Excellent patient care within the emergency department requires interdisciplinary training, teamwork, and communication to manage the chaos of the environment. Specifically, invasive procedures required to manage airway, breathing, and circulation via intubation, chest compressions, and establishing intravenous access can provide a direct benefit to save lives but also have the potential to harm both patients and health care clinicians alike; emergency health care clinicians can be exposed to significant amounts of blood and body fluids as well as other threats of (...) physical and psychological harm. The ethical components of care in this environment are often under‐recognized due to the need for rapid patient assessment and immediate action. Moreover, challenges to practice that can include lack of qualified personnel, equipment, and other resources to provide safe care to a large volume of patients can lead to moral distress in ED staff. Because the ED is a high‐uncertainty, high‐acuity environment, continuing interprofessional communication, collaboration, and planning is critical. Opportunities for multidisciplinary policy dialogue and the development of professional guidelines can make the ED a safer environment for both patients and providers. (shrink)

Collects the photographs of Carleton Watkins that contributed to the argument for creating the National Park Service, along with essays that explore the artist and his work providing context and depth to the images.

This paper begins with a discussion of two features of the everyday task environment. First, the everyday task environment is designed, and an important part of the design is the provision of explicit information to guide the individual in the adaptation of his activity. Second, some task environments are semi‐permanent. These two features of the task environment reveal some important characteristics in the psychology of the individual. When novelty occurs, expansion in the range of behavior of the individual is guided (...) by a process of internalization of information provided in the task environment by another. Because of the semi‐permanence of home task environments, there is pay‐off in organizing behavior in terms of the particulars of those environments. The body of this paper examines these ideas from the perspective of FLOABN. FLOABN is a computational cognitive model of an individual acquiring skill at using household and office devices. (shrink)

The revised Common Rule includes a new option for the conduct of secondary research with identifiable data and biospecimens: regulatory broad consent. Motivated by concerns regarding autonomy and trust in the research enterprise, regulators had initially proposed broad consent in a manner that would have rendered it the exclusive approach to secondary research with all biospecimens, regardless of identifiability. Based on public comments from both researchers and patients concerned that this approach would hinder important medical advances, however, regulators decided to (...) largely preserve the status quo approach to secondary research with biospecimens and data. The Final Rule therefore allows such research to proceed without specific informed consent in a number of circumstances, but it also offers regulatory broad consent as a new, optional pathway for secondary research with identifiable data and biospecimens. In this article, we describe the parameters of regulatory broad consent under the new rule, explain why researchers and research institutions are unlikely to utilize it, outline recommendations for regulatory broad consent issued by the Secretary's Advisory Committee on Human Research Protections, and sketch an empirical research agenda for the sorts of questions about regulatory broad consent that remain to be answered as the research community embarks on Final Rule implementation. (shrink)

The topic of self-interest raises large and intractable philosophical questions–most obviously, the question “In what does self-interest consist?” The concept, as opposed to the content of self-interest, however, seems clear enough. Self-interest is interest in one's own good. To act self-interestedly is to act on the motive of advancing one's own good. Whether what one does actually is in one's self-interest depends on whether it actually does advance, or at least, minimize the decline of, one's own good. Though it may (...) be difficult to tell whether a person is motivated by self-interest in a particular instance, and difficult also to determine whether a given act or decision really is in one's self-interest, the meaning of the claims in question seems unproblematic. My main concern in this essay is to make a point about the content of self-interest. Specifically I shall put forward the view that meaningfulness, in a sense I shall elaborate, is an important element of a good life. It follows, then, that it is part of an enlightened self-interest that one wants to secure meaning in one's life, or, at any rate, to allow and promote meaningful activity within it. Accepting this substantial conception of self-interest, however, carries with it a curious consequence: the concept of self-interest which formerly seemed so clear begins to grow fuzzy. Fortunately, it comes to seem less important as well. In Reasons and Persons, Derek Parfit distinguishes three sorts of theories about self-interest–hedonistic theories, preference theories, and what he calls “objective-list theories." Hedonistic theories hold that one's good is a matter of the felt quality of one's experiences. (shrink)

