Over the past two decades ethics committees have proliferated in healthcare institutions across the country. Catalysts for this growth include the endorsement of ethics committees by the New Jersey Supreme Court in the Quinlan case, by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research in its report entitled Deciding to Forgo Life Sustaining Medical Treatment, by the U.S. Department of Health and Human Services in its 1985 “Baby Doe” regulations, by numerous other courts in (...) treatment decisionmaking opinions issued after Quinlan, and more recently by the Joint Commission on Accreditation of Healthcare Organizations. (shrink)

This paper presents a critical analysis of code-semiotics, which we see as the latest attempt to create paradigmatic foundation for solving the question of the emergence of life and consciousness. We view code semiotics as a an attempt to revise the empirical scientific Darwinian paradigm, and to go beyond the complex systems, emergence, self-organization, and informational paradigms, and also the selfish gene theory of Dawkins and the Peircean pragmaticist semiotic theory built on the simultaneous types of evolution. As such it (...) is a new and bold attempt to use semiotics to solve the problems created by the evolutionary paradigm’s commitment to produce a theory of how to connect the two sides of the Cartesian dualistic view of physical reality and consciousness in a consistent way. (shrink)

Resumen El presente artículo discute un estilo comunicativo típico de muchos hispanohablantes, que a menudo ha sido caracterizado en la literatura sobre pragmática y comunicación intercultural como de cercanía interpersonal y de confianza. El punto de partida teórico y metodológico es la teoría de la Metalengua Semántica Natural (NSM, por sus siglas en inglés), que propone el uso de un minivocabulario de conceptos básicos para explicar otros más complejos. En este caso, presentamos descripciones (que en la teoría se denominan guiones (...) culturales) de distintos aspectos de este estilo comunicativo de cercanía y de palabras claves culturales y rasgos gramaticales relacionados con este modo de comunicar al que, consciente o inconscientemente, adhieren muchos hispanohablantes. Nos basamos en trabajos ya realizados por otros autores dentro de la NSM y proponemos también nuevas descripciones. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

Purpose Recent research has found unrealistic optimism among patient-subjects in early-phase oncology trials. Our aim was to investigate the cognitive and motivational factors that evoke this bias in this context. We expected perceptions of control to be a strong correlate of unrealistic optimism. Methods A study of patient-subjects enrolled in early-phase oncology trials was conducted at two sites in the USA. Respondents completed questionnaires designed to assess unrealistic optimism and several risk attribute variables that have been found to evoke the (...) bias in other contexts. Results One hundred and seventy-one patient-subjects agreed to be interviewed for our study. Significant levels of perceived controllability were found with respect to all nine research-related questions. Perceptions of control were found to predict unrealistic optimism. Two other risk attribute variables, awareness of indicators and mental image, were correlated with unrealistic optimism. However, in multivariate regression analysis, awareness and mental image dropped out of the model and perceived controllability was the only factor independently associated with unrealistic optimism. Conclusion Patient-subjects reported that they can, at least partially, control the benefits they receive from participating in an early-phase oncology trial. This sense of control may underlie unrealistic optimism about benefiting personally from trial participation. Effective interventions to counteract unrealistic optimism may need to address the psychological factors that give rise to distorted risk/benefit processing. (shrink)

In this article, we explore how deep brain stimulation (DBS) devices designed to “close the loop”—to automatically adjust stimulation levels based on computational algorithms—may risk taking the individual agent “out of the loop” of control in areas where (at least apparent) conscious control is a hallmark of our agency. This is of particular concern in the area of psychiatric disorders, where closed-loop DBS is attracting increasing attention as a therapy. Using a relational model of identity and agency, we consider whether (...) DBS designed for psychiatric regulation may require special attention to agency. To do this, we draw on philosophical work on relational identity and agency, connecting it with reports from people using first-generation DBS devices for depression and obsessive-compulsive disorder. We suggest a way to extend a notion of relational agency to encompass neural devices. (shrink)

For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship from (...) the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings. (shrink)

In an Isis 2008 review of research in History and Philosophy of Science (HPS), Galison opened discussion on ten on-going HPS problems. It is however unclear to what extent these problems, and constraints on their solutions, are of HPS’s own making. Recent research provides a basic resolution of these issues. In a recent paper Hooker (Perspect Sci 26(2): 266–291, 2018b) proposed that the discipline(s) of HPS should themselves also be understood to employ paradigms in HPS to understand science, analogously to (...) those employed in science to understand scientific domains. The paper argued for recognising at least two paradigms, one based on logic, and analytic forms more generally, the other based on deliberative judgement making. The present paper aims to use paradigmatic responses to Galison’s problems to explore the differing natures, merits and limitations of these two paradigms. This exploration also reveals the basic inadequacy of the analytic paradigm to illuminate the conduct of science, thereby permitting many of his problems to be dissolved rather than solved. (shrink)

