Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying assumptions may (...) be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner. (shrink)

Reference is a relation that obtains between a variety of representational tokens and objects or properties. For instance, when I assert that “Barack Obama is a Democrat,” I use a particular sort of representational token—i.e. the name ‘Barack Obama’—which refers to a particular individual—i.e. Barack Obama. While names and other referential terms are hardly the only type of representational token capable of referring (consider, for instance, concepts, mental maps, and pictures), linguistic tokens like these have long stood at the center (...) of philosophical inquiries into the nature of reference. Accordingly, and to keep things to a reasonable length, this entry will focus primarily on linguistic reference. Assuming that at least some token linguistic expressions really do refer, a number of interesting questions arise. How, for example, does linguistic reference relate to the act of referring—something that we as speakers do with referential terms? How exactly do referential terms come to refer? That is, in virtue of what do they refer to what they do? Is there a single answer to this question, a single mechanism of reference, or different answers depending on the sort of term in question—or even the circumstances in which a single term is used? And what exactly is the relationship between reference and meaning? Answers to these various questions will turn out to be closely related, and the task of this entry will be to trace out some of the main clusters of answers. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

In addition to ordinary conversations among relatively small numbers of individuals, human societies have public conversations. These are diffuse, ongoing discussions about various topics, which are largely sustained by journalistic activities. They are conversations about news – what is happening now – that members of various groups (such as the residents of a certain country, a certain town, or practitioners of a certain profession) need to know about in their capacity as members of those groups, and about how to react (...) to the news. Our topic in this chapter is a type of resistance to evidence that can arise at the level of these public conversations, rather than at the level of individual agents. We call it “relevance-based resistance to evidence”. A public conversation exhibits this kind of evidence resistance when it becomes overly focused on topics that members of the group that the conversation concerns do not in fact need to know about qua members of the group – topics which are, in a word, irrelevant. We argue that the risks of such relevance-based knowledge resistance are significantly amplified by certain structural features of online discourse. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

ABSTRACT Uncertainty as to how we should articulate empirical data and normative reasoning seems to underlie most difficulties regarding the ‘empirical turn’ in bioethics. This article examines three different ways in which we could understand ‘empirical turn’. Using real facts in normative reasoning is trivial and would not represent a ‘turn’. Becoming an empirical discipline through a shift to the social and neurosciences would be a turn away from normative thinking, which we should not take. Conducting empirical research to inform (...) normative reasoning is the usual meaning given to the term ‘empirical turn’. In this sense, however, the turn is incomplete. Bioethics has imported methodological tools from empirical disciplines, but too often it has not imported the standards to which researchers in these disciplines are held. Integrating empirical and normative approaches also represents true added difficulties. Addressing these issues from the standpoint of debates on the fact‐value distinction can cloud very real methodological concerns by displacing the debate to a level of abstraction where they need not be apparent. Ideally, empirical research in bioethics should meet standards for empirical and normative validity similar to those used in the source disciplines for these methods, and articulate these aspects clearly and appropriately. More modestly, criteria to ensure that none of these standards are completely left aside would improve the quality of empirical bioethics research and partly clear the air of critiques addressing its theoretical justification, when its rigour in the particularly difficult context of interdisciplinarity is what should be at stake. (shrink)

The "ruin" of the transcendental tradition -- Freud and the transcendental relation -- Derrida: Differance and the "plural logic of the aporia" -- The im-possibility of the psyche -- The death drive and the im-possibility of psychoanalysis -- Institutional psychoanalysis and the paradoxes of archivization -- The Lacanian real -- Sexual difference -- Feminine sexuality -- The transcendental relation in Lancanian psychoanalysis -- The death drive and ethical action -- The "talking cure": language and psychoanalysis.

Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.

B C Hurst; Teaching, Telling and Changes in Belief, Journal of Philosophy of Education, Volume 14, Issue 2, 30 May 2006, Pages 215–224, https://doi.org/10.1111/.