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Ecologists are challenged by the need to bridge and synthesize different approaches and theories to obtain a coherent understanding of ecosystems in a changing world. Both food web theory and regime shift theory shine light on mechanisms that confer stability to ecosystems, but from different angles. Empirical food web models are developed to analyze how equilibria in real multi-trophic ecosystems are shaped by species interactions, and often include linear functional response terms for simple estimation of interaction strengths from observations. Models (...) of regime shifts focus on qualitative changes of equilibrium points in a slowly changing environment, and typically include non-linear functional response terms. Currently, it is unclear how the stability of an empirical food web model, expressed as the rate of system recovery after a small perturbation, relates to the vulnerability of the ecosystem to collapse. Here, we conduct structural sensitivity analyses of classical consumer-resource models in equilibrium along an environmental gradient. Specifically, we change non-proportional interaction terms into proportional ones, while maintaining the equilibrium biomass densities and material flux rates, to analyze how alternative model formulations shape the stability properties of the equilibria. The results reveal no consistent relationship between the stability of the original models and the proportionalized versions, even though they describe the same biomass values and material flows. We use these findings to critically discuss whether stability analysis of observed equilibria by empirical food web models can provide insight into regime shift dynamics, and highlight the challenge of bridging alternative modelling approaches in ecology and beyond. (shrink)

This paper argues that an adequate conception of a good life should recognize, in addition to happiness and morality, a third dimension of meaningfulness. It further proposes that we understand meaningfulness as involving both a subjective and an objective condition, suitably linked. Meaning arises when subjective attraction meets objective attractiveness. In other words one’s life is meaningful insofar as one is gripped or excited by things worthy of one’s love, and one is able to do something positive about it. The (...) paper concludes with some speculations about how this conception of meaningfulness might help to explain the conditions under which social volunteering can be especially rewarding. (shrink)

Genomic imprinting is an epigenetic mechanism resulting in the preferential expression of the maternal or paternal alleles of a specific subset of genes in the mammalian genome. A key but relatively unexplored question is how imprints are established in the germline. New observations(1) on two classical imprinting disorders, the Prader‐Willi (PWS) and Angleman (AS) syndromes, offer the first genetic insight into this process. Molecular analysis of imprinting mutations that interfere with the appropriate establishment of the maternal and paternal epigenotypes has (...) led to the identification of imprinted transcripts that could be involved in switching imprints in the germlines. (shrink)

Many academic works as well as many works of art are such that if they had never been produced, no one would be worse off. Yet it is hard to resist the judgment that some such works are good nonetheless. We are rightly grateful that these works were created; we rightly admire them, appreciate them, and take pains to preserve them. And the authors and artists who produced them have reason to be proud. This should lead us to question the (...) view that in order for a thing to be good, in a sense which implies that the thing merits our attention and positive concern, it needs to be good for someone or something whose welfare is enhanced by it. (shrink)

This essay is primarily concerned with one type of moral luck – luck in how things turn out. Do acts that actually lead to harm deserve the same treatment as similar acts that, by chance, do not lead to harm? This paper argues that we must recognize the truth in two, opposing tendencies in such cases.

The ancient Greeks subscribed to the thesis of the Unity of Virtue, according to which the possession of one virtue is closely related to the possession of all the others. Yet empirical observation seems to contradict this thesis at every turn. What could the Greeks have been thinking of? The paper offers an interpretation and a tentative defence of a qualified version of the thesis. It argues that, as the Greeks recognized, virtue essentially involves knowledge ? specifically, evaluative knowledge of (...) what matters. Furthermore, such knowledge is essentially holistic. Perfect and complete possession of one virtue thus requires the knowledge that is needed for the possession of every other virtue. The enterprise of trying to reconcile the normative view embodied in this conception of virtue with empirical observation also serves as a case study for the field of moral psychology in which empirical and normative claims are often deeply and confusingly intertwined.1. (shrink)

How can we solve the paradox of false-belief understanding: if infants pass the implicit false belief task by nonverbal behavioural responses why do they nonetheless typically fail the explicit FBT till they are 4 years old? Starting with the divide between situational and cognitive accounts of the development of false-belief understanding, we argue that we need to consider both situational and internal cognitive factors together and describe their interaction to adequately explain the development of children’s Theory of Mind ability. We (...) then argue that a further challenge is raised for existing accounts by helping behaviour versions of the FBT. We argue that the common two-stage accounts are inadequate: we need to allow for three central stages in a continuous development. Furthermore, drawing on Perner et al.’s and Perner and Leahy’s : 491–508, 2016) recent mental files account, we provide a new account of the development of these three stages of ToM ability by describing the changes of the structure and organisation of mental files including the systematic triggering role of types of situations. Thereby we aim to establish a situational mental file account as a new and adequate solution to the paradox of false-belief understanding. (shrink)