In his 1981 article "What is 'business ethics'"? Peter Drucker maintains that the then current business ethics literature is a form of casuistry, and it provides an illegitimate argument for business apologists, while it also unjustly bashes business. I agree with W. Michael Hoffman's and Jennifer Mills Moore's criticisms of Drucker's article. However, by limiting themselves to this article, rather than considering Drucker's management works, they have missed an opportunity to benefit from his acknowledged practical wisdom. In this paper, I (...) seize the opportunity to show that Drucker takes business ethics seriously, and I develop his position on business morality. His view of business management responsibility and the related notion of a just organization is seen to be essentially Platonic. (shrink)

First published in 1985, the _Handbook for Achieving Gender Equity Through Education_ quickly established itself as the essential reference work concerning gender equity in education. This new, expanded edition provides a 20-year retrospective of the field, one that has the great advantage of documenting U.S. national data on the gains and losses in the efforts to advance gender equality through policies such as Title IX, the landmark federal law prohibiting sex discrimination in education, equity programs and research. Key features include:_ (...) Expertise_ – Like its predecessor, over 200 expert authors and reviewers provide accurate, consensus, research-based information on the nature of gender equity challenges and what is needed to meet them at all levels of education._ Content Area Focus_ – The analysis of gender equity within specific curriculum areas has been expanded from 6 to 10 chapters including mathematics, science, and engineering._ Global/Diversity Focus_ – Global gender equity is addressed in a separate chapter as well as in numerous other chapters. The expanded section on gender equity strategies for diverse populations contains seven chapters on African Americans, Latina/os, Asian and Pacific Island Americans, American Indians, gifted students, students with disabilities, and lesbian, gay, bisexual, and transgender students. _ Action Oriented_ – All chapters contain practical recommendations for making education activities and outcomes more gender equitable. A final chapter consolidates individual chapter recommendations for educators, policymakers, and researchers to achieve gender equity in and through education._ New Material_ – Expanded from 25 to 31 chapters, this new edition includes: *more emphasis on male gender equity and on sexuality issues; *special within population gender equity challenges ; *coeducation and single sex education; *increased use of rigorous research strategies such as meta-analysis showing more sex similarities and fewer sex differences and of evaluations of implementation programs; *technology and gender equity is now treated in three chapters; *women’s and gender studies; *communication skills relating to English, bilingual, and foreign language learning; and *history and implementation of Title IX and other federal and state policies. Since there is so much misleading information about gender equity and education, this _Handbook_ will be essential for anyone who wants accurate, research-based information on controversial gender equity issues—journalists, policy makers, teachers, Title IX coordinators, equity trainers, women’s and gender study faculty, students, and parents. (shrink)

This paper traces a relatively linear sequence of early research approaches to the formal verification of concurrent programs. It does so forwards and then backwards in time. After briefly outlining the context, the key insights from three distinct approaches from the 1970s are identified (Ashcroft/Manna, Ashcroft (solo) and Owicki). The main technical material in the paper focuses on a specific program taken from the last published of the three pieces of research (Susan Owicki’s): her own verification of her _Findpos_ example (...) is outlined followed by attempts at verifying the same example using the earlier approaches. Reconsidering the prior approaches on the basis of Owicki’s useful example illuminates similarities and differences between the proposals. Along the way, observations about interactions between researchers (and some “blind spots”) are noted. (shrink)

To mathematicians, mathematics is a happy game, to scientists a mere tool and to philosophers a Platonic mystery - or so the caricature runs. The caricature reflects the alleged 'cultural gap' between the disciplines a gap for which there too often has been, sadly, sound historical evidence. In many minds the lack of communication between philosophy and the exact disciplines is especially prominent. Yet in the past there was no separation - exact knowledge, covering both scientists and mathemati cians, was (...) known as natural philosophy and the business of providing a critical view of the nature of reality and an accurate mathematical de scription of it constituted a single task from the glorious tradition begun by the early Greek philosophers even up until Newton's day (but I am thinking of Descartes and Leibniz I). The lack of communication between these professional groups has been particularly unfortunate, for the past half century has seen the most ex citing developments in mathematical physics since Newton. These devel opments hinged on the introduction of vast new reaches of mathematics into physics (non-Euclidean geometries, covariant formulations, non commutative algebras, functional analysis and so on) and conversely have challenged mathematicians to develop the appropriate mathematical fields. Equally, these developments have posed profound philosophical problems to do with the rejection of traditional conceptions concerning the nature of physical reality and physical theorising. (shrink)