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified by Wenar. After (...) outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

Both Heidegger's Being and Time and Helen Keller's The Story of my Life address the problem of what it means for humans to be optimally human. In reading these texts together, I hope to show that Helen's life-story confirms Heidegger's existential analyses to some extent, but also, importantly, poses a challenge to them with respect to the interrelated issues of disability, language and others. Heidegger's hermeneutic explication of what it means to be human is intended to uncover supposedly basic human (...) existential structures. As a fore-structure for this explication, Heidegger projects an already able-bodied, self-sufficient adult, resolutely engaged in daily activity. I shall argue, however, that it is due to this starting-point in adult-Dasein that Heidegger's existential analyses miss important insights concerning the meaning of being human to be gained from Helen's experience. Starting from the essentially disabled child-Dasein, Helen describes her struggle to achieve the very condition that Heidegger assumes from the start, first through rescue by the other as teacher, who offered the gift of language and community, and thereafter in her grasp of language as a “pharmakon.” I hope to show in the end that Helen's experience of a struggle for humanity offers the model for an alternative projection, that of an essentially disabled and needy Dasein, which, I believe, provides a more viable fore-structure than Heidegger's for a hermeneutics of humanity. S. Afr. J. Philos. Vol.22(1) 2003: 98-112. (shrink)

Compared to human-operated vehicles, autonomous vehicles offer numerous potential benefits. However, public acceptance of AVs remains low. Using 4 studies, including 1 preregistered experiment, the present research examines the role of trust in AV adoption decisions. Using the Trust-Confidence-Cooperation model as a conceptual framework, we evaluate whether perceived integrity of technology—a previously underexplored dimension of trust that refers to perceptions of the moral agency of a given technology—influences AV policy support and adoption intent. We find that perceived technology integrity predicts (...) adoption intent for AVs and that messages that increase perceived integrity of AV technology result in greater AV adoption intent and policy support. This knowledge can be used to guide communication efforts aimed at increasing public trust in AVs, and ultimately enhance integration of AVs into transport systems. (shrink)

Quantum mechanics has recently indicated that temporal order is not always fixed, a finding that has far-reaching philosophical and theological implications. The phenomena, termed “indefinite causal order,” shows that events can be in a superposition with regard to their order. In the experimental setting with which this article is concerned, two events, A and B, were shown to be in the ordering relations “A before B” and “B before A” at the same time. This article introduces an ongoing project that (...) seeks to make sense of this result, with a particular focus on the methodology by which this research will be undertaken. Specific research questions, particularly regarding what indefinite causal order might mean for the metaphysics of time and the doctrine of salvation, are introduced. The collaborative approach detailed brings together the disciplinary skills of a working scientist and a working theologian. What is offered is a collaborative methodology for interaction between science and religion that is more than the sum of its parts. Alister McGrath’s idea of multiple rationalities is employed as an epistemological framework within which this research takes place. Within an epistemologically pluralistic model, collaborative efforts are not only encouraged but necessary. Complex reality requires an equally complex, usually interdisciplinary, explanation. I argue that such dialogue is both theologically justified and culturally valuable and indicates the direction in which this research will be taken. (shrink)

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of ethics consultation are (...) not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference (...) to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...) care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits. (shrink)

Instead of paralysing readers with a technical account of its nature and genealogy, I aim to accumulate a sense of Derrida's quasi-transcendental thinking over a series of expositions. I begin with a critical account of the most prevalent misreading of Derrida's work, generated by attempts, such as Rorty's, to place it on one side of a clear duality that sets old-fashioned “philosophical” foundationalism against contemporary anti-foundationalist “textuality.” In contrast, through an analogy between what occurs in the giving of a gift (...) and the happening of différance, I shall try to articulate the more complex, quasi-transcendental “logic” of Derrida's thinking, which refuses a clear-cut “either/or” choice between the poles of this duality, precisely because these alternatives stand in a relation, not of analytical contradiction, but of aporia, or dilemma. If this exposition proves to be too abstruse and metaphysical for some, a second, more practical, example concerning the aporias of ethical decision- making should go some way to wards compensation. Through these expositions, I aim to show that a complex, quasi-transcendental way of thinking serves as a more sophisticated and accurate key to the interpretation of Derrida's texts than attempts to reduce it to the anti-foundationalist side of supposedly contradictory opposites. To support this claim, I return with a critical eye to Rorty's rejection of Jonathan Culler's argument that Derrida must and does maintain a philosophy/literature distinction, and of Christopher Norris's explanation for Derrida's claim that one cannot escape philosophy. I also try to answer Rorty's rejection of the very idea of quasi-transcendentality by reducing this mode of thinking to a mere restatement of the co-implication of binaries. I conclude with a brief outline of what deconstructive practice amounts to when understood in the light of quasi-transcendental thinking. S. Afr. J. Philos. Vol.23(3) 2004: 244-266. (shrink)