In this paper we address the question of when a researcher is justified in describing his or her artificial agent as demonstrating ethical decision-making. The paper is motivated by the amount of research being done that attempts to imbue artificial agents with expertise in ethical decision-making. It seems clear that computing systems make decisions, in that they make choices between different options; and there is scholarship in philosophy that addresses the distinction between ethical decision-making and general decision-making. Essentially, the qualitative (...) difference between ethical decisions and general decisions is that ethical decisions must be part of the process of developing ethical expertise within an agent. We use this distinction in examining publicity surrounding a particular experiment in which a simulated robot attempted to safeguard simulated humans from falling into a hole. We conclude that any suggestions that this simulated robot was making ethical decisions were misleading. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Philosophers frequently distinguish between causal responsibility and moral responsibility, but that distinction is either ambiguous or confused. We can distinguish between causal responsibility and a deeper kind of responsibility, that licenses reactive attitudes and judgments that a merely causal connection would not, and we can distinguish between holding people accountable for their moral qualities and holding people accountable for their nonmoral qualities. But, because we sometimes hold people deeply responsible for nonmoral qualities of behavior and character, these distinctions are not (...) the same. A number of recent accounts of responsibility identify deep responsibility with moral responsibility and in consequence miss some key features of the concept of which they are trying to give an account. A view that distinguishes two levels of responsibility, according to which the conditions of attributability are weaker than the conditions of accountability, might seem to account for a kind of non.. (shrink)

The rapid development of machine-learning algorithms, which underpin contemporary artificial intelligence systems, has created new opportunities for the automation of work processes and management functions. While algorithmic management has been observed primarily within the platform-mediated gig economy, its transformative reach and consequences are also spreading to more standard work settings. Exploring algorithmic management as a sociotechnical concept, which reflects both technological infrastructures and organizational choices, we discuss how algorithmic management may influence existing power and social structures within organizations. We identify (...) three key issues. First, we explore how algorithmic management shapes pre-existing power dynamics between workers and managers. Second, we discuss how algorithmic management demands new roles and competencies while also fostering oppositional attitudes toward algorithms. Third, we explain how algorithmic management impacts knowledge and information exchange within an organization, unpacking the concept of opacity on both a technical and organizational level. We conclude by situating this piece in broader discussions on the future of work, accountability, and identifying future research steps. (shrink)

Drawing on a rich pragmatist tradition, this book offers an account of the different kinds of ‘oughts’, or varieties of normativity, that we are subject to contends that there is no conflict between normativity and the world as science describes it. The authors argue that normative claims aim to evaluate, to urge us to do or not do something, and to tell us how a state of affairs ought to be. These claims articulate forms of action-guidance that are different in (...) kind from descriptive claims, with a wholly distinct practical and expressive character. This account suggests that there are no normative facts, and so nothing that needs any troublesome shoehorning into a scientific account of the world. This work explains that nevertheless, normative claims are constrained by the world, and answerable to reason and argumentation, in a way that makes them truth-apt and objective. (shrink)

The newest addition to the Point/Counterpoint Series, Abortion: Three Perspectives features a debate between four noted philosophers - Michael Tooley, Celia Wolf-Devine, Philip E. Devine, and Alison M. Jaggar - presenting different perspectives on one of the most socially and politically argued issues of the past 30 years. The three main arguments include the "liberal" pro-choice approach, the "communitarian" pro-life approach, and the "gender justice" approach. Divided into two parts, the text features the authors' ideas, developed in depth, and (...) their responses to one another within each framework. As philosophers, the authors have special skills in critical analysis and thinking systematically about values. The text is appropriate for advanced courses in ethics, bioethics, sex and gender issues, and contemporary moral issues. (shrink)

In this paper, I contest increasingly common "realist" interpretations of Hegel's theory of "the concept" (der Begriff), offering instead a "isomorphic" conception of the relation of concepts and the world. The isomorphism recommended, however, is metaphysically deflationary, for I show how Hegel's conception of conceptual form creates a conceptually internal standard for the adequacy of concepts. No "sideways-on" theory of the concept-world relationship is envisioned. This standard of conceptual adequacy is also "graduated" in that it allows for a lack of (...) fit between concept and world. The possibility for a "maximally isomorphic" fit between concept and world obtains through the teleological realization of concepts, which marks especially the "artificial" world of human culture (law, art, religion, etc.). Some of the most seemingly exaggerated claims Hegel makes about the concept, I contend, can be understood when we consider the significance Hegel ascribes to human making, which is provided for in his conceptual theory. But my framework provides an interpretive key for the way Hegel sees concepts imperfectly realized in the natural world as well. (shrink)