What happens at the end of a clinical trial for an investigational neural implant? It may be surprising to learn how difficult it is to answer this question. While new trials are initiated with increasing regularity, relatively little consensus exists on how best to conduct them, and even less on how to ethically end them. The landscape of recent neural implant trials demonstrates wide variability of what happens to research participants after an neural implant trial ends. Some former research participants (...) continue to receive support for their devices (e.g., battery and component replacements, software updates, etc.). Others, when safe, have their neural implants removed through surgical explantation. Still others continue to live with a deactivated neural implant embedded in their body. In the United States, there are no uniform requirements to provide services, of any kind, after an neural implant study ends, and other nations are similarly facing this challenge. The existence of a post-trial gap in an expanding neural implant research ecosystem invites obvious questions: What is owed to neural implant research participants post-trial, and why has providing it been so difficult to accomplish in practice? To take a step forward on this difficult issue, we assembled one group of stakeholders – researchers funded for neuroethics grants by the National Institutes of Health – to explore possible starting points on one topic: ethical guidance for post-trial care of research participants in neural implant trials. Based on shared concerns discussed in the expert workshop the current paper is a call to action. It reports the key areas of convergence from the meeting and highlights important next steps towards developing much needed guidance. (shrink)

Family members can provide crucial support to individuals participating in clinical trials. In research on the “newest frontier” of Deep Brain Stimulation (DBS)—the use of DBS for psychiatric conditions—family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their (...) family members as interview participants. Using dyadic thematic analysis—an approach that takes both the individuals and the relationship as units of analyses—this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. (shrink)

This article explores the connection between the Heng Xian and the Changes of Zhou tradition, especially the “Tuan” and “Attached Verbalizations” commentaries. Two important Heng Xian terms—heng 恆 and fu 復—are also Changes of Zhou hexagrams and possible connections are explored. Second, the Heng Xian account of the creation of names is compared with the “Attached Verbalizations” account of the creation of the Changes of Zhou system. Third, the roles played by knowing and desire in both Heng Xian and the (...) Changes of Zhou tradition are explored, with particular focus on potential points of similarity. Finally, insights gained through these comparisons are used to interpret the Heng Xian advice on initiating action. (shrink)

Survival after solid-organ transplantation has improved significantly, and many contemporary transplant recipients are of childbearing potential. There are limited data to guide decision-making surrounding pregnancy after transplantation, variations in clinical practice, and significant knowledge gaps, all of which raise significant ethical issues. Post-transplant pregnancy is associated with an increased risk of maternal and fetal complications. Shared decision-making is a central aspect of patient counselling but is complicated by significant knowledge gaps. Stakeholder interests can be in conflict; exploring these tensions can (...) help patients to evaluate their options and inform their deliberations. We argue that uniform, evidence-based recommendations for pregnancy after solid organ transplantation are needed. Conducting research, including patient-engaged studies, in this area should be priority for the transplant community. (shrink)

The Meno, one of the most widely read of the Platonic dialogues, is seen afresh in this original interpretation that explores the dialogue as a theatrical presentation. Just as Socrates's listeners would have questioned and examined their own thinking in response to the presentation, so, Klein shows, should modern readers become involved in the drama of the dialogue. Klein offers a line-by-line commentary on the text of the Meno itself that animates the characters and conversation and carefully probes (...) each significant turn of the argument. "A major addition to the literature on the Meno and necessary reading for every student of the dialogue."--Alexander Seasonske, Philosophical Review "There exists no other commentary on Meno which is so thorough, sound, and enlightening."-- Choice Jacob Klein was a student of Martin Heidegger and a tutor at St. John's College from 1937 until his death. His other works include Plato's Trilogy: Theaetetus, the Sophist, and the Statesman, also published by the University of Chicago Press. (shrink)

The, Police Executive Research Forum is completing a major initiative that encourages police chiefs to formalize working relationships with emergency medical personnel. The effort is sponsored by the U.S. Department of Justice, Bureau of Justice Assistance as a demonstration with the goal of preventing recurring violence that eventually leads to homicide. The initiative originally involved a consortium of emergency room clinicians, emergency medical service personnel, as well as police executives. The collaboration initially focused on arguably preventable dimensions of domestic violence (...) and homicide. However, after “9/11” and the ensuing anthrax crisis, the project developed into a three-step draft interactive protocol for earlier police intervention in situations involving possible deaths and mass casualties. With this shift in the project, Police Executive Research Forum’s principal collaborators shifted from emergency clinicians to public health practitioners. (shrink)

Elster contends that much of Marx's most important work was characterized by methodological individualism. I argue that this is untrue, and that to assert it results, at least in part, from a misunderstanding of Marx's writings on the individual's relation to his society. Central to Marx's writings is the rejection of an abstract ?society?. Instead we find analysis of a particular social formation, with a historically specific relation between individual and society, and between ends and means. This is demonstrated from (...) Capital and from earlier writings by Marx. In Elster's critique of Marx's political economy, the same essentially historical content of Marx's categories is not seen. The natural (or general) and the historical are confused in Elster's argument on the theory of value. Elster's reconstruction of Marx's concepts of class and class struggle is critically examined, from the standpoint that class is a relation of exploitation, resting on property in the means of production. In supposing that Marx was in some sense a functionalist, Elster must once again be ignoring the historical core of Marx's thinking. (shrink)