BackgroundIn this article, we address questions regarding how people consider what they do or do not consent to and the reasons why. This article presents the findings of a citizen forum study conducted by the University of Geneva in partnership with the Geneva University Hospitals to explore the opinions and concerns of members of the public regarding predictive oncology, genetic sequencing, and cancer. MethodsThis paper presents the results of a citizen forum that included 73 participants. A research tool titled "the (...) mechanics of consent" was designed for this study. This tool is a table encouraging participants to reflect on social and research actors, types of data, and desired levels of control while sharing different types of data with different actors. Participants’ discussion that led to the completion of each table were audio-recorded, transcribed, and analyzed using thematic analysis.ResultsThe results are a compilation of responses from the mechanics of consent tool divided into two sections; the first presents quantitative results of collective responses regarding attitudes to consent to donate their data. The second section present qualitative findings emerged from the discussion amongst participants.DiscussionChoice and control of personal data is crucial for the public to be able to decide who and how to trust. Key information to be disclosed to potential research participants shall include information about potential risks and benefits; who will be accessing and using their data; as well as assurances that their choice will be respected. Furthermore, researchers ought to make sure they are trustworthy, by acting in a competent, reliable, and honest manner. Governance systems ought to be better equipped to address ethical issues raise by the growing presence of non-traditional research actors, consent of exchanges of data via digital devices and online activity such as social media and fairness of data trading. Finally, informed consent is one of the various elements that contribute to conducting ethical research. More needs to be done to strengthen governance and ensure adequate protection of research participants, particularly to address issues related to predictive health analytics. (shrink)

Researchers have studied Catholic schools for decades, often in an attempt to extrapolate from them lessons that may help public schools accomplish similar levels of academic achievement and other desirable goals, such as social mobility, social efficiency, and democratic equality. But research that attempts to understand Catholic education from a secular perspective inevitably misunderstands the purpose of education that Catholic schools themselves claim to pursue, i.e., beatitude. This unique purpose is the source of Catholic school identity. Here, Christopher Hurst (...) argues that by considering Catholic education as the practice of a distinctly Catholic tradition, researchers can authentically assess how well Catholic schools are achieving their own stated goals, and whether their practices can be applied outside of a particular Catholic context. (shrink)

According to a standard picture, normative reasons do not extend beyond the boundaries of agency. If something isn’t an agent, then there can’t be normative reasons for it to do one thing rather than another. This paper argues that the standard picture is false. There are reasons for smoke detectors to alarm when exposed to smoke, and for Venus Flytraps to close around their prey when stimulated. I argue that the collapse of the standard picture has important implications for philosophical (...) debates about reasons, and especially serious consequences for theories that analyse normative reasons in terms of the standards of good practical reasoning. (shrink)

In public health, the issue of pharmaceutical pricing is a perennial problem. Recent high-profile examples, such as the September 2015 debacle involving Martin Shkreli and Turing Pharmaceuticals, are indicative of larger, systemic difficulties that plague the pharmaceutical industry in regards to drug pricing and the impact it yields on their reputation in the eyes of the public. For public health ethics, the issue of pharmaceutical pricing is rather crucial. Simply, individuals within a population require pharmaceuticals for disease prevention and management. (...) In order to be effective, these pharmaceuticals must be accessibly priced. This analysis will explore the notion of corporate social responsibility in regards to pharmaceutical pricing with an aim of restoring a positive reputation upon the pharmaceutical industry in the public eye. The analysis will utilize the 2005 United Nations Educational, Scientific, and Cultural Organization’s Universal Declaration on Bioethics and Human Rights to establish implications regarding the societal responsibilities of pharmaceutical companies in a global context. To accomplish this, Article 14 of the UDBHR—social responsibility and health—will be articulated in order to advocate a viewpoint of socially responsible capitalism in which pharmaceutical companies continue as profit-making ventures, yet establish moral concern for the welfare of all their stakeholders, including the healthcare consumer. (shrink)

In the United States, the field of bioethics has expanded over the last two decades. Several institutions offer graduate-level training at both the masters and doctoral level. However, a lack of published literature on the outcomes of doctoral training in bioethics from the perspective of graduates exists. Researchers conducted an online survey of doctoral students who had finished all doctoral requirements but their dissertation, as well as doctoral graduates, of four US-based institutions to ascertain their perspectives on a number of (...) items regarding their doctoral training and their perception of how that training prepared them for their current role in the workforce. Responses from 34 participants were assessed. Respondents had positive overall views on the utility of a bioethics doctorate and the educational training they received in their respective programs. A number of areas for improvement were identified, including better structured clinical ethics training, greater opportunities for research and publishing, and having the ability to teach during their doctoral program, as well as formal pedagogy training. Greater exposure to clinical ethics consultation during the doctoral program was associated with feeling fully prepared as a clinical ethics consultant. This is the first study to assess the perspectives of bioethics doctoral graduates and ABD students regarding the utility of a bioethics doctorate. Per the perspectives of graduates and ABD students, bioethics doctorates are important and effective to train professional bioethicists. We recommend that a few key changes to these programs’ curricula can further bolster their effectiveness. (shrink)