Purpose/methods: This study investigated the relationship between ethics education and training, and the use and usefulness of ethics resources, confidence in moral decisions, and moral action/activism through a survey of practicing nurses and social workers from four United States (US) census regions. Findings: The sample (n = 1215) was primarily Caucasian (83%), female (85%), well educated (57% with a master's degree). no ethics education at all was reported by 14% of study participants (8% of social workers had no ethics education, (...) versus 23% of nurses), and only 57% of participants had ethics education in their professional educational program. Those with both professional ethics education and in-service or continuing education were more confident in their moral judgments and more likely to use ethics resources and to take moral action. Social workers had more overall education, more ethics education, and higher confidence and moral action scores, and were more likely to use ethics resources than nurses. Conclusion: Ethics education has a significant positive influence on moral confidence, moral action, and use of ethics resources by nurses and social workers. (shrink)

Many philosophers have been persuaded that if we don’t create our own characters, we cannot be responsible for acts that flow from our characters; they also raise doubts about whether acts that do not flow from our characters can fairly be attributed to us. Both these concerns, however, reflect a simplistic and implausible conception of character and of its relation to our actions and our selves. I suggest a different relationship between character and responsibility: We can be responsible for acts (...) that are in character and also for acts that are out of character, but to be capable of being responsible at all is closely related to the capacity to have a character. I relate this capacity to the exercise of active intelligence—a capacity that is manifested in actions in or out of character, but not in the display of many psychological conditions or disorders. (shrink)

We offer a precautionary account of why business managers should proactively rethink about what kinds of automation firms ought to implement, by exploring two challenges that automation will potentially pose. We engage the current debate concerning whether life without work opportunities will incur a meaning crisis, offering an argument in favor of the position that if technological unemployment occurs, the machine age may be a structurally limited condition for many without work opportunities to have or add meaning to their lives. (...) We term this the axiological challenge. This challenge, if it turns out to be persuasive, leads to a second challenge, to which managers should pay special attention: the teleological challenge, a topic especially relevant to the broad literature about corporate purpose and governance. We argue that both the shareholder profit-maximization model and its major alternative, stakeholder theory, are insufficient to address the meaning crisis. Unless rebutted, the two challenges compel business leaders to proactively rethink the purpose of business for future society. Otherwise, businesses will be contributors to a major ethical crisis and societal externality in the coming society. (shrink)

In the Transcendental Aesthetic (TA), Kant is typically held to make negative assertations about “things in themselves,” namely that they are not spatial or temporal. These negative assertions stand behind the “neglected alternative” problem for Kant’s transcendental idealism. According to this problem, Kant may be entitled to assert that spatio-temporality is a subjective element of our cognition, but he cannot rule out that it may also be a feature of the objective world. In this paper, I show in a new (...) way how Kant’s view (focusing on his conclusions about space) is not subject to this objection, by showing that he does not make the denial about mind-independent reality that he is typically held to make. The argument develops consequences of a new reading of Kant’s expression “an sich selbst” (‘in itself’; ‘in themselves’). I argue that “an sich selbst” or “per se” has a special, judgment-level role, so that this expression does not form new noun-terms adjectivally. It follows that the conceptual unit of Kant’s “Conclusions” in the TA is simply “things” (Dinge), since “things in themselves” is not a nominal expression; Kant adopts the Wolffian ontological use of “thing” as the basic kind-term for any existent. The arguments that things per se are not in space are arguments that space cannot be a necessary property or relations of things as a kind. I show that this does not involve the positive claim about mind-independent reality that inspires the neglected alternative objection. (shrink)

Large-scale sequencing tests, including whole-exome and whole-genome sequencing, are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute and National Cancer Institute have funded studies on clinical and research sequencing under (...) the Clinical Sequencing Exploratory Research program as well as studies on return of results. Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing. (shrink)

There are well-known problems for formalist accounts of game-play with regards to cheating. Such accounts seem to be committed to cheaters being unable to win–or even play–the game, yet it seems that there are instances of cheaters winning games. In this paper, I expand the discussion of such problems by introducing cases of pre-game cheating, and see how a formalist–specifically a Suitsian–account can accommodate such problems. Specifically, I look at two (fictional) examples where the alleged game-players cheat prior to a (...) game-instance in such as a way as to cast doubt on whether the alleged game-players are truly playing the game. To escape the worries brought about by these examples of pre-game cheating, I will appeal to the concept of nested games. This concept will give us the needed tools to explain how the alleged players are cheating and how the alleged players are players. On the whole, this discussion should help illuminate some important issues with regards to cheating and rules on a Suitsian account of game-play, and help give support for formalist accounts more generally. (shrink)

