner reality to the realm of the observable, and thus reclaims observation as the method of psychology, and behaviour as its subject matter. The notion of empathy and intuition as a reliable and valid mode of access to the psychological life of others is substantiated theoretically with reference to inter alia Husserl's concepts of "coupling" and "co-constitution", Merleau-Ponty's notions of "inter-corporeality" or "carnal intersubjectivity" and of "the intertwining and the chiasm" of the "Ineinander" as constitutive of the "flesh of the world", Laing's postulation of the possibility of "interexperience", and the sense of union with the object of perception implied by Scheler's term "Einsfühlung" as the essence of intersubjective encounter. (shrink)

Throughout the 1990s, Jaegwon Kim developed a line of argument that what purport to be nonreductive forms of physicalism are ultimately untenable, since they cannot accommodate the causal efficacy of mental states. His argument has received a great deal of discussion, much of it critical. We believe that, while the argument needs some tweaking, its basic thrust is sound. In what follows, we will lay out our preferred version of the argument and highlight its essential dependence on a causal-powers metaphysic, (...) a dependence that Kim does not acknowledge in his official presentations of the argument.i We then discuss two recent physicalist strategies for preserving the causal efficacy of the mental in the face of this sort of challenge, strategies that (ostensibly) endorse a causal powers metaphysics of properties while offering distinctive accounts of the physical realization of mental properties. We argue that neither picture can be satisfactorily worked out, and that seeing why they fail strongly suggests that nonreductive physicalism and a causal powers metaphysic are not compatible, as our original argument contends. Since we also believe that robust realism concerning mental causation should not be abandoned, we take the argument of this paper to strongly motivate an account on which the mental is unrealized by and ontologically emergent from the physical. In a final section, we sketch what an ontologically emergentist account of the mental might look like. (shrink)

This comprehensive text covers all the standard topics of the contemporary logic course--informal logic, classical deductive logic, induction and scientific reasoning, including the logical fallacies, legal reasoning, and the practice of argument analysis. Exceptionally fine examples and exercises illustrate and reinforce important points throughout. The text is accompanied by a Study Guide for students and an Instructor's Manual.

When health care providers make decisions to use resources, their devotion to the patient at hand must be mediated by a framework that puts individual autonomy and social equity into focus simultaneously. The concept of citizenship yields such a framework.

Most readers of Sartre focus only on the works written at the peak of his influence as a public intellectual in the 1940s, notably "Being and Nothingness". "Jean-Paul Sartre: Key Concepts" aims to reassess Sartre and to introduce readers to the full breadth of his philosophy. Bringing together leading international scholars, the book examines concepts from across Sartre's career, from his initial views on the "inner life" of conscious experience, to his later conceptions of hope as the binding agent for (...) a common humanity. The book will be invaluable to readers looking for a comprehensive assessment of Sartre's thinking - from his early influences to the development of his key concepts, to his legacy. (shrink)

Edmund Pellegrino claims that medical ethics must be derived from a perception of the patient's damaged humanity, rather than from the self-imposed duties of professionals. This essay explores the meaning and examines the challenges to this patient-centered ethic. Social scientific and bioethical interpretations of medicine constitute one kind of challenge. A more pervasive challenge is the ascendancy of managed care, and especially investor-owned, for-profit managed care. A list of questions addressed to patients, physicians and organizations is offered as one means (...) of assessing this threat and moving toward morally trustworthy relationships. (shrink)

Our culture is well on its way to reducing medical ethics to legal requirements, general citizen ethics, or personal values. A distinctive ethic for medicine provides critical distance and moral meaning for the profession and an enriched societal ethic.

Two decades ago, I wrote an essay expressing my skepticism about the nascent movement to certify bioethics consultants. My concerns were numerous. For example, I worried that the move toward certification would give too much weight to moral theory and neglect the importance of the less formal moral reasoning of patients and their families. I was also concerned that the effort to certify competence, complete with standardized testing, would be largely self-promotional and make unfounded claims about who has the capacity (...) to do this work. My worries were prescient. Notice, for example, the way that the American Society for Bioethics and Humanities was advertising its new Healthcare Ethics... (shrink)

Volume 19, Issue 11, November 2019, Page 63-64.

Lauris Kaldjian makes a strong case for respecting the role of conscience in the practice of medicine. His excellent book, Practicing Medicine and Ethics, presents an historically informed and carefully crafted explication of the role of conscience in Western ethics and its relevance for medical practitioners. The essay that initiates the discussion in this issue of Perspectives in Biology and Medicine is an equally well-written and lucid account of this important component of morality. But it is also worrisome in its (...) implications for insulating conscience from the other facets of moral thinking and feeling. The reasons Kaldjian's account is not finally compelling stem from his tethering conscience too... (shrink)