Clinical trials of xenotransplantation (XTx) may begin early in the next decade, with kidneys from genetically modified pigs transplanted into adult humans. If successful, transplanting pig hearts into children with advanced heart failure may be the next step. Typically, clinical trials have a specified end date, and participants are aware of the amount of time they will be in the study. This is not so with XTx. The current ethical consensus is that XTx recipients must consent to lifelong monitoring. While (...) this presents challenges to the right to withdraw in the adult population, additional and unanswered questions also linger in the paediatric population. In paediatric XTx, parents or guardians consent not only to the initial treatment of the child but also to lifelong monitoring, thus making a decision whose consequences will remain present as the child develops the capacity for assent, and finally the capacity for informed consent or refusal. This article presents and evaluates unanswered paediatric ethical questions in regard to the right to withdraw from XTx follow-up in the paediatric population. (shrink)

We read with interest the recent article on criteria for patient selection of cardiac xenotransplantation by Kögel et al.1 The authors recognise the benefits and concerns of first developing xenotransplantation trials in children (or at least concurrent development). They conclude that, based on (1) the vulnerable nature of children and (2) the observation that ‘the benefits of cardiac xenotransplantation have never been systematically proven in humans,’ that the ‘very first clinical trials should be conducted with adult patients.’ This is a (...) long-standing contention in xenotransplantation that, to our knowledge, finds its origins in the Nuffield Council on Bioethics’ 1996 report on xenotransplantation, which states: ‘It would be difficult to justify the involvement of children in major and risky xenotransplantation trials before some of the uncertainties have been eliminated in trials involving adults.’2 However, given the cardiac allotransplant waitlist mortality borne by some paediatric patients, as well as other factors that raise unique candidacy considerations in children compared with adults—and arguably make some children better candidates than adults—we do not believe …. (shrink)

Despite a predominantly digital, 21st century music production landscape, analogue hardware professional audio technologies persist. In the discoursal throes of the leading online audio technology message forum Gearslutz, such technologies are routinely objectified, sexualized, fetishized and socialized into gear. Situated in a contemporary critical, interdisciplinary framework of fetish, masculinity and sexuality studies, this research interrogates how audio technologies manufactured and intended for music production contexts become sexy. Applying a mixed-mode methodology, including an intensive discourse, image and material-semiotic analysis of an (...) ‘epic’ sexy gear thread, we collated extensive data about technological fetishization. Sexy gear discourse articulates themes of voyeurism, acquisition, control and animation – linking the fetish value of technological objects and their connoisseurship with the erotic potential of sexualized objects. Such discourses ultimately serve to maintain social order, and become sites for performing the maintenance work of hegemonic masculine formations. This research provides new insights into how hegemonic masculinities depend upon the organization of online and offline sociability around fetishized material objects. Furthermore, our findings align with those of current scholarship focused on representational politics of technoculture. (shrink)

Quantum mechanics has recently indicated that, at the fundamental level, temporal order is not fixed. This phenomenon, termed Indefinite Causal Order, is yet to receive metaphysical or theological engagement. We examine Indefinite Causal Order, particularly as it emerges in a 2018 photonic experiment. In this experiment, two operations A and B were shown to be in a superposition with regard to their causal order. Essentially, time, intuitively understood as fixed, flowing, and fundamental, becomes fuzzy. We argue that if Indefinite Causal (...) Order is true, this is good evidence in favor of a B‐theory of time, though such a B‐theory requires modification. We then turn to theology, suggesting that a B‐theoretic temporal ontology invites serious reconsideration of the doctrine of salvation. This paper concludes that the best explanation for salvation given a B‐theory is mind‐dependent salvific becoming, a type of psychological soteriological change that occurs through downward causation. (shrink)

Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient’s right to stop treatment and the physician’s role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient’s treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients (...) must grin and bear intense pain to recover and that a patient’s choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day. (shrink)