Oversight of human gene transfer research presents an important model with potential application to oversight of nanobiology research on human participants. Gene therapy oversight adds centralized federal review at the National Institutes of Health's Office of Biotechnology Activities and its Recombinant DNA Advisory Committee to standard oversight of human subjects research at the researcher's institution and at the federal level by the Office for Human Research Protections. The Food and Drug Administration's Center for Biologics Evaluation and Research oversees human gene (...) transfer research in parallel, including approval of protocols and regulation of products. This article traces the evolution of this dual oversight system; describes how the system is already addressing nanobiotechnology in gene transfer: evaluates gene therapy oversight based on public opinion, the literature, and preliminary expert elicitation; and offers lessons of the gene therapy oversight experience for oversight of nanobiotechnology. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Answering important public health questions often requires collection of sensitive information about individuals. For example, our understanding of how HIV is transmitted and how to prevent it only came about with people's willingness to share information about their sexual and drug-using behaviors. Given the scientific need for sensitive, personal information, researchers have a corresponding ethical and legal obligation to maintain the confidentiality of data they collect and typically promise in consent forms to restrict access to it and not to publish (...) identifying data.The interests of others, however, can threaten researchers' promises of confidentiality when legal demands are made to access research data. In some cases, the subject of the litigation is tightly connected to the research questions, and litigants' interest in the data is not surprising. Researchers conducting studies on tobacco or occupational or other chemical exposures, for example, are relatively frequent targets of subpoenas. (shrink)

While the idea of philosophy as conceptual analysis has attracted many adherents and undergone a number of variations, in general it suffers from an authority problem with two dimensions. First, it is unclear why the analysis of a concept should have objective authority: why explicating what we mean should express how things are. Second, conceptual analysis seems to lack intersubjective authority: why philosophical analysis should apply to more than a parochial group of individuals. I argue that Hegel’s conception of social (...) ontology, focused on his concept of “ethical life” (Sittlichkeit), helps to explain how concepts (and their explication) have both objective and intersubjective authority in the social domain. Hegel claims that modern institutions are the product of self-conscious purposes, so that they are conceptually constituted. Concepts do not just represent these objects and so depend on a contingent relation to them. As many contemporary social ontologists agree, this means that our concepts of these institutions are uniquely epistemically “transparent.” They have objective authority. Concepts have intersubjective authority in the modern world as well, according to Hegel. However, I show that this feature of Hegel’s account does not rely on the solution to a philosophical problem. Rather, since the concepts of modern ethical life are “essentially contested,” their content depends on the practical and political agreement of modern subjects. This means that concepts can only have objective authority if some prior intersubjective agreement has been reached. The role of philosophy as conceptual analysis is thus importantly dependent on political developments. (shrink)

Developing ethical standards for clinical use of large-scale genome and exome sequencing has proven challenging, in part due to the inevitability of incidental or secondary findings. Policy of the American College of Medical Genetics and Genomics has evolved but remains problematic. In 2013, ACMG issued policy recommending mandatory analysis of 56 extra genes whenever sequencing was ordered for any indication, in order to ascertain positive findings in pathogenic and actionable genes. Widespread objection yielded a 2014 amendment allowing patients to opt-out (...) from analysis of the extra genes. In 2015, ACMG published the amended policy, providing that patients could opt out of the full set of extra genes, but not a subset. In 2016, ACMG enlarged the set and indicated planned expansion of the roster of extra genes to include pharmacogenetic findings. ACMG policy does not protect the respect for patient choice that prevails in other domains of clinical medicine, where informed consent allows patients to opt in to desired testing. By creating an expanding domain of genomic testing that will be routinely conducted unless patients reject the entire set of extra tests, ACMG creates an exceptional domain clinical practice that is not supported by ethics or science. (shrink)

ABSTRACTThe close connection often cited between Hegel and Wilfrid Sellars is not only said to lie in their common negative challenges to the ‘framework of givenness,’ but also in the positive less...

Scott Kretchmar recently put forth a new definition of what it is to play a game. Unfortunately, it must be rejected. In this paper, I show that this new definition is far too broad by discussing an activity that is not an instance of playing a game but is wrongfully ruled as one on this new definition.